Background: A stroke patient with pusher behavior actively pushes themselves toward their hemiplegic side, or resists moving onto their non-hemiplegic side. This phenomenon is associated with increased length of hospitalization and health care costs, as well as delayed recovery in such patients. The present study aimed to determine the factors associated with clinical severity of pusher behavior.

Methods: In the current study, we defined clinical severity as the summation of controlled initial severity and improvement efficiency. From the retrospective data of 1,971 patients admitted to a single acute stroke hospital, 136 patients who exhibited pusher behavior were analyzed using logistic regression analysis.

Results: Age, lower limb motor function, score of Japan coma scale and Barthel Index were significantly associated with the clinical severity of pusher behavior.

Conclusions: Older age, lower limb motor impairments, consciousness disorder and Barthel Index were associated with delayed recovery from pusher behavior and initial severity in patients with pusher behavior. The results of the present study may provide evidence that these characteristics on admission are useful for early decision making regarding the rehabilitation duration and discharge planning.

Stroke patients exhibit various postural abnormalities, such as pusher behavior and lateropulsion. Commonly, patients with pusher behavior show a marked body tilt to the contralesional side with hemiparesis and sensory disturbances, such as tactile, pressure, thermal, pain and proprioceptive disturbances. On the other hand, many cases of lateropulsion exhibit a marked body tilt to the ipsilesional side with limb ataxia, vertigo, pain and thermal hypoalgesia, without hemiparesis or the above-mentioned disturbances. A 60s man had a pontine hemorrhage. He exhibited a marked body tilt toward the contralesional side with hemiparesis and several sensory disturbances. We determined the postural abnormality to be lateropulsion according to brain imaging findings and the results of previous reports. We performed physical therapy to facilitate the patient’s awareness of residual sensory input based on our determination. As a result, improvement in the patient’s body tilt was observed. The findings in the current case may contribute to the decision-making process of physiotherapists in the clinical setting.