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Clinical examination tools for lateropulsion or pusher syndrome following stroke: a systematic review of the literature

Physical Therapy Program, Hunter College and Graduate Center of the City University of New York and Burke Rehabilitation Hospital, White Plains, sbabyar{at}burke.org

Margaret GE Peterson

The Hospital for Special Surgery, New York

Richard Bohannon

Department of Physical Therapy, Naeg School of Education, University of Connecticut, Storrs, USA

Dominic Pérennou

Hôpital Nord - CHU, Clinique de Médecine Physique et Réadapatation, Pôle Réeducation et Physiologie, Université Grenoble, Grenoble, France

Michael Reding

Neurology Department, Stroke Unit, Burke Rehabilitation Hospital, White Plains, New York, USA

Objective: To examine the clinimetric properties and clinical applicability of published tools for `quantifying' the degree of lateropulsion or pusher syndrome following stroke.

Data sources: Search through electronic databases (MEDLINE, EMBASE, CINAHL, Science Citation Index) with the terms lateropulsion, pushing, pusher syndrome, validity, reliability, internal consistency, responsiveness, sensitivity, specificity, posture and stroke. Databases were searched from their inception to October 2008.

Review methods: Abstracts were selected by one author. A panel of experts then determined which should be included in this review. Five abstracts were reviewed and the panel agreed to omit one abstract because those authors did not write a full manuscript. The panel critiqued manuscripts according to predetermined criteria about clinical and clinimetric properties.

Results: Four manuscripts referencing three tools for examining lateropulsion were found. Validity and reliability data support the clinical use of the Scale for Contraversive Pushing, the Modified Scale for Contraversive Pushing and the Burke Lateropulsion Scale. The Scale for Contraversive Pushing has the most extensive testing of clinimetric properties. The other tools show promising preliminary evidence of clinical and research utility. More testing is needed with larger, more diverse samples.

Reviewers' conclusions: The Scale for Contraversive Pushing, the Modified Scale for Contraversive Pushing and the Burke Lateropulsion Scale are reliable and valid measures with good clinical applicability. Larger, more varied samples should be used to better delineate responsiveness and other clinimetric properties of these examination tools.

This version was published on July 1, 2009

Clinical Rehabilitation, Vol. 23, No. 7, 639-650 (2009)
DOI: 10.1177/0269215509104172


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