The role of unilateral spatial neglect in rehabilitation of right brain-damaged ischemic stroke patients: A matched comparison

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Abstract

Objective: To assess the specific influence of unilateral spatial neglect (USN) on rehabilitation outcome. Design: A case-control study in consecutive stroke inpatients. Setting: Rehabilitation hospital. Patients: One hundred seventy-eight patients with sequelae of first stroke, enrolled in homogeneous subgroups, matched for age (within 1yr) and onset admission interval (within 3d), and difference because of the presence of USN, evaluated by a specific neuropsychologic battery. Interventions: All patients received physical rehabilitation: physiotherapy for 60 minutes twice a day (once on Saturday), 6 days a week, within 24 hours of admission. USN-positive (USN+) patients received specific treatment of 5, 1-hour sessions per week, for 8 consecutive weeks: (1) visual scanning, (2) reading and copying, (3) copying of line drawings on a dot matrix, and (4) describing a scene. Patients were assessed with neurologic (Canadian Neurological Scale), neuropsychiatric (Hamilton Depression Rating Scale), neuroradiologic, and functional (Barthel Index, Rivermead Mobility Index [RMI]) examinations. Main Outcome Measures: Length of stay, efficiency (average daily increase in Barthel Index), effectiveness (amount of potential improvement achieved during rehabilitation) of treatment and percentage of low- and high-response patients calculated on the Barthel Index and the RMI, and percentage of urinary incontinence and return home were evaluated. Odds ratios (ORs) of dropouts and of low and high therapeutic response were also quantified. Results: Compared with USN-negative patients, USN+ patients had significantly more severe baseline neurologic and functional status at admission, less effectiveness and efficiency on activities of daily living (ADLs) and mobility, a higher percentage of low responders, longer hospitalization, a higher percentage of persistent incontinence discharge (20.5% vs 4.9%), and a lower percentage of high responders and patients returning home. The presence of USN was incompatible with a high therapeutic response, for both ADLs (OR = 2.94, 95% confidence interval [CI] = 1.05-8.20; b ± standard error = 1.08 ± .52, p <.05), and mobility (OR = 7.16, 95% CI = 2.78-18.44; b = 1.97 ± .52, p <.001) and was a relevant prognostic factor for institutional discharge (OR = 5.62, 95% CI = 1.63-19.38; b = 1.73 ± .63, p <.01, accuracy 88.41%). Conclusions: The results of this study provide further strong evidence of the relationship between USN and disability in right brain-damaged patients and of its unfavorable impact on rehabilitation, despite the cognitive training performed by all USN+ patients.

Original languageEnglish
Pages (from-to)743-749
Number of pages7
JournalArchives of Physical Medicine and Rehabilitation
Volume82
Issue number6
DOIs
Publication statusPublished - 2001

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Rehabilitation
Stroke
Brain
Odds Ratio
Confidence Intervals
Activities of Daily Living
Urinary Incontinence
Therapeutics
Case-Control Studies
Reading
Inpatients
Length of Stay
Hospitalization
Outcome Assessment (Health Care)

Keywords

  • Activities of daily living
  • Cerebrovascular accident
  • Perceptual disorders
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation

