Post-stroke lateropulsion and rehabilitation outcomes: a retrospective analysis

Abstract

Purpose

A person with post-stroke lateropulsion actively pushes themselves toward their hemiplegic side, or resists moving onto their non-hemiplegic side. This study aimed to determine the association of lateropulsion severity with: • Change in function (Functional Independence Measure – FIM) and lateropulsion severity (Four-Point Pusher Score – 4PPS) during inpatient rehabilitation; • Inpatient rehabilitation length of stay (LOS); • Discharge destination from inpatient rehabilitation.

Methods

Retrospective data for 1,087 participants (aged ≥65 years) admitted to a stroke rehabilitation unit (2005–2018) were analysed using multivariable regression models.

Results

Complete resolution of lateropulsion was seen in 69.4% of those with mild lateropulsion on admission (n = 160), 49.3% of those with moderate lateropulsion (n = 142), and 18.8% of those with severe lateropulsion (n = 181). Average FIM change was lower in those with severe lateropulsion on admission than those with no lateropulsion (p < 0.001). Higher admission 4PPS was associated with reduced FIM efficiency (p < 0.001), longer LOS (p < 0.001), (adjusted mean LOS: 35.6 days for those with severe lateropulsion versus 27.0 days for those without), and reduced likelihood of discharge home (p < 0.001).

Conclusion

Post-stroke lateropulsion is associated with reduced functional improvement and likelihood of discharge home. However, given a longer rehabilitation duration, most stroke survivors with moderate to severe lateropulsion can achieve important functional improvement.

Implications for Rehabilitation

• While people with post-stroke lateropulsion can be difficult to treat and require more resources than those without lateropulsion, the majority of those affected, even in severe cases, can make meaningful recovery with appropriate rehabilitation.

• Although those with moderate to severe post-stroke lateropulsion may have poorer outcomes (longer LOS and reduced likelihood of discharge home) it is still important to advocate for access to rehabilitation for this patient group to give them the opportunity for optimal functional recovery.

Keywords:

• lateropulsion
• pusher syndrome
• stroke
• rehabilitation
• recovery

Acknowledgements

The authors would like to acknowledge the work of all past and current Osborne Park Hospital Stroke Services team members who contributed to the development and maintenance of the stroke database, and to thank the Osborne Park Hospital Physiotherapy Department and Stroke Services team for their support over the course of this study.

Disclosure statement

The authors declare that there is no conflict of interest.

Additional information

Funding

This work was supported by the Charlies Foundation for Research (RAC 2019-20-019), a Department of Health and Raine Medical Research Foundation Clinician Research Fellowship (CRF04-R9), and the Australian Government Research Training Program Scholarship.