RehabMeasures Instrument
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  2. Modified Scale for Contraversive Pushing

Modified Scale for Contraversive Pushing

Last Updated

Purpose

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

Acronym M-SCP

Cost

Free

Diagnosis/Conditions

  • Stroke Recovery

Populations

Stroke

Key Descriptions

  • Four functional parts: static sitting, static standing, sitting transfer and standing/walking transfer
  • 0 = no sign of lateropulsion, 8 = maximum score/severe lateropulsion
  • Each part is assessed separately and the degree of pushing graded on a scale of 0 to 2 points, with 0 representing no symptoms and 2 indicating severe symptoms
  • Pushing is defined as when a patient uses the unaffected extremity (arm and/or leg) to push the body actively to the hemiplegic side so that a weight shift occurs
  • For administration instructions, see Lagerqvist, J and Skargren, E. Pusher syndrome: Reliability, validity, and sensitivity to change of a classification instrument. Adv Physiother 2006; 8, 154-160

Number of Items

4

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

  • Adding transfers and using specific scoring criteria helps clinicians who see patients whose lateropulsion becomes more evident in dynamic balance activities.
  • Lagerqvist and Skargren (2006) suggest that a change of 2 points of more is needed in the total score to demonstrate true change in the degree of lateropulsion.
  • Lagerqvist and Skargren (2006) also suggest that the modified version of the SCP is reliable if evaluations are done by clinicians with experience in neurological rehabilitation and of patients exhibiting pushing.
  • Baccini et al (2008) contend that M-SCP is sufficiently different from the original scale to be considered a new assessment tool.
  • 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).

Stroke

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Interrater/Intrarater Reliability

Interrater Reliability

Acute stroke: (Lagerqvist, & Skargren, 2006)

  • Excellent interrater reliability in individuals 4 to 8 days post stroke (Spearman’s correlation coefficient) ρ = 0.82 at admission and ρ = 0.94 at discharge for total scores

Criterion Validity (Predictive/Concurrent)

Current Validity:

Acute Stroke: (Lagerqvist, & Skargren, 2006)

  • Adequate correlations with Berg Balance Scale (ρ  = -0.52 for first evaluation, ρ = -0.49 for second evaluation)
  • Adequate correlations with Swedish Physiotherapy Outcomes Variable (ρ  = -0.43 for first evaluation, ρ = -0.45 for second evaluation)

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.

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.

Lagerqvist, J and Skargren, E. Pusher syndrome: Reliability, validity, and sensitivity to change of a classification instrument. Adv Physiother 2006;8:154-160. doi:10.1080/14038190600806596.

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