Babyar Suzanne R, White Halina, Shafi Neelofer, Reding Michael
Burke Rehabilitation Hospital, White Plains, NY 10605, USA.
Neurorehabil Neural Repair. 2008 Jul-Aug;22(4):415-23. doi: 10.1177/1545968307313511. Epub 2008 Mar 11.
Lateropulsion after stroke has not been tracked using a case-matched controlled study and a standardized lateropulsion scale. Matched pairs of patients with stroke, with and without lateropulsion, were compared for functional outcomes and discharge destination following inpatient rehabilitation.
A retrospective chart review of patients with ischemic stroke at an inpatient rehabilitation hospital matched 36 pairs of patients with versus without lateropulsion. Scores of 2 or greater on the Burke Lateropulsion Scale identified lateropulsion. Matching criteria were side of stroke, sex, age, admission motor Functional Independence Measure (FIM), and interval poststroke. FIM efficiency (change in total FIM/length of stay) and discharge destination were analyzed with Wilcoxon signed-ranks tests.
FIM efficiency and discharge FIM scores were lower in the lateropulsion group. Groups had similar mean lengths of stay. Post-hoc analyses showed that only patients with lateropulsion and right brain damage had significantly different FIM efficiency and discharge FIM scores. Lower extremity weakness was greater in the lateropulsion group at discharge; patients with right brain damage accounted for this difference. Patients with lateropulsion required more dependent living situations at discharge, especially if they had right brain damage.
Patients with lateropulsion following stroke have a lower FIM efficiency and more dependency at discharge when compared with matched controls with equal functional limitations. Secondary analyses show worse outcomes for the subgroup of patients with right hemisphere stroke; lateropulsion and greater leg weakness may account for differences. Patients with lateropulsion may require longer rehabilitation to reach outcome goals.
尚未采用病例匹配对照研究及标准化的偏侧推挤量表对卒中后偏侧推挤进行追踪研究。对有和没有偏侧推挤的配对卒中患者，比较其住院康复后的功能结局及出院去向。
对一家住院康复医院的缺血性卒中患者进行回顾性病历审查，匹配了36对有和没有偏侧推挤的患者。伯克偏侧推挤量表得分2分或更高则判定为偏侧推挤。匹配标准为卒中侧、性别、年龄、入院时运动功能独立性测量（FIM）及卒中后间隔时间。采用Wilcoxon符号秩检验分析FIM效率（总FIM变化/住院时间）及出院去向。
偏侧推挤组的FIM效率及出院时FIM得分较低。两组的平均住院时间相似。事后分析表明，只有偏侧推挤且伴有右脑损伤的患者，其FIM效率及出院时FIM得分有显著差异。出院时偏侧推挤组的下肢无力更严重；这种差异由右脑损伤患者导致。偏侧推挤患者出院时需要更多依赖他人的生活环境，尤其是伴有右脑损伤的患者。
与功能受限程度相同的匹配对照组相比，卒中后出现偏侧推挤的患者FIM效率较低，出院时更依赖他人。二次分析表明，右半球卒中患者亚组的结局更差；偏侧推挤及更严重的腿部无力可能是造成差异的原因。出现偏侧推挤的患者可能需要更长时间的康复才能达到结局目标。
