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Abstract

Objective

To generate a clinical roadmap for managing lateropulsion after supratentorial stroke which integrates theory and practice using a realist review strategy.

Data Sources

Medline Complete, CINAHL Complete, PEDro, Academic Search Complete, Health and Psychosocial Instruments, Health Source: Nursing/Academic Edition, and Embase were searched until December 2025.

Review Methods

Two searches included review and non-review articles about people with contralesional lateropulsion after supratentorial stroke. We excluded articles about people with ipsilesional lateropulsion resulting from brainstem or cerebellar stroke and non-English articles. Guided by Realist and Meta-narrative Evidence Syntheses: Evolving Standards, pairs of authors independently screened titles and abstracts, determining final lists by consensus. Pairs of authors independently extracted data, ranked levels of evidence, and collaborated to synthesise findings following the context-mechanism-outcome configuration of realist reviews. All authors used this foundation to generate the Lateropulsion Clinical Roadmap and clinical recommendations.

Results

The review article search yielded four systematic reviews and one scoping review (of 19 screened). The non-review article search yielded 39 articles (of 167 screened), categorised as neuroimaging, epidemiology, assessment and intervention. Clinical recommendations and a Lateropulsion Clinical Roadmap integrated this information.

Conclusion

A Lateropulsion Clinical Roadmap integrated theory with neuroimaging, epidemiology, assessment and interventions based upon a realist review. Thorough assessment of severity of lateropulsion and neurological impairments should guide clinical decisions about how to leverage sensorimotor systems while considering task difficulty and environment during interventions for lateropulsion. A new hypothesis linking patient presentation with interventions directed at improving sensorimotor performance of the paretic extremities requires further study.

Keywords

Stroke lateropulsion clinical recommendations realist review

Introduction

People with lateropulsion after supratentorial (hemispheric) stroke remain enigmatic because they demonstrate a contralesional postural tilt as they actively abduct and extend their ipsilesional (stronger) extremities to push themselves in the frontal plane toward their contralesional (weak) side.¹ Clinicians attempting to move the people with lateropulsion toward the ipsilesional side are met by active resistance from the patient, resulting in clinical labels such as pusher syndrome, pushing behaviour, lateropulsion with active pushing, or contraversive pushing.^1–4 The current recommended term is lateropulsion.^5,6

People with lateropulsion present at lower functional levels, demonstrate more severe lower extremity paresis, experience protracted recovery when sensory, visual, and cognitive impairments co-exist, and pose a higher burden of care.^7–13 Clinical practice guidelines for stroke, that are published in English, fail to specifically advise about lateropulsion and evidence to guide clinical management of lateropulsion is limited.^14–18 As a result, clinicians, caretakers, and researchers need evidence-based resources to guide targeted rehabilitation for lateropulsion.^19,20 A clinical roadmap linking theories about lateropulsion to assessments and interventions may be guided by expert recommendations and prior research.²¹

A realist review strategy provides the opportunity to generate a clinical roadmap by reviewing current theories, aligning findings from clinical studies with these theories, and proposing new clinical hypotheses about how to best frame the management of people with lateropulsion.^22,23 The objective of this project was to generate a clinical roadmap for managing lateropulsion after supratentorial stroke which integrates theory with practice recommendations using a realist review strategy. Specific aims were to: (1) explore theories related to lateropulsion and their clinical implications; (2) discuss interventions that may be effective, for whom and in what circumstances they would work, and why they may be effective; and, (3) create a Lateropulsion Clinical Roadmap for assessment, intervention and future research.^22,23 We hypothesised that our search results will conform with existing theories that people with lateropulsion align their central body axis to an egocentric reference system for verticality which may be tilted away from Earth vertical and/or they are exhibiting a form of neglect called graviceptive neglect.^2,24–26

Methods

Realist review strategies emerged in health care policy arenas and can be adapted for clinical research.^22,27 The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodological and publication guidance served as the foundation for our search and synthesis strategies.^22,28–30 We used a two-fold search strategy: first, we examined systematic and scoping reviews of studies related to lateropulsion after supratentorial stroke to summarise past literature; then, we searched for and examined all types of non-review literature that were published after the reviews or might have been excluded by systematic or scoping reviews. Included articles from both searches were categorised as neuroimaging studies, epidemiological research, assessment recommendations and intervention studies.

Medline Complete, CINAHL Complete, PEDro, Academic Search Complete, Health and Psychosocial Instruments, Health Source: Nursing/Academic Edition, and Embase were searched until December 2025.

The target population of this project was adults with lateropulsion following supratentorial (hemispheric) stroke, characterised by contralesional postural tilt in the frontal plane. In order to maintain a focused review on one specific clinical presentation, studies were excluded if they referred to people with traumatic brain injury or stroke in the cerebellum or brainstem who exhibited ipsilesional lateropulsion (as in Wallenberg syndrome), as well as people whose primary symptom was retropulsion (in the sagittal plane). Articles written in a language other than English were excluded.

The first search was conducted to find systematic or scoping reviews that would summarise past evidence for best practice about lateropulsion. Keywords for the first search of reviews were: (Systematic review OR literature review OR scoping review) AND (lateropulsion OR pusher syndrome OR pushing behaviour OR contraversive pushing) AND stroke NOT (medulla OR vermis OR cerebellum OR brainstem). Exclusion criteria for this search included: narrative reviews, historical reviews, randomised control trials, observational studies, case series, cohort studies, and case studies.

The second search targeted more recent articles published after the systematic or scoping reviews or those that met our search criteria but were not discussed in the systematic or scoping reviews. Keywords for the second search of non-review studies were: (Lateropulsion OR pusher syndrome OR pushing behaviour OR contraversive pushing) AND stroke AND (intervention OR examination OR assessment OR rehabilitation OR therapy) NOT (medulla OR vermis OR cerebellum OR brainstem). Exclusion criteria for the second search were: systematic reviews, scoping reviews or other literature reviews or narratives, and letters to the editor. Articles that were reviewed in the systematic and scoping reviews found in the first search were excluded.

Using these respective keywords, one pair of researchers (MWO and SB) independently searched and screened title and abstracts of review articles; another pair (NS and SB) independently searched and screened non-review articles. Pairs compared their findings and agreed to final respective lists consistent with inclusion/exclusion criteria.

