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

Background: Post-stroke lateropulsion with pusher syndrome (LP) severely impacts postural control and daily activities. In Japan, while a knee-ankle-foot orthosis (KAFO) is recommended for LP treatment, a gait exercise assist robot (GEAR) is also used. Objective: We investigated the effectiveness of gait training using a GEAR and KAFO in improving LP. Methods: Thirty-six stroke patients with LP were randomly assigned to GEAR or KAFO groups, and received 50-min daily sessions for 2 weeks. Both the GEAR group, using robot assistance, and the KAFO group, with therapist assistance, engaged in gait training with a goal of 30 min per session. Primary outcomes were changes in Burke Lateropulsion Scale (BLS) and Scale for Contraversive Pushing (SCP) scores. Results: Seventeen participants in each group completed their respective interventions. Both groups showed marked improvements in BLS and SCP scores (all p < 0.001). Although the GEAR group achieved greater walking distances and step counts (p < 0.01 each), overall BLS and SCP improvements did not significantly differ between the groups (p = 0.51 and 0.84, respectively). Both interventions demonstrated comparable LP improvement to previous studies. Conclusions: We found no significant difference in the treatment effects between the two interventions, indicating both to be effective.