Purpose
A 5 item scale that measures lateropulsion or pusher syndrome, by rating the action/reaction of patients required to keep or change position.
Acronym
BLS
Primary Image
Burke Lateropulsion Scale
Expertise, Instruction and Mentorship
Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
Upcoming Stroke Course
May 9–10
Live and Online
Offered by Academy, Shirley Ryan AbilityLab
Populations
Key Descriptions
- 5 testing positions
- 0 = no evidence of lateropulsion, 17 = maximum score
- Scoring is based on the degree and point of onset of resistance to passive correction (sit, stand) or degree of pushing evident (supine, transfer, walking). The greater the resistance noted by the therapist, the higher the score.
- For administration instructions, see Appendix in: D’Aquila, MA, Smith, T, Organ, D, Lichtman, S and Reding, M (2004). Validation of a lateropulsion scale for patients recovering from stroke. Clin Rehabil, 2004; 18(1), 102-109
Number of Items
5
Time to Administer
10 minutes
Required Training
Reading an Article/ManualICF Domain
Body FunctionBody Structure
Considerations
- The Lateropulsion Scale is subjective and results could be affected by patient and clinician familiarity and comfort with the test protocol. Training and practice by assessors in using the scale may be needed to increase consistency between raters.
- The scale is based on observations of lateropulsion in its most severe manifestations in supine, sitting, standing and walking.
- Lateropulsion scores were significantly not different with right versus left hemisphere stroke.
- Determining small body tilts or the degree of tilt may be difficult to rate using the BLS (Bergmann et al, 2014; Clark et al, 2012).
- The Lateropulsion Scale is the only scale to incorporate assessment with a patient in a supine position and walking. This may make it more useful in an acute care setting where patients may demonstrate lateropulsion to a greater degree.
- There is only a moderate relationship between the Burke Lateropulsion Scale (BLS), Scale for Contraversive Pushing (SCP), and Modified Scale for Contraversive Pushing (M-SCP) and existing scales of balance and function (Babyar et al, 2009).
- Bergmann et al (2014) found that the Burke Lateropulsion Scale has a higher sensitivity (100%) but a lower specificity (67%) than the Scale for Contraversive Pushing for detecting pusher behavior and might produce more false-negative diagnoses.
- Bergmann et al (2014) contend the BLS is more useful in detecting small changes in pusher behavior in patients
Stroke
back to PopulationsStandard Error of Measurement (SEM)
Acute stroke: (D’Aquila et al, 2004; n = 85; mean interval post stroke 19 days +/- 2)
- SEM for entire group (n = 85)= 0.79 (calculated from statistics in D’Aquila et al, 2004)
Minimal Detectable Change (MDC)
Acute stroke: (D’Aquila et al, 2004)
- MDC for entire group (n = 85) = 2.18 (calculated from statistics in D’Aquila et al, 2004)
Interrater/Intrarater Reliability
Iterrater Reliability
Acute stroke: (D’Aquila et al, 2004)
- Excellent inter-rater reliability in individuals 19 days post stroke (ICC = 0.93)
Intrarater Reliability
- Excellent intra-rater reliability with individuals 19 days post stroke (ICC = 0.94)
Criterion Validity (Predictive/Concurrent)
Concurrent validity:
Acute stroke: (D’Aquila et al, 2004)
- Adequate correlations with the Fugl-Meyer Assessment of Motor Performance (r = -0.570)
- Adequate correlations with admission FIM mobility score (r = -0.56)
- Adequate correlations with discharge FIM mobility score (r = -0.58)
- Excellent correlations with length of rehabilitation stay (r = .60)
Content Validity
Acute Stroke: (D’Aquila et al, 2004)
- Items selected based on use and three revisions of the Lateropulsion Scale over an eight-year period based on feedback from the physical therapy team using the scale.
- Final version contains five test positions but provides for weighting scores for features thought to be most characteristic of lateropulsion.
- Weighting was based on the consensus of the therapy team responsible for developing the scale.
Face Validity
Acute Stroke: (D’Aquila et al, 2004)
- Not statistically assessed, although face validity was considered inherent in the scoring where resistance to passive correction of the posture of the presence of pushing during the test positions was observed.
Bibliography
Bergmann, J, Krewer, C, Katrin, R, Friedemann, M, Eberhard, K and Jahn, K. Inconsistent classification of pusher behavior in stroke patients: A direct comparison of the Scale for Contraversive Pushing and the Burke Lateropulsion Scale. Clin Rehabil 2014; 28(7):696-703. doi:10.1177/0269215513517726. Find it on PubMed
Babyar, SR, Peterson, MG, Bohannon, R, Perennou, D, and Reding, M. Clinical examination tools for lateropulsion of pusher syndrome following stroke: A systematic review of the literature. Clin Rehabil 2009;23:639-650. doi:10:1177/0269215509104172. Find it on PubMed
Clark, E, Hill, KD, and Punt, TD. Responsiveness of 2 scales to evaluate lateropulsion or pusher syndrome recovery after stroke. Arch Phys Med Rehabil 2012;93:149-155. doi:10.1016/j.apmr.2011.06.017. Find it on Pubmed
D’Aquila, MA, Smith, T, Organ, D, Lichtman, S and Reding, M. Validation of a lateropulsion scale for patients recovering from stroke. Clin Rehabil 2004;18(1):102-109. doi:101191/0269215504cr709oa. Find it on PubMed