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.