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Birnbaum M, Brock K, Clark R, Burton E, Hill KD. Six-month outcomes and patterns of recovery for people with lateropulsion following stroke. Disabil Rehabil 2024; 46:2405-2413. [PMID: 37312557 DOI: 10.1080/09638288.2023.2222644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE This study investigated the (1) six-month outcomes of individuals with lateropulsion; (2) the relationship between baseline measures (from in-patient hospitalisation) and six-month functional abilities; and (3) recovery patterns for lateropulsion in stroke survivors. MATERIALS AND METHODS Forty-one individuals with lateropulsion participated in this study. Measures of lateropulsion, postural function, and weight-bearing asymmetry in standing were taken initially and fortnightly over eight weeks. Functional independence and walking abilities were assessed at six months post-stroke. RESULTS Compared to individuals with moderate to severe lateropulsion, those with mild lateropulsion achieved higher levels of functional outcome at six months. However, there were a wide range of scores. Baseline lateropulsion severity explained 26% of the variation in functional outcome. A stronger correlation with functional outcome was observed for lateropulsion (-0.526) than function independence at baseline (0.384). For the task of standing with arm support, patterns of asymmetry were divergent at baseline, favouring either the paretic or non-paretic leg. Over the eight-week period, asymmetry moved towards the non-paretic leg and lateropulsion reduced consistently. CONCLUSIONS Individuals with lateropulsion can recover from lateropulsion and make meaningful functional gains, including some individuals with more severe lateropulsion. Lateropulsion severity is a key indicator of functional outcome post-stroke.IMPLICATIONS FOR REHABILITATIONIndividuals with lateropulsion can make significant gains in terms of mobility and functional abilities by six months post-stroke, learning to compensate for their verticality impairment in standing by loading their non-paretic leg.It is important that stroke survivors with lateropulsion, including those with moderate and severe lateropulsion, are provided with adequate rehabilitation to optimise their longer-term mobility and functional abilities.Routine screening of acute stroke survivors for lateropulsion is recommended, given lateropulsion may negatively impact longer-term functional outcomes in stroke survivors.Therapists should carefully analyse the weight-bearing pattern which an individual with lateropulsion adopts in standing and subsequently tailor treatment to target this.
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Affiliation(s)
- Melissa Birnbaum
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kim Brock
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ross Clark
- School of Health and Behavioural Science, University of the Sunshine Coast, Queensland, Australia
| | - Elissa Burton
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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Salazar López E, Krewer C, Bergmann J, Möhwald K, Müller F, Jahn K. Lateropulsion in Right-Sided Stroke: Brain Anatomical Correlates of Severity and Duration. J Neurol Phys Ther 2024; 48:38-45. [PMID: 37306456 DOI: 10.1097/npt.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Lateropulsion (LP) is a profound disorder of postural control that has a significant impact on neurorehabilitation. Knowledge of relevant brain areas could guide decisions on appropriate intervention methods. Although LP severity and duration are highly variable in individuals with LP, imaging studies on LP have not sufficiently considered these aspects. The aim of this study was to investigate the lesion location in individuals after stroke and the correlation with LP duration and severity. METHODS A retrospective case-control study using voxel lesion symptom mapping (VLSM) in 74 individuals with right-sided brain lesion (49 with and 25 without LP) was performed to analyze the correlation between lesion location and LP severity. Duration was investigated in a subsample of 22 individuals with LP. LP was diagnosed by means of the Scale for Contraversive Pushing. RESULTS Individuals with LP showed significantly larger lesion sizes compared with the individuals with no LP. VLSM analysis of LP severity did not reveal statistically significant results. VLSM analysis showed a statistically significant association with longer LP duration for the inferior frontal gyrus, the hippocampus, the inferior parietal gyrus, the supramarginal gyrus, the angular gyrus, the temporal cortex, the sagittal stratum, and the superior longitudinal fasciculus. DISCUSSION AND CONCLUSION LP-relevant areas are located in the multisensory network. Areas of the frontoparietal network, which are related to spatial cognition, memory, and attention, were found to be relevant for duration and severity. The findings, especially those regarding duration involving the middle temporal cortex, could explain the better intervention outcomes for methods based more on implicit than on explicit knowledge of verticality.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A433 ).
