Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel

Jessica Nolan*, Angela Jacques, Erin Godecke, Hiroaki Abe, Suzanne Babyar, Jeannine Bergmann, Melissa Birnbaum, Shenhao Dai, Cynthia Danells, Taiza Edwards, Marialuisa Gandolfi, Klaus Jahn, Ryan Koter, Avril Mansfield, Junji Nakamura, Vicky Pardo, Dominic Perennou, Celine Piscicelli, David Punt, Devra Romick-SheldonWim Saeys, Nicola Smania, Nathalie Vaes, Abigail Whitt, Barbara Singer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel.

Design: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations.

Participants: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion.

Main Measures: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding ‘unsure’ responses.

Results: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which ‘some agreement’ (50%–74% agreement) was achieved and those for which recommendations remain to be clarified were recorded.

Conclusions: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.
Original languageEnglish
JournalClinical Rehabilitation
Publication statusAccepted/In press - 10 Apr 2023


  • Lateropulsion
  • pusher behaviour
  • pusher syndrome
  • stroke rehabilitation
  • Delphi process


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