Lateropulsion Prevalence After Stroke

Abstract

Background and Objectives:Lateropulsion is a deficit of active body orientation with respect to gravity in the frontal plane, mostly observed after a stroke. It magnifies mobility limitations and so represents an emerging target in rehabilitation. Efforts to design specific interventional studies require some basic knowledge of epidemiology, which is insufficient today because many studies focused on a few severe forms in individuals called pushers. The objectives of this study were to bridge this gap.Methods:We systematically searched MEDLINE, EMBASE, CINAHL, and Cochrane Clinical Trials up to 31 May 2021 for original research reporting a prevalence or incidence of post-stroke lateropulsion. We followed MOOSE and PRISMA guidelines. Eligibility for inclusion, data extraction, and study quality (Joanna Briggs Institute guidelines) were evaluated by two reviewers who used a standardized protocol: PROSPERO (CRD42020175037). A random-effects meta-analysis was used to obtain the pooled prevalence, whose heterogeneity was investigated by subgroup analysis (stroke locations and post-stroke phases) and meta-regression.Results:We identified 22 studies (5125 individuals; mean age 68.5 years; 42.6% female; assessed 24 days, on average, after stroke), most published after 2000. The studies’ quality was adequate, with only 8 (36.4%) showing risk of bias. The pooled lateropulsion prevalence was 55.1% (95% confidence interval [CI] [35.9–74.2]) and was consistent across assessment tools. After supratentorial stroke, lateropulsion prevalence was 41% (95%CI [33.5–48.5]), and only 12.5% (95%CI [9.2–15.9]) in individuals with severe lateropulsion, called pushers. Meta-regression did not reveal any effect of age, sex, geographic region, publication year, or study quality. Lateropulsion prevalence progressively decreased from 52.8% (95%CI [40.7–65]) in the acute phase to 37% (95%CI [26.3–47.7]) in the early subacute phase and 22.8% (95%CI [0–46.3]) in the late subacute phase. The ratio of right- to left-hemispheric stroke with lateropulsion increased as a function of time: 1.7 in the acute phase to 7.7 in the late subacute phase. After infratentorial stroke, lateropulsion prevalence was very high, reaching 83.2% (95%CI [63.9–100.3]).Conclusions:Post-stroke lateropulsion prevalence is high, which appeals for its systematic detection to guide early interventions. Uprightness is predominantly controlled from the right hemisphere.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…In a meta-analysis of 22 studies including 5125 participants, the prevalence of lateropulsion (pusher syndrome) after stroke was 55.1% (95% CI, 35.9%–74.2%). 209 This decreased from 52.8% (95% CI, 40.7%–65%) in the acute phase to 37% (95% CI, 26.3%–47.7%) in the early subacute phase and 22.8% (95% CI, 0%–46.3%) in the late subacute phase.…”

Neural bases of the bodily self as revealed by electrical brain stimulation: A systematic review

“…When considering only the retrospective studies with a sample above 30 patients in order to avoid bias related to small samples (for similar procedures, see Dai et al, 2022 ), we observed that the prevalence of bodily self disturbances ranged from 0.1% to 27.3% (mean ± SD : 6.2% ± 7.3%; Table 2 ).…”

“…When considering only the retrospective studies with a sample above 30 patients in order to avoid bias related to small samples (for similar procedures, see Dai et al, 2022), we observed that the prevalence of bodily self disturbances ranged from 0.1% to 27.3% (mean ± SD: 6.2% ± 7.3%; Table 2). Figure 4b shows that only EBS in the parietal lobe evoked disturbances of all five phenomenal components underlying the ordinary and healthy sense of the bodily self that were considered in the present systematic review (including all three subcategories of self location, agency, perceptual body image, first-person perspective, body ownership).…”

Lateropulsion in Right-Sided Stroke: Brain Anatomical Correlates of Severity and Duration

“…Clinical data and brain images (computed tomography [CT] and magnetic resonance imaging [MRI]) of participants in one of the aforementioned studies were analyzed and met the following criteria: (1) ischemic or hemorrhagic stroke in the right hemisphere according to the definitions of the World Health Organization24; (2) hemiparesis based on the neurologic examination; and (3) no previous infarcts, bilateral lesions, or other substantial brain structural changes. Individuals with right-hemispheric lesions were selected as the right hemisphere is the most frequently affected hemisphere in imaging and prevalence studies reporting a prevalence of LP during the acute phase and over time 25…”

“…Individuals with right-hemispheric lesions were selected as the right hemisphere is the most frequently affected hemisphere in imaging and prevalence studies reporting a prevalence of LP during the acute phase and over time. 25…”