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Affiliation(s)
- Elvira Salazar López
- German Center for Vertigo and Balance Disorders (DSGZ) (E.S.L., C.K., J.B., K.M., F.M., K.J.), Ludwig-Maximilians University of Munich, Munich, Germany; Department of Neurology (C.K., J.B., F.M., K.J.), Schoen Clinic Bad Aibling, Bad Aibling, Germany; Department of Sports and Health Sciences - Chair of Human Movement Science (C.K.), Technical University of Munich, Munich, Germany; and Department of Neurology (K.M.), Ludwig-Maximilians University of Munich, Munich, Germany
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Nolan J, Jacques A, Godecke E, Abe H, Babyar S, Bergmann J, Birnbaum M, Dai S, Danells C, Edwards TGS, Gandolfi M, Jahn K, Koter R, Mansfield A, Nakamura J, Pardo V, Perennou D, Piscicelli C, Punt D, Romick-Sheldon D, Saeys W, Smania N, Vaes N, Whitt AL, Singer B. Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel. Clin Rehabil 2023; 37:1559-1574. [PMID: 37122265 PMCID: PMC10492423 DOI: 10.1177/02692155231172012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel. DESIGN This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations. PARTICIPANTS Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion. MAIN MEASURES The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses. RESULTS Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded. CONCLUSIONS These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
- Osborne Park Hospital, Stirling, Australia
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Department of Research, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Allied Health Research, Sir Charles Gairdner Hospital, Nedlands, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Hiroaki Abe
- School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Suzanne Babyar
- Department of Physical Therapy, Hunter College, New York, NY, USA
- Department of Neurology, Stroke Unit, Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Jeannine Bergmann
- Schoen Clinic Bad Aibling, Schoen Clinic, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munchen, Germany
| | - Melissa Birnbaum
- Department of Physiotherapy, St Vincent's Hospital, Melbourne, Australia
| | - Shenhao Dai
- Department of NeuroRehabilitation South Hospital, CHU Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - Cynthia Danells
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Taiza GS Edwards
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
| | - Klaus Jahn
- Schoen Clinic Bad Aibling, Schoen Clinic, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munchen, Germany
| | - Ryan Koter
- Department of Physical Therapy, Shepherd Center, Atlanta, GA, USA
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | - Junji Nakamura
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
- Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Vicky Pardo
- Physical Therapy/Health Care Sciences, Wayne State University, Detroit, MI, USA
| | - Dominic Perennou
- CHU Grenoble Alpes, Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - Celine Piscicelli
- Department of NeuroRehabilitation South Hospital, CHU Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, University of Grenoble Alpes, Grenoble, France
| | - David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Devra Romick-Sheldon
- Department of Physical Therapy, Schwab Rehabilitation Hospital, Chicago, IL, USA
| | - Wim Saeys
- Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, Neuromotor and Cognitive Rehabilitation Research Center (CRRNC)
| | - Nathalie Vaes
- Medicine and Health Sciences, Rehabilitation Hospital RevArte, Antwerp, Belgium
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Abigail L Whitt
- Department of Physical Therapy, ALL Whitt Physical Therapy, Alexandria, VA, USA
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, Australia
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Nolan J, Godecke E, Spilsbury K, Singer B. Post-Stroke Lateropulsion: Resolution and Function After Discharge From Inpatient Rehabilitation - A Cohort Study. Physiother Can 2023; 75:264-268. [PMID: 37736404 PMCID: PMC10510537 DOI: 10.3138/ptc-2021-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 09/23/2023]
Abstract
Purpose A person with post-stroke lateropulsion pushes their body toward their hemiparetic side and/or resists accepting weight onto their nonparetic side. Research findings regarding long-term persistence of lateropulsion and its association with function are lacking. This study reports associations between lateropulsion severity (Four Point Pusher Score - 4PPS) and functional outcome (Functional Independence Measure - FIM) at three months after discharge. Methods This prospective cohort study included 41 consecutive admissions to a stroke rehabilitation unit. Lateropulsion severity and FIM were measured at admission, discharge and three-month follow-up. Lateropulsion status at discharge, stroke laterality, ongoing physiotherapy after discharge, and demographic variables (age and sex) were tested for association with FIM change over the follow-up period. Results Complete data were available for 38 participants. Among these, 17 (44.7%) showed lateropulsion (4PPS ≥ 1) on admission, 9 (23.7%) showed persistent lateropulsion on discharge, and 7 (18.4%) showed persistent lateropulsion at three month follow-up. Improved functional status (FIM score) was seen at follow-up in those discharged with lateropulsion who had right-sided lesions but not in those with left-sided lesions. Conclusions Lateropulsion can continue to resolve after discharge from inpatient rehabilitation. Larger cohort studies are needed to further explore associations between persistent lateropulsion and long-term outcomes.
