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Treatment for Lateropulsion in Standard Clinical Practice: A Multicenter Randomized Controlled Trial.

Hiroaki Abe1, Shingo Ueno2, Yohei Kurita3

  • 1Department of Physical Therapy, Fukushima Medical University School of Health Sciences, Fukushima, Japan.

Neurorehabilitation
|August 29, 2025
PubMed
Summary

Gait training with a gait exercise assist robot (GEAR) and knee-ankle-foot orthosis (KAFO) both effectively improve post-stroke lateropulsion (LP). Neither intervention showed a significant difference in treatment effects, indicating comparable efficacy for LP recovery.

Keywords:
gait exercise assist robotgait trainingknee-ankle-foot orthosislateropulsionpusher syndrome

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Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Biomechanics

Background:

  • Post-stroke lateropulsion (LP), also known as pusher syndrome, significantly impairs patients' postural control and daily functioning.
  • In Japan, both knee-ankle-foot orthosis (KAFO) and gait exercise assist robots (GEAR) are utilized for LP treatment.
  • Understanding the comparative effectiveness of these interventions is crucial for optimizing stroke rehabilitation strategies.

Purpose of the Study:

  • To investigate the effectiveness of gait training using a GEAR compared to KAFO in improving lateropulsion in stroke patients.
  • To quantitatively assess the impact of both interventions on postural control and pushing behaviors.

Main Methods:

  • A randomized controlled trial involving 36 stroke patients diagnosed with lateropulsion.
  • Participants were assigned to either a GEAR group (robot-assisted gait training) or a KAFO group (therapist-assisted gait training) for 2 weeks of daily 50-minute sessions.
  • Primary outcome measures included changes in the Burke Lateropulsion Scale (BLS) and the Scale for Contraversive Pushing (SCP).

Main Results:

  • Both the GEAR and KAFO groups demonstrated significant improvements in BLS and SCP scores (p < 0.001).
  • The GEAR group exhibited greater improvements in walking distance and step count compared to the KAFO group (p < 0.01).
  • No statistically significant differences were observed in the overall improvements of BLS and SCP scores between the two groups (p = 0.51 and p = 0.84, respectively).

Conclusions:

  • Both gait training with GEAR and KAFO are effective interventions for improving lateropulsion in stroke patients.
  • The study found comparable efficacy between GEAR and KAFO in terms of lateropulsion improvement, despite differences in secondary measures like walking distance.
  • These findings suggest that both robotic assistance and traditional orthotic support can yield similar benefits for patients with pusher syndrome.