Cite this

@article{ee5237e07daf41dabb7aa8f57acf224c,
title = "The role of unilateral spatial neglect in rehabilitation of right brain-damaged ischemic stroke patients: A matched comparison",
abstract = "Objective: To assess the specific influence of unilateral spatial neglect (USN) on rehabilitation outcome. Design: A case-control study in consecutive stroke inpatients. Setting: Rehabilitation hospital. Patients: One hundred seventy-eight patients with sequelae of first stroke, enrolled in homogeneous subgroups, matched for age (within 1yr) and onset admission interval (within 3d), and difference because of the presence of USN, evaluated by a specific neuropsychologic battery. Interventions: All patients received physical rehabilitation: physiotherapy for 60 minutes twice a day (once on Saturday), 6 days a week, within 24 hours of admission. USN-positive (USN+) patients received specific treatment of 5, 1-hour sessions per week, for 8 consecutive weeks: (1) visual scanning, (2) reading and copying, (3) copying of line drawings on a dot matrix, and (4) describing a scene. Patients were assessed with neurologic (Canadian Neurological Scale), neuropsychiatric (Hamilton Depression Rating Scale), neuroradiologic, and functional (Barthel Index, Rivermead Mobility Index [RMI]) examinations. Main Outcome Measures: Length of stay, efficiency (average daily increase in Barthel Index), effectiveness (amount of potential improvement achieved during rehabilitation) of treatment and percentage of low- and high-response patients calculated on the Barthel Index and the RMI, and percentage of urinary incontinence and return home were evaluated. Odds ratios (ORs) of dropouts and of low and high therapeutic response were also quantified. Results: Compared with USN-negative patients, USN+ patients had significantly more severe baseline neurologic and functional status at admission, less effectiveness and efficiency on activities of daily living (ADLs) and mobility, a higher percentage of low responders, longer hospitalization, a higher percentage of persistent incontinence discharge (20.5{\%} vs 4.9{\%}), and a lower percentage of high responders and patients returning home. The presence of USN was incompatible with a high therapeutic response, for both ADLs (OR = 2.94, 95{\%} confidence interval [CI] = 1.05-8.20; b ± standard error = 1.08 ± .52, p <.05), and mobility (OR = 7.16, 95{\%} CI = 2.78-18.44; b = 1.97 ± .52, p <.001) and was a relevant prognostic factor for institutional discharge (OR = 5.62, 95{\%} CI = 1.63-19.38; b = 1.73 ± .63, p <.01, accuracy 88.41{\%}). Conclusions: The results of this study provide further strong evidence of the relationship between USN and disability in right brain-damaged patients and of its unfavorable impact on rehabilitation, despite the cognitive training performed by all USN+ patients.",
keywords = "Activities of daily living, Cerebrovascular accident, Perceptual disorders, Rehabilitation",
author = "Stefano Paolucci and Gabriella Antonucci and Grasso, {Maria Grazia} and Luigi Pizzamiglio",
year = "2001",
doi = "10.1053/apmr.2001.23191",
language = "English",
volume = "82",
pages = "743--749",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - The role of unilateral spatial neglect in rehabilitation of right brain-damaged ischemic stroke patients

T2 - A matched comparison

AU - Paolucci, Stefano

AU - Antonucci, Gabriella

AU - Grasso, Maria Grazia

AU - Pizzamiglio, Luigi

PY - 2001

Y1 - 2001

N2 - Objective: To assess the specific influence of unilateral spatial neglect (USN) on rehabilitation outcome. Design: A case-control study in consecutive stroke inpatients. Setting: Rehabilitation hospital. Patients: One hundred seventy-eight patients with sequelae of first stroke, enrolled in homogeneous subgroups, matched for age (within 1yr) and onset admission interval (within 3d), and difference because of the presence of USN, evaluated by a specific neuropsychologic battery. Interventions: All patients received physical rehabilitation: physiotherapy for 60 minutes twice a day (once on Saturday), 6 days a week, within 24 hours of admission. USN-positive (USN+) patients received specific treatment of 5, 1-hour sessions per week, for 8 consecutive weeks: (1) visual scanning, (2) reading and copying, (3) copying of line drawings on a dot matrix, and (4) describing a scene. Patients were assessed with neurologic (Canadian Neurological Scale), neuropsychiatric (Hamilton Depression Rating Scale), neuroradiologic, and functional (Barthel Index, Rivermead Mobility Index [RMI]) examinations. Main Outcome Measures: Length of stay, efficiency (average daily increase in Barthel Index), effectiveness (amount of potential improvement achieved during rehabilitation) of treatment and percentage of low- and high-response patients calculated on the Barthel Index and the RMI, and percentage of urinary incontinence and return home were evaluated. Odds ratios (ORs) of dropouts and of low and high therapeutic response were also quantified. Results: Compared with USN-negative patients, USN+ patients had significantly more severe baseline neurologic and functional status at admission, less effectiveness and efficiency on activities of daily living (ADLs) and mobility, a higher percentage of low responders, longer hospitalization, a higher percentage of persistent incontinence discharge (20.5% vs 4.9%), and a lower percentage of high responders and patients returning home. The presence of USN was incompatible with a high therapeutic response, for both ADLs (OR = 2.94, 95% confidence interval [CI] = 1.05-8.20; b ± standard error = 1.08 ± .52, p <.05), and mobility (OR = 7.16, 95% CI = 2.78-18.44; b = 1.97 ± .52, p <.001) and was a relevant prognostic factor for institutional discharge (OR = 5.62, 95% CI = 1.63-19.38; b = 1.73 ± .63, p <.01, accuracy 88.41%). Conclusions: The results of this study provide further strong evidence of the relationship between USN and disability in right brain-damaged patients and of its unfavorable impact on rehabilitation, despite the cognitive training performed by all USN+ patients.