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Affiliation(s)
- Jessica Nolan
- From the:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, W.A., Australia
- Osborne Park Hospital, Stirling, W.A., Australiea
| | - Erin Godecke
- From the:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, W.A., Australia
- Sir Charles Gairdner Hospital, Nedlands, W.A., Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Vict., Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, W.A., Australia
| | - Barbara Singer
- Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, W.A., Australia
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Nolan J, Godecke E, Spilsbury K, Wu A, Singer B. Accuracy of the Australian National Sub-Acute and Non-Acute Patient Classification in predicting rehabilitation length of stay for stroke survivors who are ≥65 years of age and have lateropulsion. Top Stroke Rehabil 2023; 30:203-211. [PMID: 35068380 DOI: 10.1080/10749357.2021.2008594] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateropulsion is a common impairment after stroke. Regardless of stroke severity, functional recovery is slower in people with lateropulsion, resulting in requirement for longer rehabilitation duration. In Australia, inpatient rehabilitation funding is determined via the Australian National Sub-Acute and Non-Acute Patient Classification (AN-SNAP). AN-SNAP class is determined using age, diagnosis, weighted Functional Independence Measure (FIM) motor score, and FIM cognitive score. OBJECTIVES To explore accuracy of the AN-SNAP to predict length of stay (LOS) for people with poststroke lateropulsion. METHODS A retrospective database audit was undertaken. AN-SNAP predicted LOS for each participant was calculated based on 2019 calendar year national benchmarks. A multivariable linear regression model estimated mean differences in reported LOS and AN-SNAP predicted LOS after adjusting for lateropulsion severity (Four Point Pusher Score). A separate logistic regression model assessed whether FIM change during admission was associated with reported LOS exceeding AN-SNAP predicted LOS. RESULTS Data were available from 1126 admissions. Reported LOS exceeding AN-SNAP predicted LOS was associated with greater lateropulsion severity on admission. Where AN-SNAP predicted LOS was longer, those with no lateropulsion on admission showed shorter reported than predicted LOS. Greater improvement in FIM during rehabilitation was associated with increased odds of reported LOS exceeding AN-SNAP predicted LOS (OR 1.02, 95%CI 1.01-1.03, p < .001). CONCLUSIONS Inclusion of a measure of poststroke lateropulsion in the AN-SNAP classification model would result in more accurate LOS predictions to inform funding. Costs of longer rehabilitation LOS may be countered by optimized long-term physical function, reducing requirement for ongoing care.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.,Physiotherapy Department, Osborne Park Hospital, Stirling, Western Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.,Allied Health, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia
| | - Andy Wu
- Strategy, Policy and Intergovernmental Relations Directorate, Department of Health, East Perth, Western Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.,Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, Western Australia
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Paci M, Macchioni G, Ferrarello F. Treatment approaches for pusher behaviour: a scoping review. Top Stroke Rehabil 2023; 30:119-136. [PMID: 35156566 DOI: 10.1080/10749357.2021.2016098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Some individuals with hemiplegia show a postural disorder called pusher behavior. Various underlying theoretical mechanisms have been proposed, thus leading to various treatment approaches. OBJECTIVES The aim of this scoping review is to identify and analyze the available evidence on the treatment approaches for pusher behavior. METHODS Two independent reviewers conducted a literature search for original studies reporting on treatments for pusher behavior. Studies were searched in PubMed, Scopus, Web of Science, CINAHL and PEDro from their inception to December 2020. Treatment approaches were grouped in homogeneous areas based on the supposed underlying mechanism. To assess the reporting of the interventions, the Template for Intervention Description and Replication (TIDieR) was used. RESULTS Thirty-one papers describing 45 interventions were included in the review. Most of the studies were case reports (i.e. including 1 person) (n = 16), followed by randomized controlled trials (n = 5), single subject design trials (n = 5), non-randomized controlled trials (n = 3), and case series (i.e. including more than 1 person) (n = 2). Treatment approaches were grouped into five categories: visual feedback, somatosensory cues, visual-somatosensory integration, brain stimulation, and other nonspecific treatments. The median number of TIDIeR items reported was 7 (range 4 to 10). CONCLUSION Pusher behavior is still little-known. Five main categories of treatment approaches based on the alleged etiological underlying mechanisms have been identified. Most of studies are case reports; controlled trials should be further conducted. Intervention reporting should be improved to allow treatment replication in larger trials.