The same pair of researchers then independently extracted the following pre-determined information from selected reviews (MWO and SB): type of study, goal of the study, search criteria, main findings, and relationship to theory, if noted by authors. For non-reviews, the second pair of researchers (NS and SB) independently extracted: category (neuroimaging, epidemiology, assessment or intervention), purpose of the study, study design, sample and sample size, outcome measures, method, major findings, what should be known when interpreting results, and relationship to theory, if noted by authors. All review and non-review articles were assessed according to the following levels of evidence: systematic review or meta-analysis of a randomised controlled trial (Level 1); single randomised controlled trial (Level 2); quasi-experimental study or randomised controlled trial (Level 3); cohort study or case-control study (Level 4); systematic review or meta-analysis of a qualitative study (Level 5); single qualitative or descriptive study (Level 6); and, expert opinion (Level 7).³¹ Alternate team members reviewed articles authored by any reviewer to maintain integrity and fairness of the review process. Reviewers achieved consensus through discussion in cases of differing initial opinions.

Following suggestions of the Delphi panel for a common terminology, we used the term lateropulsion throughout our summaries, despite original authors using more traditional terms like pusher syndrome or behaviour.²¹ The researchers who conducted the searches (MWO, NS, SB) then collaborated to produce a context–mechanism–outcome configuration to integrate the findings from the selected studies and show how postural mechanisms may be triggered within certain contexts or conditions to yield specific outcomes.^22,32,33 The focus of the context-mechanism-outcome was to refine the theory and to help clinicians focus on decision points with the format of: If A, then B; If C, then D; and, clinical recommendations.²² Findings relating to an articles’ purpose statements fell into the ‘If A, then B’ category. Additional findings or findings from the control group or other clinically relevant findings were considered as ‘If C, then D’. Both categories were considered for the clinical recommendations.

The research team examined the context–mechanism–outcome paradigm and looked for other neurophysiological or clinical hypotheses that might be consistent with the literature but outside of the existing theories. The research team developed a systematic framework for assessment and interventions and labelled it the Lateropulsion Clinical Roadmap to guide management of people with lateropulsion after stroke. A Supplemental Guide explains rationale for the Roadmap items and offers a clinical example. Recommendations for future research were based on the clinical recommendations and the Roadmap.

Results

Figure 1 shows the RAMESES diagram illustrating both search processes.²⁹ Four systematic reviews and one scoping review resulted from the first search of review manuscripts. Comprehensive profiles of neuroimaging,⁴ epidemiology,^12,13 assessment,^4,34 and intervention¹⁷ review research related to lateropulsion after supratentorial stroke are detailed in Supplemental Table 1.

Figure 1.

The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) flow sheet showing search results for review articles (left) and articles not included in reviews (right) to July 2025.

The second search yielded 39 articles that met inclusion criteria and were not included in prior reviews. Extracted information for neuroimaging (n = 7, Supplemental Table 2), epidemiology (n = 12, Supplemental Table 3), assessment (n = 12, Supplemental Table 4) and intervention (n = 8) Supplemental Table 5) research were considered for the next step of analysis.

Authors discussed findings from the extracted information and collaborated to generate Table 1. Here, a context (study details)-mechanism (study findings)-outcome (clinical recommendations) framework highlights major findings of reviews and non-review research and offers clinical recommendations. Table 1 uses a format of ‘If A, then B; if C, then D’.

Table 1.

Synthesis of study results and implication for management of people with lateropulsion. Systematic or scoping reviews are presented first in each section, followed by other studies not included in these reviews.

