Case-Control Study of Impairments Associated with Recovery from "Pusher Syndrome" after Stroke: Logistic Regression Analyses.
BACKGROUND
Comparing cohorts with similar functional and motor status at admission to inpatient rehabilitation may delineate demographics or impairments associated with recovery from lateropulsion, also known as "pusher syndrome," after stroke based on lesion side. The aim of this case-control study was to determine how demographics and severity of stroke impairments at admission to inpatient rehabilitation distinguish patients who recover from lateropulsion from those who do not.


METHODS
Patients with admission motor Functional Independence Measure (FIM) scores less than 31 and contralesional lower extremity Fugl-Meyer motor scores less than 19 out of 34 were included. Burke Lateropulsion Scales score of 2 or higher at the time of discharge from inpatient rehabilitation indicated persistent lateropulsion; a score of 0 or 1 indicated resolved lateropulsion. Logistic regression tests included age, gender, admission Motricity Index score, limb placement error, and cognitive FIM score. χ2analyses compared groups for neglect.


RESULTS
For patients with left brain lesion, older age and worse admission motor status distinguished those with persistent lateropulsion at discharge. For right brain lesion, related factors were older age, greater admission limb placement error, and lower cognitive FIM scores. Visuospatial neglect did not influence recovery from lateropulsion.


CONCLUSIONS
Older age and severe impairments were associated with delayed recovery from lateropulsion in a manner specific to lesion side in a sample with motor and functional deficits. The study provides evidence that lesion side and admission characteristics are useful in early decision making for the duration of rehabilitation, selection of interventions, and discharge planning.
Department of Physical Therapy, Hunter College, New York, New York. Electronic address: sbabyar@burke.org.
Suzanne R
SR
Babyar
Research Division, The Hospital for Special Surgery, New York, New York.
Margaret G E
MG
Peterson
Department of Neurology, Stroke Unit, Burke Rehabilitation Hospital, White Plains, New York.
Michael
M
Reding
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000209:etiology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
Stroke; lateropulsion; logistic regression; pusher syndrome