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Affiliation(s)
- Matteo Paci
- Department of Allied Health Professions, Unit of Functional Rehabilitation, Azienda Usl Toscana Centro, Florence, Italy
| | | | - Francesco Ferrarello
- Department of Allied Health Professions, Unit of Functional Rehabilitation, Azienda Usl Toscana Centro, Prato, Italy
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Nolan J, Godecke E, Singer B. Authors' response to commentary on the article entitled, "Post-stroke lateropulsion rehabilitation outcomes: a retrospective analysis". Disabil Rehabil 2023; 45:1752-1754. [PMID: 36722342 DOI: 10.1080/09638288.2023.2172221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,School of Physiotherapy and Health Sciences, University of Notre Dame Australia, Fremantle, Australia.,Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Fukata K, Fujino Y, Inoue M, Inoue M, Sekine D, Miki H, Sato H, Kobayashi Y, Hasegawa K, Amimoto K, Makita S, Takahashi H. Early incidence and factors affecting recovery from lateropulsion after acute hemispheric stroke. Ann Phys Rehabil Med 2022; 66:101706. [PMID: 36182061 DOI: 10.1016/j.rehab.2022.101706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 3-2-12, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Mamiko Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Miki
- Department of Rehabilitation, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Hirofumi Sato
- Department of Rehabilitation, Saitama Citizens Medical Center, 299-1, Shimane, Nishi-ku, Saitama, Saitama, 331-0054, Japan
| | - Yohei Kobayashi
- Department of Rehabilitation, Saitama Sekishinkai Hospital, 2-37-20, Irumagawa, Sayamashi, Saitama, 350-1305, Japan
| | - Koki Hasegawa
- Department of Rehabilitation, Sainokuni Higashiomiya Medical Center, 1522, Torocyo, kita-ku, Saitama, Saitama, 331-8577, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashi-Ogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
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Nestmann S, Röhrig L, Müller B, Ilg W, Karnath HO. Tilted 3D visual scenes influence lateropulsion: A single case study of pusher syndrome. J Clin Exp Neuropsychol 2022; 44:478-486. [DOI: 10.1080/13803395.2022.2121382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sophia Nestmann
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lisa Röhrig
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Björn Müller
- Section for Computational Sensomotorics, Hertie-Institute for Clinical Brain Research & Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Winfried Ilg
- Section for Computational Sensomotorics, Hertie-Institute for Clinical Brain Research & Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Hans-Otto Karnath
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Stefano LHS, Favoretto DB, Nascimento DC, Santos LRA, Louzada F, Bikson M, Leite JP, Pontes-Neto OM, Edwards DJ, Edwards TGS. Middle cerebral artery blood flow stability in response to high-definition transcranial electrical stimulation: a randomized sham-controlled clinical trial. Clin Neurol Neurosurg 2022; 220:107345. [DOI: 10.1016/j.clineuro.2022.107345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
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Sue K, Usuda D, Moriizumi S, Momose K. Preexisting brain lesions in patients with post stroke pusher behavior and their association with the recovery period: A one year retrospective cohort study in a rehabilitation setting. Neurosci Lett 2021; 769:136323. [PMID: 34742861 DOI: 10.1016/j.neulet.2021.136323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
The presence of preexisting brain lesions due to previous stroke and cerebral small vessel disease has been reported to influence stroke related disability or rehabilitation outcomes. However, there is no data about the impact of such lesions on the recovery period after pusher behavior (PB). This retrospective cohort study aimed to determine the influence of preexisting brain lesions on PB recovery time. Nineteen patients who were suffering from PB were included in the study. The presence of preexisting brain lesions, including previous stroke, silent brain infarcts, microbleed, white matter hyperintensity, and enlarged perivascular spaces were assessed using medical history reports, radiological reports, and magnetic resonance imaging data. The lesion score, ranging from 0 to 6, was calculated based on each preexisting brain lesion. The time to recovery from PB was assessed using the Scale for Contraversive Pushing. Based on the median value of the lesion score, we divided patients into those with a lesion score <2 and those with a lesion score ≥2. A Kaplan Meier survival analysis was performed between these two groups. A multivariable Cox proportional hazards analysis was also performed using the side with hemiparesis and the score of preexisting brain lesions as covariates to determine the hazard ratio. The results showed that the group with a lesion score ≥2 had significantly delayed recovery from PB and the hazard ratio of preexisting brain lesions score was 0.458 (95 % confidence interval: 0.221, 0.949), while the side of hemiparesis was not identified a significant covariate. Our results indicated that patients with PB having higher score of preexisting brain abnormalities might require a longer time to recover, and this might be useful in planning inpatient rehabilitation and treatment goals for patients with PB.
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Affiliation(s)
- Keita Sue
- Department of Rehabilitation, Kakeyu-Misayama Rehabilitation Center, Kakeyu Hospital, 1308, Kakeyuonsen, Ueda, Nagano, 386-1701, Japan; Department of Health Sciences, Graduate School of Medicine, Science and Technology, Shinshu University, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Daiki Usuda
- Department of Rehabilitation, Kakeyu-Misayama Rehabilitation Center, Kakeyu Hospital, 1308, Kakeyuonsen, Ueda, Nagano, 386-1701, Japan
| | - Shutaro Moriizumi
- Department of Rehabilitation, Kakeyu-Misayama Rehabilitation Center, Kakeyu Hospital, 1308, Kakeyuonsen, Ueda, Nagano, 386-1701, Japan
| | - Kimito Momose
- Department of Physical Therapy, School of Health Science, Shinshu University, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
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Martín-Nieto A, Atín-Arratibel MÁ, Bravo-Llatas C, Moreno-Bermejo MI, Martín-Casas P. Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:577-583. [PMID: 34654531 DOI: 10.1016/j.nrleng.2018.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/12/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.