SourceStudy typeLevel of evidenceTool(s) to measure Lateropulsion	If A, then B	If C, then D	Clinical recommendations
Neuroimaging review and studies
van der Waal et al. (2023)⁴ Systematic Review Level of Evidence = 1 Mixed	If lesion of one or more of the following areas, lateropulsion may be present: thalamus, internal capsule, inferior parietal lobe (near postcentral gyrus), posterior insula and superior temporal gyrus. If lesion size larger, then more severe lateropulsion.	If lateropulsion, expect altered postural vertical perception but an altered visual vertical may not impact lateropulsion.	Determine if lateropulsion resulted from lesions within any of the aforementioned sites within cortical and subcortical network of grey and white matter that are associated with the transmission and processing of sensory information. Determine if a larger lesion size is associated with lateropulsion presence and severity and judge duration of rehabilitation accordingly. Determine if aforementioned right-sided grey and white matter lesions exist and plan for prolonged rehabilitation. Determine if lesions in the right frontoparietal and middle temporal cortex network impact ability to use explicit learning. Determine if visual vertical is impaired and consider use of alternate cues for verticality when training, especially for people with right brain lesions.
Salazar Lopez et al. (2024)³⁵ Retrospective Case Control Level of Evidence = 4 Scale for Contraversive Pushing	If lesion of one or more of the following right brain areas, lateropulsion may be present: superior occipital gyrus, superior parietal lobe, precuneus, superior frontal gyrus, posterior corona radiata, and posterior thalamic radiation. If lesions of the temporal cortex with impact on working memory, use of explicit learning may be limited.	If lesions of the right frontal gyrus, supramarginal gyrus, angular gyrus, temporal cortex, sagittal striatum and/or superior longitudinal fasciculus, then duration of lateropulsion may be longer. If visual vertical impaired, training with visual cues may not be effective.
Sue et al. (2022)³⁶ Retrospective Cohort Study Level of Evidence = 4 Scale for Contraversive Pushing	If prior stroke or cerebral small vessel disease, recovery from lateropulsion may be longer.	If prior stroke or cerebral small vessel disease, proportion of persons with stroke and lateropulsion may be similar to those with stroke alone.	Determine presence of small vessel disease or prior stroke and plan for more protracted rehabilitation. Determine if moderate to severe white matter lesion present along with partial anterior circulation ischaemia and expect more severe lateropulsion. Determine if thalamic or parietal stroke exists and assess for lateropulsion. Determine if haemorrhagic stroke exists and assess for lateropulsion. Haemorrhagic stroke volume may not correlate to lateropulsion severity or recovery time.
Fujino et al. (2017)³⁷ Retrospective Cohort Study Level of Evidence = 4 Scale for Contraversive Pushing	If moderate to severe white matter lesions and partial anterior circulation ischaemia, lateropulsion may be more severe.	If total anterior circulation ischaemia, lateropulsion may be worse than partial anterior circulation ischaemia, regardless of presence of white matter lesions.
Nolan et al. (2024)³⁸ Nested Sub-Study of Prospective, Longitudinal Cohort Study Level of Evidence = 4 4-Point Pusher Score	If haemorrhagic stroke or frontal cortical involvement (especially white matter) or thalamus lesion, lateropulsion may be present.	If lateropulsion, lesion size may not be a factor.
Santos-Pontelli et al., 2011³⁹ Observational Study Level of Evidence = 4 Scale for Contraversive Pushing	If lesions of the thalamus or parietal lobe, note greater incidence of lateropulsion.	If midline shift or larger haemorrhagic stroke volume, do not expect correlation with lateropulsion severity or recovery time.
Rosenzopf et al. (2023)⁴⁰ Observational Connectivity Study Level of Evidence = 4 Scale for Contraversive Pushing	If thalamic lesion and lateropulsion, posterior thalamus lesion is more prevalent, regardless of lesion side. If cortical lesion, lateropulsion is present in those with transverse temporal and supramarginal gyri lesions, especially left-sided. Left cortical lesions also presented with lateropulsion.If thalamic lesion, thalamocortical functional diaschisis exists.	If thalamic lesion and no lateropulsion, posterior thalamus is not involved. If cortical lesion, corticothalamic diaschisis does not exist.	Determine if posterior thalamic lesion (either hemisphere), left-sided cortical and transverse temporal and supramarginal gyri lesions exist and test for lateropulsion. Functional diaschisis of thalamocortical pathways may exist if thalamic lesion exists. Note that current research is attempting to understand connectivity of brain centres within the proposed network as they relate to lateropulsion prevalence and recovery.
Yeo et al. (2020)⁴¹ Case Study Level of Evidence = 6 Scale for Contraversive Pushing	If right infarct of premotor cortex, primary motor cortex, corona radiata and temporal and occipital lobes, tract volume will improve from 4 months to 12 months, left > right.	If lateropulsion that lasts 4 months post-stroke, projection pathways between vestibular nuclei and parieto-insular- vestibular cortex may be responsible.
Epidemiological reviews and studies
Dai et al. (2022)¹³ Nolan et al. (2022)¹² Systematic Reviews Level of Evidence = 1 Mixed	If minimal or moderate lateropulsion, then more likely discharge from inpatient rehab to home, shorter length of stay. If severe lateropulsion, longer length of stay and more dependent discharge destination after inpatient rehabilitation will exist.	If right brain lesion, expect slower recovery from lateropulsion.	Judge expected length of stay in inpatient rehabilitation based on: Lesion side Severity of lateropulsion Number and severity of other stroke deficits Stage of recovery (for example, Brunnström Stages of Recovery) Track resolution of lateropulsion over time but note that residual tilt, arm abduction or pushing as well as abnormal postural vertical or visual vertical may persist up to 6 months post-stroke. Note the direction of altered postural vertical and visual vertical misperception, if present. Note that unilateral hemispatial neglect may persist to 6 months post-stroke along with persistent lateropulsion. Recommend longer duration of inpatient and post-discharge rehabilitation to allow for better resolution of lateropulsion and increased likelihood of returning home.
Dai et al. (2024)⁴² Longitudinal Cohort Study to 90 days post-stroke Level of Evidence = 3 Scale for Contraversive Pushing	If left brain lesion, then faster attenuation of lateropulsion.	If severe initial lateropulsion (Scale for Contraversive Pushing > 3 with all sitting and standing tests at least 1) at Day 30 post-stroke, protracted recovery from lateropulsion in presence of a severe clinical picture is likely.
Karnath et al. (2002)⁴³ Longitudinal Cohort Study to 6 months post-stroke Level of Evidence = 4 Scale for Contraversive Pushing	If rehabilitation in acute care, inpatient rehabilitation facility and outpatient rehabilitation, then lateropulsion resolves by 6 months.	If severe initial lateropulsion, some residual resistance, body tilt or arm abduction may persist at 6 months.
Birnbaum et al. (2023)⁴⁴ Longitudinal Cohort Study to 6 months Level of Evidence = 4 Burke Lateropulsion Scale	If lateropulsion upon admission to inpatient rehabilitation, then expect this to be the rate limiting factor in functional recovery.	If lateropulsion resolves, other stroke deficits become the rate limiting factors for functional recovery for those who could be initially tested for lateropulsion in standing.