AB - Objective: To assess the specific influence of unilateral spatial neglect (USN) on rehabilitation outcome. Design: A case-control study in consecutive stroke inpatients. Setting: Rehabilitation hospital. Patients: One hundred seventy-eight patients with sequelae of first stroke, enrolled in homogeneous subgroups, matched for age (within 1yr) and onset admission interval (within 3d), and difference because of the presence of USN, evaluated by a specific neuropsychologic battery. Interventions: All patients received physical rehabilitation: physiotherapy for 60 minutes twice a day (once on Saturday), 6 days a week, within 24 hours of admission. USN-positive (USN+) patients received specific treatment of 5, 1-hour sessions per week, for 8 consecutive weeks: (1) visual scanning, (2) reading and copying, (3) copying of line drawings on a dot matrix, and (4) describing a scene. Patients were assessed with neurologic (Canadian Neurological Scale), neuropsychiatric (Hamilton Depression Rating Scale), neuroradiologic, and functional (Barthel Index, Rivermead Mobility Index [RMI]) examinations. Main Outcome Measures: Length of stay, efficiency (average daily increase in Barthel Index), effectiveness (amount of potential improvement achieved during rehabilitation) of treatment and percentage of low- and high-response patients calculated on the Barthel Index and the RMI, and percentage of urinary incontinence and return home were evaluated. Odds ratios (ORs) of dropouts and of low and high therapeutic response were also quantified. Results: Compared with USN-negative patients, USN+ patients had significantly more severe baseline neurologic and functional status at admission, less effectiveness and efficiency on activities of daily living (ADLs) and mobility, a higher percentage of low responders, longer hospitalization, a higher percentage of persistent incontinence discharge (20.5% vs 4.9%), and a lower percentage of high responders and patients returning home. The presence of USN was incompatible with a high therapeutic response, for both ADLs (OR = 2.94, 95% confidence interval [CI] = 1.05-8.20; b ± standard error = 1.08 ± .52, p <.05), and mobility (OR = 7.16, 95% CI = 2.78-18.44; b = 1.97 ± .52, p <.001) and was a relevant prognostic factor for institutional discharge (OR = 5.62, 95% CI = 1.63-19.38; b = 1.73 ± .63, p <.01, accuracy 88.41%). Conclusions: The results of this study provide further strong evidence of the relationship between USN and disability in right brain-damaged patients and of its unfavorable impact on rehabilitation, despite the cognitive training performed by all USN+ patients.

KW - Activities of daily living

KW - Cerebrovascular accident

KW - Perceptual disorders

KW - Rehabilitation

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U2 - 10.1053/apmr.2001.23191

DO - 10.1053/apmr.2001.23191

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SN - 0003-9993

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