Time Course and Influence of Pusher Behavior on Outcome in a Rehabilitation Setting: A Prospective Cohort Study

Abstract

Objective: To examine the prevalence and the time course of pusher behavior (PB) among patients with hemiparesis in a rehabilitation setting and the influence of this behavior on rehabilitation outcome. Methods: Over a 1-year period, 448 inpatients with hemiparesis after stroke and nonstroke etiologies were screened in the first week after admission to a neurological rehabilitation hospital. The Clinical Scale for Contraversive Pushing was used to differentiate pusher from nonpusher patients. If PB was present, the patient was examined weekly. The prevalence and duration of PB was assessed, and influence on rehabilitation efficiency and effectiveness according to the Motor Function Assessment Scale and Barthel Index was calculated. Results: PB was present in 16% of all examined, in 17% of the stroke patients, and in 31% of patients (33% of stroke patients) unable to stand erect without support. PB duration within the rehabilitation hospital was 5 ± 4.3 weeks (median = 4; range, 1-20). PB is a negative predictor for the rehabilitation outcome: PB patients are only half as efficient and effective as nonpusher patients. The effect worsened if PB had been present for a longer period of time. Conclusion: The prevalence of PB and its influence on rehabilitation outcome reveal PB as a relevant disorder in stroke rehabilitation. However, the duration of the behavior differed widely among the PB patients. Further studies are needed to establish prognostic criteria for identifying patients with a potential for developing long-term PB.