Nolan et al. (2024)⁴⁵ Prospective, Longitudinal Cohort Study Level of Evidence = 4 4-Point Pusher Score	If lateropulsion present at admission to Stroke Rehabilitation Unit, greatest functional improvement occurs during inpatient rehabilitation. The odds of resolution of lateropulsion increases over time after discharge. Probability of falls is greater at 3 months post-discharge when 4-Point Pusher Score=1 as compared to a score of 0.	If lateropulsion is severe at admission, functional status improves but change is less than for those without lateropulsion.
Nolan et al. (2023)⁴⁶ Retrospective Database Audit Level of Evidence = 4 4-Point Pusher Score	If lateropulsion present for an older adult at admission to Stroke Rehabilitation Unit, actual length of stay likely to exceed predicted length of stay (Australian National Sub-Acute and Non-Acute Patient Classification).	If lateropulsion present, greater Functional Independence Measure improvement may be associated with greater odds of actual length of stay exceeding predicted length of stay.
Nolan et al. (2023)⁴⁷ Prospective Cohort Study Level of Evidence = 4 4-Point Pusher Score	If older adult with lateropulsion, function may improve from discharge from inpatient rehabilitation until 3 months post-discharge.	If lateropulsion persists until 3 months post-discharge from inpatient rehabilitation, ongoing physical therapy is recommended.
Kato et al. (2025)⁴⁸ Retrospective Observational Study Level of Evidence = 4 Scale for Contraversive Pushing	If severe lateropulsion or severe unilateral spatial neglect and low Brunnström Stage of Recovery, limited improvement of activities of daily living may occur	If mild lateropulsion and mild or severe unilateral spatial neglect, motor status may improve during rehabilitation.
Mansfield et al. (2015)⁴⁹ Case–Control Study at 6 months post-stroke Level of Evidence = 4 Burke Lateropulsion Scale & Scale for Contraversive Pushing	If lateropulsion, postural vertical and Scale for Contraversive Pushing will recover concomitantly after stroke.	If lateropulsion resolves by 6 months, postural vertical and visual vertical may still be impaired in small percentage of people.
Sawa et al. (2024)⁵⁰ Cross-sectional Observational Study Level of Evidence = 4 Scale for Contraversive Pushing	If using a specialised motorised chair to assess postural vertical of people with stroke, the sum of variability of postural vertical with eyes open plus variability with eyes closed will indicate deficits in visuospatial and somatosensory perception.	If lateropulsion and unilateral spatial neglect present, the sum of eyes open and eyes closed variability will be greater and indicate greater difficulty with somatosensory processing and visual integration.
Lafosse et al. (2007)⁵¹ Hierarchical Classes Analysis Level of Evidence = 4 Therapist assessment of lateropulsion	If right brain lesion, unilateral hemineglect and lateropulsion may present with postural abnormalities of head tilt and trunk alignment that differ from groups with neglect alone or no neglect or lateropulsion.	If right brain lesion and neglect, expect ipsilesional bias of the postural vertical; if right brain lesion, neglect and lateropulsion, expect inconsistent findings about direction of bias of the postural vertical.
Castillo-Torres et al. (2023)⁵² Case Study Level of Evidence = 6 None	If ischemic, parietal lobe stroke, gait lateropulsion is the primary impairment.	If gait lateropulsion, then rule out sensory ataxia, cerebellar ataxia and limb dysmetria.	Determine lesion site to rule out other causes of gait lateropulsion. Analyse the impact of second lesions on severe lateropulsion and consider reporting findings
Lee et al. (2018)⁵³ Case Study Level of Evidence = 6 Scale for Contraversive Pushing	If left basal ganglia and thalamic haemorrhage and severe lateropulsion, then second left pontine stroke can mitigate lateropulsion.
Assessment Review and Studies
Koter et al. (2017)³⁴Systematic Review Level of Evidence = 1 Mixed	If using Scale for Contraversive Pushing, all aspects of lateropulsion are assessed in 2 positions.If using Burke Lateropulsion Scale, responsiveness to change may be adequate because scale is larger and more positions are tested.		Select Lateropulsion Assessment Tool based upon: Desire to track progress over weeks in lying, sitting, transferring, standing and walking – Select Burke Lateropulsion Scale; select cut-off of 2 to define lateropulsion unless conducting research then select cut-off of 3. Desire for a quick assessment that incorporates lying, sitting, standing and walking – Select 4-Point Pusher Score Desire to assess in sitting and standing – Select Scale for Contraversive Pushing
Birnbaum et al. (2023)⁵⁴Validation Study Level of Evidence = 4 Burke Lateropulsion Scale	If using Burke Lateropulsion Scale and sample on average 58.5 y (SD = 14) in acute care and rehabilitation, then expect good internal validity, minimal ceiling effect and good unidimensionality of the test.	If sample consists of older individuals or has more female participants, internal validity and ceiling effects could not be determined by this study.
Bergmann et al. (2019)⁵⁵ValidationStudy Level of Evidence = 4 Burke Lateropulsion Scale	If using Burke Lateropulsion Scale and sample on average 71 y (SD = 10) and averaging 8.7 weeks post-stroke (SD = 5), then consider a Burke Lateropulsion Scale ≥ 3 as the benchmark for presence of lateropulsion.
Cuenca Zaldivar et al. (2022)⁵⁶Validation Study Level of Evidence = 4 Scale for Contraversive Pushing	If using Scale for Contraversive Pushing and sample on average 70 y (IQR = 61–79) with time since stroke approximately 27 d (IQR = 20–36) and about 20% of sample with lateropulsion, expect good discriminant validity, convergent validity, sensitivity to change, internal consistency, and intra and interrater reliability and minimal detectable change of 1.29 for the Scale for Contraversive Pushing.
Birnbaum et al. (2018)⁵⁷Pilot Feasibility Study Level of Evidence = 6 Burke Lateropulsion Scale	If participant is between 1 and 12 weeks post-stroke, mediolateral centre of pressure can be measured with a Wii Balance System in sitting and standing using specialised software		Note that medial-lateral centre of pressure assessment may assist with understanding magnitude of lateropulsion in sitting and standing but more study needed.
Birnbaum et al. (2021)⁵⁸Repeated Measures Observational Study Level of Evidence = 4 Burke Lateropulsion Scale	If participants have mild or moderate lateropulsion and are 7 days post-stroke, degree of weight-bearing asymmetry may not correlate with Burke Lateropulsion Scale (50% loaded the non-paretic side more, 50% loaded the paretic side more).
Barra et al. (2009)⁵⁹Prospective Observational Study Level of Evidence = 4 Scale for Contraversive Pushing	If participants can maintain upright standing for 37 seconds and are within 13 weeks post-stroke, then greater tilt of the longitudinal body axis and greater weight-bearing asymmetry favouring the ipsilesional leg on a force plate may exist.		Note that more research is needed to determine if assessment of self-perceived longitudinal body axis in supine and standing weight bearing asymmetry are correlated when lateropulsion is present.Note that more research is needed to determine if a relationship exists between degree of lateropulsion and misperception of longitudinal body axis.
Barra et al. (2007)⁶⁰Matched Case–Control Study Level of Evidence = 4 Scale for Contraversive Pushing	If right brain lesion, perception of longitudinal body axis to the contralesional side may be evident.	If misperception of longitudinal body axis, causal link to lateropulsion could not be established with this sample.
Vaes et al. (2015)⁶¹Multicentre Double-blind Case Control Study Level of Evidence = 4 Scale for Contraversive Pushing	If right brain lesions and spatial neglect, computer-based visual navigation test and line bisection test may be more biased to the contralesional side than if neglect existed without lateropulsion.	If left brain lesions and spatial neglect, not tested.If lateropulsion present, then neglect may not be severe.	Note that computerised systems for visual navigation tests and line bisection for neglect may assess the impact of neglect plus lateropulsion on the internal reference for vertical with people with right hemispheric stroke.Note that such systems might be useful in interventions targeting internal reference system.