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Affiliation(s)
- A Martín-Nieto
- Departamento de Fisioterapia, Universidad Católica Santa Teresa de Jesús de Ávila, Ávila, Spain.
| | - M Á Atín-Arratibel
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - C Bravo-Llatas
- Área de Gobierno de Tecnologías de la Información y de Apoyo Técnico al Usuario-Investigación y Docencia, Universidad Complutense de Madrid, Madrid, Spain
| | - M I Moreno-Bermejo
- Departamento de Fisioterapia, Hospital Universitario de La Princesa, Madrid, Spain
| | - P Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
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Birnbaum M, Brock K, Clark R, Muir S, Burton E, Hill KD. Standing weight-bearing asymmetry in adults with lateropulsion following stroke. Gait Posture 2021; 90:427-433. [PMID: 34597984 DOI: 10.1016/j.gaitpost.2021.09.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Weight-bearing asymmetry biasing the non-paretic leg is common following stroke. However, little is known as to how lateropulsion impacts on the weight-bearing patterns adopted in standing by individuals following stroke. RESEARCH QUESTIONS (1) Are there differences in weight-bearing asymmetry patterns observed in standing in people with lateropulsion relative to healthy controls; (2) What is the relationship between weight-bearing asymmetry and clinical measures of lateropulsion and postural function; and (3) Are measures of weight-bearing asymmetry reliable between test occasions. METHODS Thirty-three individuals with lateropulsion and 35 healthy controls participated in this study. For the participants with lateropulsion, weight-bearing asymmetry during standing tasks (measured using two Wii Balance Boards) and clinical measures of lateropulsion (Burke Lateropulsion Scale) and postural function (Postural Assessment Scale for Stroke) were assessed initially and fortnightly over eight weeks. RESULTS Individuals with lateropulsion displayed marked weight-bearing asymmetry in standing compared to healthy controls. This asymmetry was predominantly towards their non-paretic leg when standing unsupported, and mixed presentation of weight-bearing asymmetry directions when standing with arm support. No significant correlations were observed between directional weight-bearing asymmetry and the Burke Lateropulsion Scale. A moderate correlation was found between absolute weight-bearing asymmetry for the stand with arm support task and the Postural Assessment Scale for Stroke (r = -0.608). The weight-bearing asymmetry variables for the standing with arm support task were found to be highly reliable between test occasions (ICC 0.915-0.972) and the standard error of measurement was 8.2%-9.3% body weight. SIGNIFICANCE Individuals with lateropulsion following stroke demonstrate marked and varied patterns of asymmetry in standing. Weight-bearing asymmetry when standing with arm support may be an appropriate outcome measure for use with patients with lower functional abilities, including those with lateropulsion.
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Affiliation(s)
- Melissa Birnbaum
- St. Vincent's Hospital Melbourne, Physiotherapy Department, PO Box 2900, Fitzroy, Victoria, 3065, Australia; School of Allied Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Kim Brock
- St. Vincent's Hospital Melbourne, Physiotherapy Department, PO Box 2900, Fitzroy, Victoria, 3065, Australia.
| | - Ross Clark
- School of Health and Behavioural Science, T3.29, University of the Sunshine Coast, Sippy Downs, Queensland, 4556, Australia.
| | - Sophie Muir
- St. Vincent's Hospital Melbourne, Physiotherapy Department, PO Box 2900, Fitzroy, Victoria, 3065, Australia.
| | - Elissa Burton
- School of Allied Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Keith D Hill
- School of Allied Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University (Peninsula Campus), McMahons Road, Frankston, Victoria, 3199, Australia.
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Nolan J, Godecke E, Spilsbury K, Singer B. Post-stroke lateropulsion and rehabilitation outcomes: a retrospective analysis. Disabil Rehabil 2021; 44:5162-5170. [PMID: 34038657 DOI: 10.1080/09638288.2021.1928300] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE A person with post-stroke lateropulsion actively pushes themselves toward their hemiplegic side, or resists moving onto their non-hemiplegic side. This study aimed to determine the association of lateropulsion severity with: • Change in function (Functional Independence Measure - FIM) and lateropulsion severity (Four-Point Pusher Score - 4PPS) during inpatient rehabilitation; • Inpatient rehabilitation length of stay (LOS); • Discharge destination from inpatient rehabilitation. METHODS Retrospective data for 1,087 participants (aged ≥65 years) admitted to a stroke rehabilitation unit (2005-2018) were analysed using multivariable regression models. RESULTS Complete resolution of lateropulsion was seen in 69.4% of those with mild lateropulsion on admission (n = 160), 49.3% of those with moderate lateropulsion (n = 142), and 18.8% of those with severe lateropulsion (n = 181). Average FIM change was lower in those with severe lateropulsion on admission than those with no lateropulsion (p < 0.001). Higher admission 4PPS was associated with reduced FIM efficiency (p < 0.001), longer LOS (p < 0.001), (adjusted mean LOS: 35.6 days for those with severe lateropulsion versus 27.0 days for those without), and reduced likelihood of discharge home (p < 0.001). CONCLUSION Post-stroke lateropulsion is associated with reduced functional improvement and likelihood of discharge home. However, given a longer rehabilitation duration, most stroke survivors with moderate to severe lateropulsion can achieve important functional improvement.Implications for RehabilitationWhile people with post-stroke lateropulsion can be difficult to treat and require more resources than those without lateropulsion, the majority of those affected, even in severe cases, can make meaningful recovery with appropriate rehabilitation.Although those with moderate to severe post-stroke lateropulsion may have poorer outcomes (longer LOS and reduced likelihood of discharge home) it is still important to advocate for access to rehabilitation for this patient group to give them the opportunity for optimal functional recovery.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Osborne Park Hospital, Stirling, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Sir Charles Gairdner Hospital, Nedlands, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Training Centre in Subacute Care, South Metropolitan Health Service, Fremantle Hospital, Fremantle, Australia
