Ipsilateral pushing in stroke: Incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen Stroke Study

Objectives: A ''pusher syndrome'' encompassing postural imbalance and hemineglect is believed to aggravate the prognosis of stroke patients. Our aim was to determine the incidence, associated neuropsychological symptoms, and the consequences for rehabilitation of ipsilateral pushing. Design: Consecutive and community-based. Setting: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were completed within the unit. Patients: 647 acute stroke patients admitted during a 1-year period. Excluded were 320 patients who did not receive physiotherapy because they did not have pareses of the leg, had a fast remission, or died. Main Outcome Measures: Gain in activities of daily living (ADL) function (Barthel Index), time course of functional remission, and discharge rate to nursing home. The independent impact of ipsilateral pushing was analyzed with multiple linear and logistic regression analyses. Results: Ipsilateral pushing was found in 10% of the included patients. No significant differences were found in the incidence of hemineglect and anosognosia between patients with and without ipsilateral pushing. No association with side of stroke lesion was found. Ipsilateral pushing had no independent influence on gain in ADL function or discharge rate to nursing home, but patients with ipsilateral pushing used 3.6 weeks (p < .0001) more to reach the same final outcome level than did patients without ipsilateral pushing. Conclusions: The existence of a ''pusher syndrome'' was not confirmed. Ipsilateral pushing did not affect functional outcome, but slowed the process of recovery considerably. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation