Inconsistent classification of pusher behaviour in stroke patients: a direct comparison of the Scale for Contraversive Pushing and the Burke Lateropulsion Scale.
OBJECTIVE
To compare the classification of two clinical scales for assessing pusher behaviour in a cohort of stroke patients.


METHODS
Observational case-control study.


METHODS
Inpatient stroke rehabilitation unit.


METHODS
A sample of 23 patients with hemiparesis due to a unilateral stroke (1.6 ± 0.7 months post stroke).


METHODS
Immediately before and after three different interventions, the Scale for Contraversive Pushing and the Burke Lateropulsion Scale were applied in a standardized procedure.


RESULTS
The diagnosis of pusher behaviour on the basis of the Scale for Contraversive Pushing and the Burke Lateropulsion Scale differed significantly (χ2 = 54.260, p < 0.001) resulting in inconsistent classifications in 31 of 138 cases. Changes immediately after the interventions were more often detected by the Burke Lateropulsion Scales than by the Scale for Contraversive Pushing (χ2 = 19.148, p < 0.001). All cases with inconsistent classifications showed no pusher behaviour on the Scale for Contraversive Pushing, but pusher behaviour on the Burke Lateropulsion Scale. 64.5% (20 of 31) of them scored on the Burke Lateropulsion Scale on the standing and walking items only.


CONCLUSIONS
The Burke Lateropulsion Scale is an appropriate alternative to the widely used Scale for Contraversive Pushing to follow-up patients with pusher behaviour (PB); it might be more sensitive to detect mild pusher behaviour in standing and walking.
Schoen Klinik Bad Aibling, Germany German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany JBergmann@Schoen-Kliniken.de.
Jeannine
J
Bergmann
Schoen Klinik Bad Aibling, Germany German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany.
Carmen
C
Krewer
Schoen Klinik Bad Aibling, Germany German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany.
Katrin
K
Rieß
Schoen Klinik Bad Aibling, Germany German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany.
Friedemann
F
Müller
Schoen Klinik Bad Aibling, Germany German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany.
Eberhard
E
Koenig
German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany Department of Neurology, Ludwig-Maximilians University of Munich, Germany.
Klaus
K
Jahn
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000145:classification* / Q000209:etiology / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology; D011187:Posture / Q000502:physiology*; D020521:Stroke / Q000145:classification* / Q000150:complications / Q000503:physiopathology*
Burke Lateropulsion Scale; Scale for Contraversive Pushing; Stroke; pusher syndrome