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RehabMeasures Instrument

Scale for Contraversive Pushing

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Purpose

A three item scale that measures lateropulsion or pusher syndrome, by rating the action/reaction of patients required to keep or change position.

Acronym SCP

Cost

Free

Diagnosis/Conditions

  • Stroke Recovery

Populations

Key Descriptions

  • Three variables:
    (1) spontaneous body posture(0, 0.25, 0.75, 1 = severe tilt)
    (2) abduction and extension of the non-paretic extremities (0, 0.5, 1 = performed spontaneously at rest)
    (3) resistance to passive correction of tilted posture (0, 1 = resistance occurs) are assessed in both sitting and standing
  • 0 = no contraversive pushing, 1 = minimum score for each item, 2 = maximum score. Score on each component > 1 indicative of lateropulsion. Total score not used by originator of the Scale for Contraversive Pushing (SCP)
  • For administration instructions, see Karnath, HO and Brotz, D. Letter to the editor: Instructions for the Clinical Scale of Contraversive Pushing (SCP). Neurorehabil Neural Repair 2007; 21, 370-371; and Baccini, M, Paci, M and Rinaldi, LA (2006). The Scale for Contraversive Pushing: A reliability and validity study. Neurorehabil Neural Repair, 2006; 20(4), 468-472

Number of Items

3

Equipment Required

  • Mat Table or Bed

Time to Administer

10 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

John M. Dudzik, MHS, OTR/L

ICF Domain

Body Function
Body Structure

Considerations

  • Baccini et al (2006) state that agreement between the clinical and SCP diagnosis is relatively low because the original cutoff criterion suggested by Karnath and others was too high. As a result, the SCP failed to detect pusher syndrome in a significant number of patients. They recommend a modified cutoff criterion (noted above) as it increased agreement of the SCP with the clinical diagnosis.
  • Baccini et al (2006) recommend additional studies with a more heterogeneous sample of stroke patients to validate the diagnostic value of the SCP further.
  • Baccini et al (2006) found the sensitivity of the SCP increased from 64.7% with the original criterion (all subscores > 1) to 100% with the modified criterion (all subscores > 0). Specificity was found to be 100% with the original criterion, 97.7% with the modified criterion.
  • According to Babyar et al (2009), the SCP is the only scale that has been compared to level of contralesional tilt of the postural, visual and haptic vertical sensory modalities in a laboratory setting.
  • There is only a moderate relationship between the SCP, M-SCP, and Burke Lateropulsion Scale (BLS) and existing scales of balance and function.  Moreover, there is no “gold standard” for comparison for validity testing of these measures (Babyar et al, 2009).

Stroke

back to Populations

Cut-Off Scores

Acute stroke: (Baccini, et al, 2008; n = 105)

Three different cutoff scores were used to identify the greatest agreement between clinical and SCP diagnosis.

  • When the cutoff score was defined as the SPC total score >0, clinical agreement was low (k=.212)
  • When the cutoff score was defined as the subscores in each section >0, clinical agreement was highest (k=.933)
  • When the cutoff score was defined as the subscores in each section > 1, clinical agreement was less accurate (k=.754), but false positive results were minimized.

Interrater/Intrarater Reliability

Acute stroke: (Baccini, et al, 2006)

  • Excellent interrater reliability (ICC = 0.944 for section A, 0.929 for section B, 0.939 for section C, and 0.971 for SCP total score)

Internal Consistency

Acute stroke: (Baccini, et al, 2006)

  • Excellent: Internal consistency (Cronbach’s alpha = 0.919) 19 days post onset, component scores correlated to each other and with the total score (r ranged from 0.711 to 0.956)

Construct Validity

Acute stroke:  (Baccini, et al, 2008; n = 105; mean age 70.6 (11.2) years; concurrent study)

  • Excellent correlation of total SCP with Barthel Index (ρ = -0.632)
  • Excellent correlation of total SCP with balance score of Fugl-Meyer Assessment (ρ = -0.666)
  • Adequate correlation of total SCP with mobility section of Lindmark and Hamrin motor assessment chart (ρ = -0.595)

Values are negative due lower scores indicating better function with the SCP

Bibliography

Baccini, M, Paci, M, Nannetti, L, Biricolti, C, and Rinaldi, LA. Scale for Contraversive Pushing: Cutoff scores for diagnosing “pusher behavior” and construct validity. Phys Ther, 2008; 88(8):947-955. Find it on PubMed

Baccini, M, Paci, M and Rinaldi, LA. The Scale for Contraversive Pushing: A reliability and validity study. Neurorehabil Neural Repair, 2006;20(4):468-472. doi:10.1177/1545968306291849. Find it on PubMed

Babyar, SR, Peterson, MG., Bohannon, R Perennou, 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

Karnath, HO and Brotz, D. Letter to the editor: Instructions for the Clinical Scale of Contraversive Pushing (SCP). Neurorehabil Neural Repair, 2007;21:370-371. doi:10.1177/154968307300702. http://nnr.sagepub.com/content/21/4/370.extract

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