Honoré et al. (2009)⁶²Case–Control Study Level of Evidence = 6 Scale for Contraversive Pushing	If right-handed people with right hemisphere stroke and neglect, then they may exhibit a right-ward deviation of straight-ahead pointing with a manipulandum.	If right-handed people with right hemisphere stroke and lateropulsion and neglect, then expect left-ward deviation of straight-ahead pointing with manipulandum. [People with left hemispheric stroke with neglect with and without lateropulsion were not studied.]	Note that more research is needed to determine if assessment of straight ahead pointing will assess impact of neglect on self-perceived position in space.
Paci et al. (2011)⁶³Case–Control Pilot Study Level of Evidence = 6 Scale for Contraversive Pushing	If testing people with (n = 3) and without lateropulsion (n = 5), they may respond to a Two Alternatives Forced Choice procedure (clockwise/anti-clockwise) about orientation of a visual stimulus which reflects their bias of the internal reference for verticality		Note that more research is needed to determine if visual estimations of vertical are consistent with the internal reference for verticality.
Kamada et al. (2023)⁶⁴Retrospective Observational Study Level of Evidence = 4 Scale for Contraversive Pushing	If participant was up to 13 days after haemorrhage in putamen or thalamus and mild to moderate lateropulsion, then radiographic ocular deviation may be ipsilesional on Day 1 and contralesional on Days 10 and 20.	If lateral medullary stroke and ipsilesional body tilt, radiographic ocular deviation was ipsilesional throughout study period	Note that more research is needed to determine impact of subtle ocular deviations with lateropulsion on relearning vertical upright position.
Lee, JH et al. (2013)⁶⁵Case–Control Study Level of Evidence = 4 Scale for Contraversive Pushing	If lateropulsion after stroke, Cumulative Somatosensory Impairment Index for pressure or vibration sense, ankle proprioception and graphesthesia of the lower limb as well as somatosensory evoked potential will not differ from people without lateropulsion at week 1 and week 14.	If severe lateropulsion at week 1, Scale for Contraversive Pushing will decrease by week 14.	Note that more research is needed to determine if somatosensation can be quantified and tracked longitudinally after stroke.
Intervention review and studies
Paci et al. (2023)¹⁷Scoping Review Level of Evidence = 1 Mixed	If lateropulsion after stroke, multiple aetiologies based on lesion site may require choice of various options for interventions.If visual vertical not impaired, visual feedback may be compensatory strategy.If lateropulsion, choose somatosensory cueing.If targeting somatosensory cues (for example, robot-assisted gait training), lateropulsion may be decreased with combination of implicit and explicit training.	If visual vertical impaired, visual feedback may be less effective.	Use visual feedback for relearning postural upright if visual vertical is within normal range of ± 2.5 degrees.Use robot-assisted gait training with Lokomat or Gait Exercise Assist Robot as a means to combine implicit and explicit learning as well as to increase sensory input from the affected extremities.Use knee-ankle-foot orthosis and support of the physical therapist for intensive gait training when robot assisted gait trainer is not available.Use somatosensory cueing with or without visual feedback to remediate lateropulsion.Use postural orientation training, start in supine or prone where influence of gravity is less. Whole body tilting may stimulate somatosensory pathways along with visual feedback.
Abe et al. (2025)⁶⁶Randomised Controlled Trial (n = 36) Level of Evidence = 2 Burke Lateropulsion Scale and Scale for Contraversive Pushing	If using Gait Exercise Assist Robot for 30 minutes of daily gait training over a 2-week period plus standard rehabilitation, one may observe the same improvement as intense gait training using a knee-ankle-foot orthosis and physical therapist assistance.
Ikeda et al. (2024)⁶⁷Retrospective Cross-Sectional Observational Study (n = 37)Level of Evidence = 4Scale for Contraversive Pushing	If acute stroke and lateropulsion, 10 minutes of prone positioning prior to standard rehabilitation may have an immediate effect on reducing lateropulsion.	If mild paresis after stroke and lateropulsion, the immediate effect of prone positioning may be more pronounced than when more severe paresis is present.
Gillespie et al. (2023)⁶⁸Case Series (n = 11)Level of Evidence = 6 Burke Lateropulsion Scale	If Burke Lateropulsion Scale approximately 7.7/17 (SD = 3.3) and right brain lesion, Prioritising Upright, Standing and Higher-level stepping strategy may improve return to home after inpatient rehabilitation.	If severe lateropulsion or left brain lesion, more study required.	Note that more study needed to determine if intensive standing practice will improve recovery from lateropulsion and help return to home after inpatient rehabilitation.
Sawa et al. (2025)⁶⁹Longitudinal, Retrospective Study with Matching (n = 44) Level of Evidence = 4 Scale for Contraversive Pushing	If severe hemiplegia, lateropulsion and unilateral spatial neglect at admission to subacute rehabilitation, extended gait training (over 3 months) with knee–ankle–foot orthosis will yield less improvement in gait than if severe hemiplegia without lateropulsion and neglect.	If postural vertical sensation is altered with eyes open and lateropulsion present, visual integration may be impaired.	Note that use of any knee-ankle-foot orthosis provides sensory input as well as stability for people with severe hemiplegia but expect less improvement if lateropulsion and unilateral spatial neglect co-exist.
Inoue et al. (2022)⁷⁰Case Study (n = 1) Level of Evidence = 6 Burke Lateropulsion Scale & Scale for Contraversive Pushing	If older adult male with right middle cerebral artery stroke and severe lateropulsion (Burke Lateropulsion Scale = 14), dynamic supported standing over 3 days plus standard physical therapy may improve and sustain standing and sitting items in Burke Lateropulsion Scale.	If dynamic supported standing for 15-min sessions over 3 days plus standard therapy, greater improvements may occur in sitting than standing when measured with Scale for Contraversive Pushing.	Note that weak evidence exists for some types of stroke favouring Dynamic supported standing Covering the contralesional eye during standing and walking training Tilting the 3-dimensional virtual reality scene to the ipsilesional side.
Zhang et al. (2021)⁷¹Case Study (n = 2) Level of Evidence = 6 Burke Lateropulsion Scale	If right putamen and temporal lobe lesion and severe lateropulsion, covering the left eye while doing 30 minutes of standing and walking training twice daily, then standing balance and Burke Lateropulsion Scale may improve within 1 week.
Nestmann et al. (2022)⁷²Case Study (n = 1) Level of Evidence = 6 Scale for Contraversive Pushing	If adult with basal ganglion haemorrhage and intraventricular haemorrhage with severe right hemiplegia and Scale for Contraversive Pushing = 5, then a 3-dimensional virtual reality system scene tilted to the ipsilesional side may reduce resistance to upright correction.
Sethy et al. (2011)⁷³Case Study (n = 2) Level of Evidence = 6 Scale for Contraversive Pushing	If older adult with chronic stroke and lateropulsion, progress can be made using an integrated treatment approach daily for 4 weeks.	If adult with ipsilesional tilt, progress after integrated treatment approach may be greater because pushing was not part of patient problem.	Note that integrated treatment with visual feedback and somatosensory feedback requires further study.