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Nolan J, Godecke E, Singer B. The association between contraversive lateropulsion and outcomes post stroke: A systematic review. Top Stroke Rehabil 2021; 29:92-102. [PMID: 33648434 DOI: 10.1080/10749357.2021.1886640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Contraversive lateropulsion is a common post-stroke impairment. Rehabilitation outcomes in stroke survivors exhibiting lateropulsion may differ from those without lateropulsion.Objectives: To systematically review evidence regarding associations between:1. Presence/severity of lateropulsion after stroke and functional outcome, rehabilitation length of stay, and discharge destination;2. Stroke-related factors and resolution of lateropulsion, functional outcome, rehabilitation length of stay, and discharge destination in affected stroke survivors.Methods: Medline, CINAHL, and Embase databases were searched. Journal articles published in English reporting on resolution of lateropulsion, length of stay, functional outcome, and/or discharge destination associated with post-stroke lateropulsion were included for review. Studies that did not include a comparison group (stroke survivors without lateropulsion, or sub-groups of participants with lateropulsion based on stroke-related factors), animal studies, and studies reporting only on ipsiversive lateropulsion and/or lateral medullary syndrome were excluded. Two authors independently assessed studies for inclusion. Included studies were evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies.Results: Screening identified 133 articles. Seven articles met inclusion criteria. People with contraversive lateropulsion after stroke can achieve similar improvements in function as those without lateropulsion, increasing likelihood of discharge home, but require longer rehabilitation durations to do so.Conclusions: The finding that longer rehabilitation durations are required for people with post-stroke lateropulsion to achieve their functional potential and increase likelihood of discharge home has implications for resourcing rehabilitation services. Given an additional three to four weeks in rehabilitation, people with post-stroke lateropulsion can achieve functional improvements function similar to those without lateropulsion.
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Affiliation(s)
- Jessica Nolan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australian.,Physiotherapy Department, Osborne Park Hospital, Stirling, Western Australia, Australian
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australian.,Speech Pathology Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australian.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Barbara Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australian.,Western Australian Department of Health, Training Centre in Subacute Care WA, Fremantle, Western Australia, Australia
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Birnbaum M, Brock K, Parkinson S, Burton E, Clark R, Hill KD. Rasch analysis of the Burke Lateropulsion Scale (BLS). Top Stroke Rehabil 2020; 28:268-275. [PMID: 32975165 DOI: 10.1080/10749357.2020.1824724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lateropulsion is a common problem following stroke. Whilst the Burke Lateropulsion Scale (BLS) is recommended in the literature as the outcome measure of choice for measuring lateropulsion, the internal validity of the BLS has not been investigated. OBJECTIVES To evaluate the internal validity of the BLS for use in evaluating the effectiveness of therapies aimed at reducing lateropulsion. METHODS Rasch analysis procedures were undertaken including assessment of overall model fit, item, and person fit, threshold ordering, differential item functioning, internal consistency, targeting, and dimensionality. RESULTS Data from 132 participants were utilized to perform Rasch analysis of the BLS. In this preliminary study, overall model fit and individual item and person fit were found to be good using fit residual statistics and chi-square probability values. The BLS was found to be unidimensional and have good internal consistency (Person Separation Index 0.867). Thresholds for four of the five items were found to be only marginally disordered and were subsequently not modified. Non-uniform differential item functioning was detected for age for the transfers item; however, this item did not display item misfit and was therefore not removed. CONCLUSIONS This study identified good psychometric properties of the BLS using Rasch analysis and supports the use of the BLS as a measure of lateropulsion following stroke. Further use of Rasch analysis on the BLS using a larger sample is recommended to confirm these preliminary findings and allow transformation into an interval-level scale.
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Affiliation(s)
- Melissa Birnbaum
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Kim Brock
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Stephanie Parkinson
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Elissa Burton
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
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Yamaguchi T, Satow T, Komuro T, Mima T. Transcranial Direct Current Stimulation Improves Pusher Phenomenon. Case Rep Neurol 2019; 11:61-65. [PMID: 31543787 PMCID: PMC6739711 DOI: 10.1159/000497284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/19/2022] Open
Abstract
An 83-year-old man suffered from cerebral infarction of the right middle cerebral artery territory. In association with severe left hemiparesis and hemispatial neglect on the left side, he showed severe pusher phenomenon (PP), which made rehabilitation difficult. Transcranial direct current stimulation (tDCS) was applied to the parietal area (2 mA × 20 min/day; anode on the right and cathode on the left) for 8 days, which resulted in remarkable improvement of PP and caused prolongation of static sitting time. tDCS of the parietal area could be a novel treatment option of PP following stroke.
