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 push ing. Design: Consecutive and community-based. Setting: A stroke unit r eceiving 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 n ot have pareses of the leg, had a fast remission, or died. Main Outcom e Measures: Gain in activities of daily living (ADL) function (Barthel Index), time course of functional remission, and discharge rate to nu rsing home. The independent impact of ipsilateral pushing was analyzed with multiple linear and logistic regression analyses. Results: Ipsil ateral pushing was found in 10% of the included patients. No significa nt differences were found in the incidence of hemineglect and anosogno sia between patients with and without ipsilateral pushing. No associat ion with side of stroke lesion was found. Ipsilateral pushing had no i ndependent influence on gain in ADL function or discharge rate to nurs ing home, but patients with ipsilateral pushing used 3.6 weeks (p < .0 001) more to reach the same final outcome level than did patients with out ipsilateral pushing. Conclusions: The existence of a ''pusher synd rome'' was not confirmed. Ipsilateral pushing did not affect functiona l outcome, but slowed the process of recovery considerably. (C) 1996 b y the American Congress of Rehabilitation Medicine and the American Ac ademy of Physical Medicine and Rehabilitation