Post-stroke lateropulsion terminology: pushing for agreement among experts - 03/06/22

Doi : 10.1016/j.rehab.2022.101684

Jessica Nolan ^1,^⁎ , Angela Jacques ², Erin Godecke ³, Hiroaki Abe ⁴, Suzanne Babyar ⁵, Jeannine Bergmann ⁶, Melissa Birnbaum ⁷, Shenhao Dai ⁸, Cynthia Danells ⁹, Taiza GS Edwards ¹⁰, Marialuisa Gandolfi ¹¹, Klaus Jahn ¹², Ryan Koter ¹³, Avril Mansfield ¹⁴, Junji Nakamura ¹⁵, Vicky Pardo ¹⁶, Dominic Perennou ⁸, Celine Piscicelli ⁸, David Punt ¹⁷, Devra Romick-Sheldon ¹⁸, Wim Saeys ¹⁹, Nicola Smania ²⁰, Nathalia Vaes ²¹, Abigail L Whitt ²², Barbara Singer ²³
¹ School of Medical and Health Sciences, Edith Cowan University, Osborne Park Hospital, Joondalup, Stirling, Australia
² Institute for Health Research, The University of Notre Dame Australia; Department of Research, Sir Charles Gairdner Hospital, Fremantle, Nedlands, Australia
³ School of Medical and Health Sciences, Sir Charles Gairdner Hospital, Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Edith Cowan University; Joondalup, Melbourne, Nedlands, Vic, Australia
⁴ Fukushima Medical University, Fukushima, Japan
⁵ Hunter College; Burke Rehabilitation Hospital, New York, White Plains, NY, USA
⁶ Schoen Clinic; Ludwig-Maximilians University of Munich, German Center for Vertigo and Balance Disorders (DSGZ), Bad Aibling, Munich, Germany
⁷ St Vincent's Hospital, Melbourne, Vic, Australia
⁸ UMR CNRS 5105 Neuropsychology and NeuroCognition, Univ. Grenoble Alpes, CHU Grenoble Alpes, Dept of NeuroRehabilitation South Hospital, Cs 10217 - 38043 cedex 9 Grenoble, France
⁹ KITE-Toronto Rehabilitation Institute, University Health Network; University of Toronto, Toronto, ON, Canada
¹⁰ Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
¹¹ Department of Neurosciences, Biomedicine and Movement Sciences, Neurorehabilitation Unit, AOUI Verona; Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
¹² Schoen Clinic; German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Bad Aibling, Munich Germany
¹³ Sherherd Center, Atlanta, GA, USA
¹⁴ KITE-Toronto Rehabilitation Institute, University Health Network; University of Toronto; Sunnybrook Research Institute, Toronto, ON, Canada
¹⁵ Nishiyamato Rehabilitation Hospital; Graduate School of Health Sciences, Kio University, Nara, Japan
¹⁶ Wayne State University, Detroit, MI, USA
¹⁷ University of Birmingham, Birmingham, UK
¹⁸ Schwab Rehabilitation Hospital, Chicago, IL, USA
¹⁹ University of Antwerp, Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
²⁰ Neurorehabilitation Unit, AOUI Verona, Neuromotor and Cognitive Rehabilitation Research Center (CRRNC); Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
²¹ Rehabilitation Hospital RevArte; Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Antwerp, Brussels, Belgium
²² Inova Fairfax Hospital Health System, Fairfax, VA, USA
²³ School of Medical and Health Sciences; Training Centre in Subacute Care, South Metropolitan Health Service, Edith Cowan University, Fremantle Hospital, Fremantle, Joondalup, WA, Australia

^⁎Corresponding author: Jessica Nolan, Physiotherapy Department, Osborne Park Hospital, Osborne Place, STIRLING, WA 2021, AustraliaPhysiotherapy DepartmentOsborne Park HospitalOsborne PlaceSTIRLINGWA2021Australia

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Abstract

Post-stroke lateropulsion is prevalent. The global inconsistency in terminology used to describe the condition presents obstacles in accurately comparing research results, reaching consensus on use of measurement tools, agreeing upon a consistent approach to rehabilitation, and translating research to clinical practice.

Commencing in 2021, 20 international experts undertook a Delphi Process that aimed to compile clinical practice recommendations for the rehabilitation of lateropulsion. As a part of the process, the panel agreed to aim to reach consensus regarding terminology used to describe the condition. Improved understanding of the condition could lead to improved management, which will enhance patient outcomes after stroke and increase efficiency of healthcare resource utilisation.

While consensus was not reached, the panel achieved some agreement that ‘lateropulsion’ is the preferred term to describe the phenomenon of ‘active pushing of the body across the midline toward the more affected side, and / or actively resisting weight shift toward the less affected side’. This group recommends that ‘lateropulsion'is used in future research and in clinical practice.

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Keywords : lateropulsion, pusher behaviour, pusher syndrome, stroke rehabilitation