Lateropulsion After Stroke: Prevalence, Predictors And Impact On Recovery In Subacute Rehabilitation – A Prospective Observational Study

Abstract

Background: Lateropulsion, also known as contraversive pushing, is a common post-stroke disorder that disrupts vertical orientation and significantly interferes with functional recovery. Its prevalence in subacute rehabilitation settings varies widely, and the clinical factors predicting its occurrence and its influence on rehabilitation outcomes remain incompletely defined.

Objectives: To determine the prevalence of lateropulsion in patients undergoing subacute stroke rehabilitation, identify clinical predictors associated with its presence, and evaluate its impact on functional recovery.

Methods: A prospective observational study was conducted in an Institution and Rehabilitation centre from South India. Consecutive stroke patients meeting eligibility criteria were enrolled. Demographic data, stroke characteristics, and neurological assessments were recorded. Lateropulsion was evaluated using the Burke Lateropulsion Scale (BLS). Functional outcomes were assessed using standardized measures such as the Berg Balance Scale (BBS) and Functional Independence Measure (FIM). Prevalence was calculated, and predictors were analyzed using appropriate statistical models.

Results: A total of 176 subacute stroke rehabilitation patients were assessed to determine the prevalence and clinical impact of lateropulsion. The cohort was predominantly older adults, with most between 40 and 90 years, and females formed 53.41% of the sample. Ischemic stroke was the major subtype (76.70%), and left-sided involvement slightly predominated (56.25%). Lateropulsion was present in 34.09% of patients and was more frequent among those aged ≥70 years. Within the lateropulsion group, ischemic strokes (75%), left-sided lesions (58.33%), and severe NIHSS scores (68.33%) were common, and spatial neglect was highly prevalent (76.67%). Co-morbidities such as diabetes and heart disease were frequent. Although mean age and NIHSS values were comparable between groups, individuals with lateropulsion showed significantly poorer functional performance, reflected by lower BLS (10.56 ± 3.37), BBS (25.72 ± 9.27) and FIM (68.7 ± 14.2) scores compared to those without lateropulsion.

Conclusion: Overall, the findings indicate that lateropulsion affects one-third of the rehabilitation population and is strongly associated with older age, neglect, greater stroke severity, and reduced functional balance.