Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany.
Top Stroke Rehabil. 2013 Jul-Aug;20(4):331-9. doi: 10.1310/tsr2004-331.
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.
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.
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.
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.
在康复环境中检查偏瘫患者中推挤行为（PB）的流行率和时间进程，以及这种行为对康复结果的影响。
在 1 年期间，对一家神经康复医院住院的 448 例中风和非中风病因引起的偏瘫患者在入院后第 1 周进行了筛选。使用对立性推挤临床量表来区分推挤患者和非推挤患者。如果存在 PB，则每周检查一次。评估 PB 的流行率和持续时间，并根据运动功能评估量表和巴氏指数计算对康复效率和效果的影响。
在所有检查的患者中，16%存在 PB，17%的中风患者和 31%（33%的中风患者）无法在没有支撑的情况下直立。在康复医院内 PB 的持续时间为 5 ± 4.3 周（中位数= 4；范围，1-20）。PB 是康复结果的负面预测因子：PB 患者的效率和效果只有非推挤患者的一半。如果 PB 存在时间较长，效果会恶化。
PB 的流行率及其对康复结果的影响表明 PB 是中风康复中的一个相关障碍。然而，PB 患者的行为持续时间差异很大。需要进一步研究以确定识别有发展为长期 PB 潜力的患者的预后标准。
