Factors associated with Severe Balance Impairment After Right-Hemisphere Stroke: The Role of Spatial Neglect and Lateropulsion: A Secondary Analysis of Multicenter Cross-Sectional Study POSTIM

Background Balance impairment remains a major concern after right-hemisphere stroke (RHS), even after regaining unsupported standing, reflecting multifactorial and insufficiently explored postural control deficits. Objective To identify factors associated with balance impairment and to assess its severity using the Berg Balance Scale (BBS), in RHS patients who have recovered unsupported standing but exhibit marked weight-bearing asymmetry. Methods This cross-sectional secondary analysis used baseline data (May 2013–May 2018) from a multicenter randomized controlled trial on weight-bearing asymmetry, across eight French rehabilitation centers. Patients aged 18–80 with a first right supratentorial stroke within 9 months, standing unassisted for 30 s with eyes closed, and bearing <40% body weight on the paretic leg were included. BBS scores <45/56 defined severe balance impairment associated with increased fall risk. Lower-limb motor deficits, spasticity, sensory function, lateropulsion, spatial neglect, and body perception were analyzed using univariate and multivariable logistic regression. Results Among 82 patients (mean age 59.3 ± 10.3 years; post-stroke delay 91.3 ± 59.6 days), 61(74%) had a BBS <45/56. In the multivariable model ( n = 67), spatial neglect (OR 11.15; 95%CI [1.29–96.24]; p = 0.028), lateropulsion (OR 3.54; 95%CI [1.10–11.39]; p = 0.034), and lower-limb motor deficit (OR 0.91; 95%CI [0.85–0.96]; p = 0.002) were independently associated with balance impairment. Conclusion In RHS patients with marked postural asymmetry and recently recovered unsupported standing, severe balance impairment was associated with spatial neglect and lateropulsion. These factors may represent important targets for rehabilitation, although this cross-sectional analysis precludes causal inference. ClinicalTrials.gov: NCT01677091