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

Abstract

Recent researches suggested that postural disorders after stroke may be partly caused by a wrong referential of verticality, expressed by a lateropulsion behavior. The role played by lateropulsion in the postural and gait disorders after stroke remained to be investigated, which was the objective of the present study. Retrospective cohort study (2012–2017) of 147 consecutive patients investigated in a neurorehabilitation ward in average at 32.7 days after a first hemispheric stroke: age 62.8 ± 12.6 years, 41 females, 120 with infarction, 57 with right lesion. Trained physiotherapists assessed: lateropulsion with the Scale for Contraversive Pushing (SCP, 0-6), Balance disorders with the Postural Assessment Scale for Stroke (PASS, 0-36) and gait disorders with Lindmark Scale (0–6). Brain imaging was carefully checked (138 MRI, 9 CT). Patients with a malignant stroke, dementia, instable medical status that could interfere with balance and gait recovery, or those who refused the assessments were not included. Descriptive data are given in the form median (first-third quartile). One month poststroke, postural and gait data were: SCP 0 (0–0.25), PASS 32 (25–35) and Gait score 4 (2–6). Fifteen patients were pushers (10%), among them 80% had a right hemisphere stroke. A first result was to confirm that lateropulsion was more severe in right hemisphere stroke than in left (right 46% vs. left 10%, χ2 =47.7; P < 0.001). As a corollary postural disorder and gait disorder were also more severe after right hemisphere stroke. In patients with a right hemisphere stroke, lateropulsion explained 77% of the variance of postural disorders (P < 0.001) and 76% of the variance of gait disorders (P < 0.001). Postural disorders explained 81% of the variance of gait disorders (P < 0.001). Lateropulsion, which is a sign of biased representation of the vertical, is a primary cause of postural and gait disorders at the subacute phase after right hemisphere stroke, explaining almost 80% of balance and gait disabilities. A greater attention should be focused on the assessment and the rehabilitation of the poststroke lateropulsion.