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Affiliation(s)
- Takuya Yamaguchi
- Department of Rehabilitation Medicine, Nagahama City Hospital, Nagahama, Japan
| | - Takeshi Satow
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Taro Komuro
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
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Chow E, Parkinson S, Jenkin J, Anderson A, King A, Maccanti H, Minaee N, Hill K. Reliability and Validity of the Four-Point Pusher Score: An Assessment Tool for Measuring Lateropulsion and Pusher Behaviour in Adults after Stroke. Physiother Can 2019; 71:34-42. [PMID: 30787497 DOI: 10.3138/ptc.2017-69] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The authors determined the reliability and validity of the Four-Point Pusher Score (4PPS) among stroke survivors. Method: Stroke survivors were invited to participate within 48 hours of admission to a stroke rehabilitation unit in a tertiary hospital. Intrarater reliability was determined by examining scores assigned to the same patient by the same physiotherapist. Interrater reliability was determined by examining scores assigned to the same patient by two other physiotherapists. Validity was determined by examining associations with the Burke Lateropulsion Scale (BLS), Scale for Contraversive Pushing (SCP), and functional scales. Results: A total of 85 participants who were a median of 13 (interquartile range 9-21) days post-stroke completed this study. The weighted κ statistic for 4PPS intra- and interrater reliability was 0.97 (p < 0.001). Scores on the 4PPS were very strongly associated with scores on the BLS (r s = 0.95) and the SCP (r s = 0.86). Strong associations were evident between the 4PPS and the Berg Balance Scale (r s = -0.77), Chedoke-McMaster Stroke Assessment postural control scale (r s = -0.76), and FIM Motor sub-scale (r s = -0.64; all ps < 0.001). Conclusion: The 4PPS is a reliable and valid scale to assess lateropulsion and pusher behaviour in stroke survivors in an in-patient rehabilitation setting.
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Affiliation(s)
- Emmanuelle Chow
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Stephanie Parkinson
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Joanna Jenkin
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Alisha Anderson
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Andrea King
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Heidi Maccanti
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Novia Minaee
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
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Bergmann J, Krewer C, Müller F, Jahn K. A new cutoff score for the Burke Lateropulsion Scale improves validity in the classification of pusher behavior in subactue stroke patients. Gait Posture 2019; 68:514-517. [PMID: 30623845 DOI: 10.1016/j.gaitpost.2018.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 12/20/2018] [Accepted: 12/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pusher behavior substantially hampers balance during sitting, standing, and posture transitions in stroke patients. The Burke Lateropulsion Scale (BLS) was recommended to evaluate pusher behavior. However, its cutoff score has not been validated and recent studies found evidence for a need to modify it. As there is no gold standard for the diagnosis of pusher behavior, functions that are typically disturbed in these patients should be used for the validation of the cutoff score. RESEARCH QUESTION To investigate whether pusher behavior correlates with balance performance during sitting, standing and posture transitions, and to validate the BLS cutoff score. METHODS 44 subacute stroke patients with pusher behavior (BLS ≥ 2) were included in this study. The BLS and the Performance-Oriented Mobility Assessment Balance subscale (POMA-B) were assessed several times at intervals of two weeks resulting in a total of 137 data sets. RESULTS Correlation analysis between the BLS score and the POMA-B score revealed a moderate negative correlation (rSp=-0.602, p < 0.001): The lower the BLS score, the higher the balance performance. The maximum Youden Index (J=0.864) was found for a cutoff score ≥2.5. Patients with a BLS score ≥2 scored ≥1 on the POMA-B, while patients with a BLS score ≥3 scored at no item or only at the sitting balance task. SIGNIFICANCE In line with previous findings, the results of this study support using a BLS cutoff score of ≥3 instead of ≥2 to diagnose PB for research purposes and intervention planning. A score ≥3 correlates with severe balance impairments and with an impaired verticality perception in the frontal plane, and it improves the agreement with the Scale for Contraversive Pushing.
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Affiliation(s)
- Jeannine Bergmann
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany; German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | - Carmen Krewer
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany.
