Danells Cynthia J, Black Sandra E, Gladstone David J, McIlroy William E
Heart and Stroke Foundation of Ontario Centre for Stroke Recovery, Sunnybrook and Women's College Health Science Centre, Toronto, Canada.
Stroke. 2004 Dec;35(12):2873-8. doi: 10.1161/01.STR.0000147724.83468.18. Epub 2004 Nov 4.
Patients with hemiparetic stroke have impaired balance control. Some patients ("pushers") are resistant to accepting weight on and actively "push" away from the nonparetic side. This research identified pushers from stroke patients with moderate to severe hemiparesis and examined longitudinal changes in symptoms, level of impairment, and functional independence.
Prospective sample of hemiparetic stroke patients (n=65) located in Toronto, Canada. Detailed clinical assessments were performed within 10 days postonset, at 6 weeks, and at 3 months.
At 1 week after stroke, 63% of patients demonstrated features of pushing. In 62% of pushers, symptoms resolved by 6 weeks, whereas in 21%, pushing symptoms persisted at 3 months. Motor recovery and functional abilities at 3 months were significantly lower among the pushers compared with the nonpushers. Pushers also had a significantly longer hospital length of stay (89 days versus 57 days). It is noteworthy that motor and functional recovery improved significantly over the 3-month study period for both pushers and nonpushers.
Identification of stroke patients with pushing symptoms has prognostic implications for recovery. In light of this potential recovery, rehabilitation specialists need to refine treatment approaches for the pushers to further improve functional outcome.
偏瘫性卒中患者的平衡控制受损。一些患者（“推者”）抗拒在患侧负重，并主动向健侧“推”。本研究从患有中度至重度偏瘫的卒中患者中识别出推者，并研究了症状、损伤程度和功能独立性的纵向变化。
对位于加拿大多伦多的偏瘫性卒中患者进行前瞻性抽样（n = 65）。在发病后10天内、6周和3个月时进行详细的临床评估。
卒中后1周，63%的患者表现出推的特征。在62%的推者中，症状在6周时消失，而在21%的推者中，推的症状在3个月时仍持续存在。与非推者相比，推者在3个月时的运动恢复和功能能力明显较低。推者的住院时间也明显更长（89天对57天）。值得注意的是，在3个月的研究期间，推者和非推者的运动和功能恢复均有显著改善。
识别有推症状的卒中患者对恢复有预后意义。鉴于这种潜在的恢复情况，康复专家需要改进针对推者的治疗方法，以进一步改善功能结局。
