Postural and gait disorders in subacute stroke patients: Lateropulsion is the key

Abstract

Postural disorders after stroke may be partly caused by a wrong referential of verticality, leading to a deficit in the upright orientation (lateropulsion). The part played by lateropulsion in the postural and gait disorders after stroke remained to be investigated. Cohort study of consecutive patients admitted in a neurorehabilitation ward after a first hemispheric stroke, from 2012 to 2017. Retrospective analysis of data collected at one month post-stroke (M1). Many deficits were assessed: spatial neglect, aphasia, apraxia, depression, visual field defect, motor weakness, spasticity, sensory loss, and lateropulsion with the SCP. Balance disorders were assessed with the PASS and gait disorders with the Lindmark Scale. Statistical analyses comprised uni and multivariate analyses. Descriptive data are given in the form median (first-third quartile). Hundred and seventy-eight persons met inclusion criteria: age 63.2 (12.2) years, 57 females, 150 with infarction, 71 with a right hemispheric stroke. At M1, 21 presented a pushing behavior (12%), among them 86% had a right hemisphere stroke. We run a Generalized Linear Model to explain postural and gait disorders by deficits. Lateropulsion was the primary deficit (body orientation) contributing to postural and gait disorders. The second one was weakness. In patients with a right hemisphere stroke, lateropulsion explained 90% of the variance of postural disorders (P < 0.001), and 65% of the variance of gait disorders (P < 0.001). Lateropulsion, which is a sign of biased representation of the vertical, is the primary cause of postural and gait disorders at the subacute phase. A greater attention should be focused on it assessment and rehabilitation.