| | - Friedemann Müller
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany; German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | - Klaus Jahn
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany; German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
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Yun N, Joo MC, Kim SC, Kim MS. Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial. Eur J Phys Rehabil Med 2018; 54:827-836. [PMID: 30507899 DOI: 10.23736/s1973-9087.18.05077-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Some stroke patients are known to use nonparetic extremities to push toward the paretic side, a movement known as lateropulsion. Lateropulsion impairs postural balance and interferes with rehabilitation. AIM The aim of the present study was to investigate the effect of robot-assisted gait training (RAGT) on recovery from lateropulsion compared with conventional physical therapy (CPT). DESIGN This was a single-blinded, randomized controlled trial. SETTING Participants were recruited from a rehabilitation department of a tertiary hospital. POPULATION Patients diagnosed with lateropulsion after a stroke. METHODS Thirty-six subacute stroke patients with lateropulsion were recruited. RAGT was performed in the experimental group (N.=18), and CPT was performed in the control group (N.=18). The participants received treatment for 3 weeks, 30 minutes per day, 5 days per week. Outcomes were assessed before the intervention (T0), immediately after the intervention (T1), and 4 weeks after the intervention (T2). The Burke Lateropulsion Scale (BLS) was evaluated as a primary outcome to assess the severity of lateropulsion. The secondary outcome measures were the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), and Somatosensory Evoked Potentials (SSEP). RESULTS After intervention, the experimental group showed greater improvement in the BLS score at T1 (experimental group: Δ=-1.9, control group: Δ=-1.1, P=0.032) and T2 (experimental group: Δ=-2.8, control group: Δ=-6.5, P<0.001) than the control group. In addition, the BBS was significantly improved in the experimental group at T1 (experimental group: Δ=+7.1, control group: Δ=+1.9, P<0.001) and T2 (experimental group: Δ=+13.0, control group: Δ=+6.1, P<0.001). There were significant between-group differences in the PASS at T1 (experimental group: Δ=+3.2, control group: Δ=+1.6, P=0.014) and T2 (experimental group: Δ=+8.8, control group: Δ=+4.3, P<0.001). CONCLUSIONS RAGT ameliorated lateropulsion and balance function more effectively than CPT in subacute stroke patients. CLINICAL REHABILITATION IMPACT Early RAGT may be recommended for patients with lateropulsion after stroke.
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Affiliation(s)
- Nari Yun
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Min C Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Seung-Chan Kim
- Department of Statistics, Pukyong National University, Busan, Republic of Korea
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea -
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21
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Bergmann J, Krewer C, Jahn K, Müller F. Robot-assisted gait training to reduce pusher behavior: A randomized controlled trial. Neurology 2018; 91:e1319-e1327. [PMID: 30171076 DOI: 10.1212/wnl.0000000000006276] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 07/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the effects of 2 weeks of intensive robot-assisted gait training (RAGT) on pusher behavior compared to nonrobotic physiotherapy (nR-PT). METHODS In a single-blind, randomized, controlled trial with 2 parallel arms, we compared 2 weeks of daily RAGT (intervention group) with the same amount of nR-PT (control group). Patients with subacute stroke who had pusher behavior according to the Scale for Contraversive Pushing (SCP) were included. The primary research questions were whether changes in pusher behavior would differ between groups post intervention, and at a follow-up 2 weeks afterward (SCP and Burke Lateropulsion Scale, Class II evidence). Secondary outcomes included the Performance-Oriented Mobility Assessment, the Functional Ambulation Classification, and the Subjective Visual Vertical. RESULTS Thirty-eight patients were randomized. Thereof, 30 patients received the allocated intervention and were included in the analyses. RAGT led to a larger reduction of pusher behavior than nR-PT at post test (SCP: U = 69.00, r = -0.33, p = 0.037; Burke Lateropulsion Scale: U = 47.500, r = -0.50, p = 0.003) and at follow-up (SCP: U = 54.00, r = -0.44, p = 0.008). Pusher behavior had ceased in 6 of 15 participants in the intervention group and 1 of 15 participants in the control group at post test. At follow-up, 9 of 15 and 5 of 15 participants, respectively, no longer exhibited the behavior. CONCLUSIONS Two weeks of RAGT seems to persistently reduce pusher behavior, possibly by recalibrating the disturbed inner reference of verticality. The potential benefits of RAGT on pusher behavior and verticality perception require further investigation. TRIAL REGISTRATION German Clinical Trials Register (registration number: DRKS00003444). CLASSIFICATION OF EVIDENCE This study provides Class II evidence that RAGT is beneficial to reduce pusher behavior in patients with stroke.
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Affiliation(s)
- Jeannine Bergmann
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany.
| | - Carmen Krewer
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany
| | - Klaus Jahn
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany
| | - Friedemann Müller
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany
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Martín-Nieto A, Atín-Arratibel MÁ, Bravo-Llatas C, Moreno-Bermejo MI, Martín-Casas P. Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour. Neurologia 2018; 36:S0213-4853(18)30148-8. [PMID: 29891334 DOI: 10.1016/j.nrl.2018.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.
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Affiliation(s)
- A Martín-Nieto
- Departamento de Fisioterapia, Universidad Católica Santa Teresa de Jesús de Ávila, Ávila, España.
| | - M Á Atín-Arratibel
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, España
| | - C Bravo-Llatas
- Área de Gobierno de Tecnologías de la Información y de Apoyo Técnico al Usuario-Investigación y Docencia, Universidad Complutense de Madrid, Madrid, España
| | - M I Moreno-Bermejo
- Departamento de Fisioterapia, Hospital Universitario de La Princesa, Madrid, España
| | - P Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, España
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