Six-month outcomes and patterns of recovery for people with lateropulsion following stroke

• Published in: Disability and rehabilitation Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 9
• Main Authors: Birnbaum, Melissa, Brock, Kim, Clark, Ross, Burton, Elissa, Hill, Keith D.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-06-2024
• Subjects: Aged; Aged, 80 and over; Female; Humans; Lateropulsion; Male; Middle Aged; outcome; Postural Balance - physiology; postural control; recovery; Recovery of Function; stroke; Stroke - complications; Stroke - physiopathology; Stroke Rehabilitation - methods; Treatment Outcome; Walking - physiology; Weight-Bearing - physiology; postural control; recovery; Lateropulsion; stroke; outcome
• ISSN: 0963-8288; 1464-5165
• DOI: 10.1080/09638288.2023.2222644

This study investigated the (1) six-month outcomes of individuals with lateropulsion; (2) the relationship between baseline measures (from in-patient hospitalisation) and six-month functional abilities; and (3) recovery patterns for lateropulsion in stroke survivors.
Forty-one individuals with lateropulsion participated in this study. Measures of lateropulsion, postural function, and weight-bearing asymmetry in standing were taken initially and fortnightly over eight weeks. Functional independence and walking abilities were assessed at six months post-stroke.
Compared to individuals with moderate to severe lateropulsion, those with mild lateropulsion achieved higher levels of functional outcome at six months. However, there were a wide range of scores. Baseline lateropulsion severity explained 26% of the variation in functional outcome. A stronger correlation with functional outcome was observed for lateropulsion (−0.526) than function independence at baseline (0.384). For the task of standing with arm support, patterns of asymmetry were divergent at baseline, favouring either the paretic or non-paretic leg. Over the eight-week period, asymmetry moved towards the non-paretic leg and lateropulsion reduced consistently.
Individuals with lateropulsion can recover from lateropulsion and make meaningful functional gains, including some individuals with more severe lateropulsion. Lateropulsion severity is a key indicator of functional outcome post-stroke.
IMPLICATIONS FOR REHABILITATION
Individuals with lateropulsion can make significant gains in terms of mobility and functional abilities by six months post-stroke, learning to compensate for their verticality impairment in standing by loading their non-paretic leg.
It is important that stroke survivors with lateropulsion, including those with moderate and severe lateropulsion, are provided with adequate rehabilitation to optimise their longer-term mobility and functional abilities.
Routine screening of acute stroke survivors for lateropulsion is recommended, given lateropulsion may negatively impact longer-term functional outcomes in stroke survivors.
Therapists should carefully analyse the weight-bearing pattern which an individual with lateropulsion adopts in standing and subsequently tailor treatment to target this.