These clinical recommendations served as the basis for the Lateropulsion Clinical Roadmap (Figure 2). A Supplemental Guide outlines the steps found within the roadmap, the rationale for their inclusion, and an example of decision-making during treatment. Figure 3 outlines a hypothetical neurophysiological mechanism/model related to lateropulsion and highlights an approach that may be suitable.

Figure 2.

Lateropulsion clinical roadmap: clinical decision-making model for the assessment and treatment of post-stroke lateropulsion based upon realist review.

Figure 3.

Hypothetical model linking problems associated with lateropulsion with possible interventions.

The following summaries detail the results of both searches for neuroimaging, epidemiology, assessment and intervention categories. Summaries from review articles are followed by those for non-review articles for each category. Key clinical findings that complement Table 1 and the Lateropulsion Clinical Roadmap conclude each summary.

Neuroimaging review and original studies

A systematic review by van der Waal et al. examined publications about the lesion sites associated with lateropulsion (n = 7 articles) as well as the association between verticality perception and lateropulsion (n = 11 articles; n = 1 both topics) until December 2021 (Supplemental Table 1).⁴ Prominent lesion sites linked with lateropulsion included the thalamus,^2,74–76 inferior parietal lobe,^75,77,78 internal capsule,^2,76,79 pre and post-central gyri,^75,77,80 superior temporal gyrus^75,78,79 and insula.^{4,75,76,78–80}

Our second search revealed 6 studies^35–40 and 1 case study⁴¹ that were not included in the previous review (Supplemental Table 2). Some studies exclusively examined neuroimaging for people with right brain lesions.^35,41 One study compiled data from 3 prior studies³⁵ and one was a nested sub-study from a prospective longitudinal cohort.³⁸ One study also included people with brain trauma and brain tumor haemorrhage with and without lateropulsion and only information relevant to supratentorial stroke was extracted.³⁹ Sue et al. retrospectively analysed the impact of prior stroke or small vessel disease on lateropulsion recovery.³⁶ Fujino et al. retrospectively studied the relationship of white matter lesions on lateropulsion severity.³⁷ A case study tracked a person with multiple infarctions at 4 months and 12 months post-stroke using diffusion tensor imaging to examine connectivity.⁴¹

The second search of neuroimaging studies added several right brain sites that may be part of the body orientation network related to lateropulsion: superior occipital gyrus,³⁵ precuneus and cuneus,³⁵ superior parietal lobe,^35,40 posterior corona radiata,³⁵ posterior thalamic radiation,³⁵ anterior and posterior mesial temporal lobe,⁴⁰ and, superior frontal gyrus.³⁵ Left brain sites associated with lateropulsion included the transverse temporal gyrus, supramarginal gyrus, paracingulate and cingulate cortex, and, insula.⁴⁰ Studies confirmed the importance of the thalamus^38,39 (particularly the posterior thalamus⁴⁰), the pre and post-central gyri,³⁸ and, the parietal lobe^38,39 (particularly the right inferior parietal lobe⁴⁰). Moderate to severe right matter lesions,³⁷ and white matter lesions of the frontal cortex³⁸ were added to body orientation network.

A key clinical point from the systematic review by van der Waal et al. includes their determination that a complex, multi-centre brain network is responsible for body orientation and control of the body against gravity (see lesion sites listed in Table 1, Lateropulsion Clinical Roadmap, and Supplemental Table 2).⁴ These findings agree with the theory that lesions to one or more critical areas result in an altered egocentric reference system caused by impaired processing of both normal or abnormal somatosensory, visual and vestibular input, depending on the lesion site.^4,25 Although both hemispheres have the postural orientation network, the right hemisphere network is dominant, having bilateral influence, whereas the left hemisphere network may not exert much ipsilesional influence when lesions occur.^{4,35,42,81,82} This latter idea links with epidemiological studies which demonstrate more protracted recovery from lateropulsion for people with right brain lesions.^12,13 Understanding the history of prior stroke or the extent of white matter lesions or small vessel disease supports the theory that lateropulsion expression depends on the severity of the neural network involvement and may also assist in guiding clinical decisions and predicting a longer duration of recovery from lateropulsion.^{4,36,37,75,76,83}

van der Waal et al. also reviewed verticality perception which addresses the egocentric reference system as a product of somatosensory, vestibular, and visual graviceptive information processing.^4,82,84 Specialised tilting chairs or frames measured perceived postural vertical and demonstrated that people with lateropulsion exceeded normal error in either the contralesional⁸⁵ or ipsilesional direction.^2,86 Consensus about visual vertical perceptual errors has not been reached: some reported that visual vertical was intact for people with lateropulsion,^2,63 while others noted ipsilesional⁸⁷ or contralesional error^76,85,88 in estimating when a visual stimulus was truly vertical.⁸⁹ A contralesional bias of haptic vertical was demonstrated for people with lateropulsion tasked with setting a hand-held bar into a vertical position.⁸⁵ This information guides clinicians to use simple tests like the bucket test to assess the degree to which a person with lateropulsion can use visual vertical perception to relearn vertical upright.⁹⁰ In some cases, explicit visual feedback with a mirror to correct posture may not be effective and more implicit training with cognitive challenges via task and environmental modifications, laser targeting or virtual reality computer gaming may help relearning of verticality.^17,91–94 Similarly, if people with lateropulsion demonstrate intact haptic vertical perception, then clinicians may chose more haptic feedback like asking them to touch the ipsilesional shoulder and hip to a wall during gait training.²⁰

Epidemiological reviews and original studies

Nolan et al. summarised seven studies published until August 2020, which covered factors related to the prediction of the resolution of lateropulsion, rehabilitation length of stay, functional outcomes, and discharge destination after inpatient rehabilitation.¹² Dai et al. conducted a systematic review and meta-analysis of 22 studies to estimate the prevalence of lateropulsion in supratentorial and infratentorial stroke.¹³ They also analysed prevalence by side, time after stroke and stroke severity from studies conducted between 1986 and 2021.¹³

Supplemental Table 3 outlines 12 epidemiological studies from the second search. Four longitudinal studies,^42–45 a cross-sectional observational study,⁵⁰ a retrospective observational study,⁴⁸ and one longitudinal case study⁵³ were reviewed. Studies examined participants in the acute and subacute inpatient rehabilitation periods^46,47,51,95 and chronic phases of stroke recovery.^44,45,49 One case study focused on a person with left basal ganglia and thalamic haemorrhage with subsequent pontine infarct⁵³; one case study included 4 people with parietal lobe lesions.⁵²

Key clinical messages from epidemiological studies include suggestions to target lateropulsion in the acute and subacute rehabilitation phases, and to plan for protracted inpatient and outpatient rehabilitation if severe lateropulsion is present, especially if right brain lesions exist.⁴⁵ The cumulative impact of other stroke deficits should be addressed throughout lateropulsion recovery.

Assessment review and original studies

Koter et al. added to a previous review of assessment tools for lateropulsion to examine 4 tools from 7 manuscripts published until March 2017.^34,96 The Scale for Contraversive Pushing, Swedish Scale for Contraversive Pushing, Modified Scale for Contraversive Pushing and the Burke Lateropulsion Scale were analysed.³⁴

The second search identified 12 studies that focused on assessment. Two studies examined the clinometric properties of the Burke Lateropulsion Scale^54,55 and one about the Scale for Contraversive Pushing.⁵⁶ Other research has emerged for assessment of longitudinal body axis,⁶⁰ weight-bearing asymmetry,^57–59 unilateral spatial neglect,^61,62 ocular lateral deviation,⁶⁴ somatosensation⁶⁵ and visual vertical perception⁶³ (Supplemental Table 4).

