Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel.

OBJECTIVE: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel. DESIGN: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations. PARTICIPANTS: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion. MAIN MEASURES: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses. RESULTS: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded. CONCLUSIONS: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

Post-stroke lateropulsion terminology: pushing for agreement amongst experts.

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.

Novel Treatment Approach to Contraversive Pushing after Acute Stroke: A Case Report.

Purpose: The purpose of this case report is to provide an alternative treatment approach to pushing behavior (PB), adapting widely used equipment for persons with stroke demonstrating such behaviour. The aim is to change their graviceptive experience during interventions while performing repeated stepping and righting practice to resolve PB more quickly. Client Description: The subject is a man aged 56 years who sustained a right middle-cerebral-artery ischemic stroke. He entered in-patient rehabilitation from an acute care hospital 7 days post-stroke. Intervention: Lateral stepping with body weight-supported treadmill training (LS-BWSTT) was used such that the subject stepped laterally toward the uninvolved side. Measures and Outcome: Scores on the Scale for Contraversive Pushing and the FIM were recorded at regular intervals. After intervention, the subject demonstrated decreased PB and improved function. Implications: The individual's PB improved after LS-BWSTT. LS-BWSTT is a novel treatment intervention that could be considered in future clinical decision making using evidence-based principles.

Objectif : le présent rapport de cas vise à proposer une autre approche thérapeutique qui consiste à adapter du matériel largement utilisé pour les personnes qui ont subi un accident vasculaire cérébral et démontrent un comportement de poussée (CP­pushing). On cherche ainsi à modifier leur expérience de graviception pendant les interventions, tout en exécutant des pas et des redressements répétés afin de régler le CP plus rapidement. Description du client : le patient est un homme de 56 ans qui a souffert d'un accident ischémique de l'artère cérébrale moyenne droite. Il a été hospitalisé en réadaptation à sa sortie d'un hôpital de soins aigus sept jours après son accident ischémique. Intervention : les pas latéraux avec entraînement sur tapis roulant soutenu par le poids corporel (LS-BWSTT) ont été utilisés de manière que le sujet fasse des pas latéraux vers le côté non touché. Mesures et résultats : à intervalles réguliers, les chercheurs ont enregistré les résultats de l'échelle de poussée de contraversion et de la mesure d'autonomie fonctionnelle. Après l'intervention, le sujet a démontré une diminution du CP et une meilleure fonction. Implications : le patient a réduit son CP après la LS-BWSTT. Cette nouvelle intervention thérapeutique pourrait être envisagée dans le cadre des prochaines décisions cliniques faisant appel à des principes fondés sur des données probantes.