A key clinical message resulting from our realist review of assessment and epidemiological studies includes that clinicians should provide a formal, baseline assessment of lateropulsion severity in order to gauge rehabilitation needs, track recovery and predict duration of rehabilitation.^13,21 The Burke Lateropulsion Scale⁹⁷ and the Scale for Contraversive Pushing² have prevailed over time.^34,54,56 Although not included in the Koter et al. review, acceptable concurrent validity, convergent construct validity and strong inter and intra-rater reliability have been demonstrated for the 4-Point Pusher Score.^13,98 The Lateropulsion Clinical Roadmap used the Burke Lateropulsion Scale with a cut-off score of 2 or above to define lateropulsion because this 17-point scale can track subtle changes in various functional positions. Bergmann et al. determined that a Burke Lateropulsion Scale score of 3 better defined lateropulsion when compared to a balance scale.⁵⁵

Other assessment studies focused on the theoretical root of the problem of people with lateropulsion. Barra et al. assessed perceived longitudinal body axis of supine people with and without lateropulsion and observed a contralesional tilt of this axis with lateropulsion.⁶⁰ Participants were asked to adjust a luminous 50 × 1 cm bar to align to their longitudinal body axis while in a darkened room.⁶⁰ Attempts to assess self-perceived body midline in supine, without reaction to gravity (as in postural vertical testing when upright), may also be appropriate for explicit training for body midline alignment in the early post-stroke period. Assessment of weight-bearing asymmetry with force plates⁵⁹ and Wii Balance Board^57,58 aligns with egocentric reference system theory. How these tools might assist in later retraining of vertical upright requires further study.

Intervention review and original studies

Paci et al. provided a comprehensive scoping review of 31 articles about interventions for lateropulsion through 2020. Their review included case studies (n = 16), randomised controlled studies (n = 5), single-subject designs (n = 5), non-randomised controlled trials (n = 3), and two case series.¹⁷

The second search revealed one randomised controlled trial,⁶⁶ one longitudinal, retrospective study with matching,⁶⁹ one retrospective cross-sectional study,⁶⁷ four intervention case studies,^70–73 and one case series⁶⁸ in Supplemental Table 5. Using the Paci et al.¹⁷ categorisation of studies, these additional studies fit into the categories of: visual-somatosensory integration,^{66,68,69,72,73} somatosensory cues^67,70 or visual feedback.⁷¹ Participants in these studies had Burke Lateropulsion Scale scores of 3 or more,⁶⁸ Scale for Contraversive Pushing score at or above 1.75,⁶⁹ or greater than 0 for each component,^66,67 severe lateropulsion,^70–72 or severe and protracted lateropulsion.⁷³

A key clinical message from these intervention studies includes categorising interventions according to the systems that they target.¹⁷ The Lateropulsion Clinical Roadmap suggests a thorough neurological assessment so that clinicians can understand which sensory, motor, perceptual and cognitive systems are available to the patient before deciding which category of intervention would be appropriate. Visual-sensorimotor interventions included tilting the surface upon which the person with lateropulsion sat or stood.^17,93,94 Such forced cognitive processing required for these training techniques was similar to the use of motor learning principles to allow the person to self-correct from a supported fall.⁹⁹ Specific body alignment retraining and use of a standing frame demonstrated that time spent in upright is important for recovery from lateropulsion.^68,70,100 Other sensorimotor studies used knee-ankle-foot orthoses to provide stability during gait training for people with hemiparesis, lateropulsion and unilateral spatial neglect.^66,69 The most rigorous studies support robot-assisted gait training which provided dynamic lower extremity stability and postural control when lateropulsion existed.^{3,17,66,101,102} Abe et al. noted that 30 minutes of daily gait training with either a robotic system or overground training using therapist support and lower extremity orthotics were equally effective in reducing lateropulsion.⁶⁶

Discussion

This realist review was appropriate for creating a practical, theory-based Lateropulsion Clinical Roadmap for evaluation and management of lateropulsion in supratentorial stroke (Figure 2, Supplemental Guide).²⁸ Bridging heterogeneous sources dealing with lateropulsion in a realist review format, we explored theories about lateropulsion and their clinical implications, demonstrating for whom, in what circumstances, and why interventions for lateropulsion may be effective (Table 1).^22,23 Our work complements a recent Delphi process, whereby experts showed consensus on common treatment interventions for people with lateropulsion.²¹

As we hypothesised, most of the research was grounded in prevalent theories that lateropulsion results from misinterpretation of multi-modal sensory inputs at the brain level yielding a faulty internal, egocentric frame of reference for verticality and/or results from graviceptive neglect whereby the sensory inputs are neglected even though they may be intact.^59,88 Realist reviews allow researchers to look at available evidence and identify areas that are not addressed or not fully developed.²² During this process, we noted that, although epidemiological studies show that people with lateropulsion tend to have moderate to severe contralesional lower extremity weakness, research about specific motor retraining was lacking.^8,12,13,20 The overuse of non-paretic extremities to push toward the contralesional side, combined with the lack of use of paretic limbs, allows for a cortical imbalance between sensorimotor feedback from paretic and non-paretic limbs and perhaps for greater than normal interhemispheric inhibition of the damaged motor and sensorimotor transmission centres (Figure 3).¹⁰³ Studies using non-invasive brain stimulation over the multisensory temporo-parietal cortex that induced transient graviceptive neglect (verticality misperception) and postural control disturbance in healthy individuals support the present hypothesis of interhemispheric inhibition imbalance associated with lateropulsion.^{81,90,104–106} Successful forced use of the hemiplegic lower extremity through robotics or bracing aligns with this hypothesis. Protracted recovery from lateropulsion results from prolonged, non-paretic sensorimotor output perpetuating inhibition of the damaged sites of the body orientation network or primary cortices. This hypothesis requires confirmation with connectivity studies and intervention research.^107–109

An important corollary of this hypothesis suggests that increased use of the paretic extremities or even electrical stimulation to the paretic side would enhance sensorimotor transmission to and from the lesioned cortex and restore interhemispheric inhibition to the non-lesioned cortex.^107,110 Clinically, this concept implies that best practice may involve selecting functional positions for training in which lateropulsion is less strong, limiting over-use of the non-paretic extremities, and increasing use of the paretic extremities (through active, active-assistive or even passive movement), thus promoting balanced interhemispheric inhibition. Research suggests that the focus of interventions might be shifted to evaluating and training the key issue which is the misperception of body centring in positions that are gravity-reduced.^59,62,63 Maximally engaging paretic extremities within these gravity-reduced positions, may further enhance cortical signals within the lesioned hemisphere.

Other practical suggestions emerge from this paradigm. Minimising sensory processing demands of the environment, physical challenge, and/or cognitive challenge may further minimise lateropulsion allowing for optimised learning. In contrast, some studies support the addition of a new cognitive challenge by tilting the actual^93,94 or virtual support surface⁷² from the horizontal in order to bypass faulty somatosensory processing or augment intact somatosensory processing. Clinicians may consider evaluating whether people with lateropulsion respond better to implicit training (e.g., gaming with virtual reality avatars, training for related tasks like side-stepping with body-weight support, using robot-assisted gait training) versus explicit training of body centring.^{21,35,72,93,111,112} All of these strategies require further research before they can be recommended in routine clinical practice.

Table 1 indicates where weak evidence exists and enumerates areas for future study. We agree with other authors that more randomised, controlled intervention trials are needed to strengthen the evidence-base for lateropulsion rehabilitation.^17,21 Structural and functional connectivity studies are required for a better understanding of the neural network related to lateropulsion. Future research may consider investigating the effect and appropriate staging of challenges to the sensory, motor, or cognitive systems under various task and environmental conditions, the impact of sensory feedback and attentional focus, as well as the impact of paretic extremity engagement (with passive or active assistive functional tasks or through functional electrical stimulation) on the severity of lateropulsion. A paradigm shift from an explicit-based functional treatment approach to an implicit-based recalibration of sensorimotor signals and processing and graviceptive reference may be warranted.

This realist review presents with limitations. Selecting only articles published in English may have biased results. Case study and case series evidence was included but future, more robust research would need to confirm these findings. Our foundation for interpreting existing research rested on theories and neuroimaging associated with lateropulsion. Others may look at the findings from different perspectives and derive further hypotheses. Such subjective interpretation is inherent in realist reviews.²² We do not expect prescriptive generalisability of the findings because people with stroke and lateropulsion have varying degrees of deficit and diverse stroke-related symptoms. We opted for the ‘If A, then B and If C, then D’ paradigm (Table 1) because participants in individual studies often presented or responded differently, depending on lesion side/site and other stroke-related problems, but other ways to examine the literature are possible.

In conclusion, a Lateropulsion Clinical Roadmap (Figure 2, Supplemental Guide) and clinical recommendations (Table 1, Figure 3) were easily derived from a realist review. New ideas include focusing on correcting the egocentric reference system and using implicit learning strategies after a thorough assessment of how stroke-related deficits impact relearning of the vertical upright posture. Clinicians are encouraged to use the Lateropulsion Clinical Roadmap to conduct a thoughtful neurological assessment and to select and stage interventions based on somatosensory processing demands of the training tasks, as well as the level of task challenge that may impact the degree of lateropulsion. This realist review has highlighted current evidence gaps and informed future research to globally progress care for people with lateropulsion.

Clinical Messages

The Lateropulsion Clinical Roadmap, derived from a realist review, suggests consideration of brain lesion sites, sensory transmission and processing / perception, motor performance, and cognition, in addition to the degree of lateropulsion, when deciding a plan of care for people with lateropulsion after supratentorial stroke.

Clinicians should evaluate the impact of functional positions and activities in which lateropulsion is present during interventions and select appropriately difficult tasks, environments and sensorimotor challenges during functional training for post-stroke lateropulsion.

A key to managing lateropulsion may rest in engagement of paretic extremities when lateropulsion is not exacerbated, thus counterbalancing inhibitory influences of the overactive, non-lesioned cortex. Future research must confirm this hypothesis.

Clinicians are encouraged to review cited literature and critically apply findings within the framework of the Lateropulsion Clinical Roadmap when selecting appropriate management strategies for people with lateropulsion after stroke.

Supplemental Material

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Supplemental material, sj-pdf-1-cre-10.1177_02692155261418609 for A clinical roadmap for lateropulsion after stroke based on a realist review strategy by Suzanne Babyar, Nicholas Sheehan, Jessica Nolan, Taiza G.S. Edwards, Jeannine Bergmann, Amy Meyer and Michael W. O’Dell in Clinical Rehabilitation

Supplemental Material

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Supplemental material, sj-pdf-2-cre-10.1177_02692155261418609 for A clinical roadmap for lateropulsion after stroke based on a realist review strategy by Suzanne Babyar, Nicholas Sheehan, Jessica Nolan, Taiza G.S. Edwards, Jeannine Bergmann, Amy Meyer and Michael W. O’Dell in Clinical Rehabilitation

Supplemental Material

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Supplemental material, sj-pdf-3-cre-10.1177_02692155261418609 for A clinical roadmap for lateropulsion after stroke based on a realist review strategy by Suzanne Babyar, Nicholas Sheehan, Jessica Nolan, Taiza G.S. Edwards, Jeannine Bergmann, Amy Meyer and Michael W. O’Dell in Clinical Rehabilitation

Supplemental Material

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Supplemental material, sj-pdf-4-cre-10.1177_02692155261418609 for A clinical roadmap for lateropulsion after stroke based on a realist review strategy by Suzanne Babyar, Nicholas Sheehan, Jessica Nolan, Taiza G.S. Edwards, Jeannine Bergmann, Amy Meyer and Michael W. O’Dell in Clinical Rehabilitation

Supplemental Material

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Supplemental material, sj-pdf-5-cre-10.1177_02692155261418609 for A clinical roadmap for lateropulsion after stroke based on a realist review strategy by Suzanne Babyar, Nicholas Sheehan, Jessica Nolan, Taiza G.S. Edwards, Jeannine Bergmann, Amy Meyer and Michael W. O’Dell in Clinical Rehabilitation

Supplemental Material

sj-pdf-6-cre-10.1177_02692155261418609 - Supplemental material for A clinical roadmap for lateropulsion after stroke based on a realist review strategy

Supplemental material, sj-pdf-6-cre-10.1177_02692155261418609 for A clinical roadmap for lateropulsion after stroke based on a realist review strategy by Suzanne Babyar, Nicholas Sheehan, Jessica Nolan, Taiza G.S. Edwards, Jeannine Bergmann, Amy Meyer and Michael W. O’Dell in Clinical Rehabilitation

Footnotes

ORCID iDs

Suzanne Babyar

Nicholas Sheehan

Jessica Nolan

Taiza G.S. Edwards

Jeannine Bergmann

Amy Meyer

Michael W. O’Dell

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability

Data are available from the corresponding author upon reasonable request.

Supplemental material

Supplemental material for this article is available online.

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