Severity of Unilateral Spatial Neglect Is an Independent Predictor of Functional Outcome After Acute Inpatient Rehabilitation in Individuals With Right Hemispheric Stroke

Monaco, Marco Di; Schintu, Selene; Dotta, Manuela; Barba, Sonia; Tappero, Rosa; Gindri, Patrizia

doi:10.1016/j.apmr.2011.03.018

Cited by 117 publications

(100 citation statements)

References 39 publications

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“…Among them, the orientation of visual attention is crucial for the execution of the ADL [10]. Disturbed attentional orienting, for instance, in patients with spatial neglect, may have a negative impact on the functional outcome after stroke [11,12]. Until now it is not known how the functional recovery of upper limb use in the ADL is influenced by spatial neglect.…”

Section: Introductionmentioning

confidence: 99%

Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living

Vanbellingen

Ottiger²,

Maaijwee³

et al. 2017

Cerebrovasc Dis

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Background and Purpose: Motor tests performed at stroke onset have been shown to predict the recovery of upper limb motor impairment. Less is known about upper limb recovery at the level of functional activity or of participation and how spatial neglect may influence the integration of the upper limb in the activities of daily living (ADL). Our objective was to investigate whether the initial severity of spatial neglect may predict upper limb use in ADL. Methods: Eighty-two patients with a right-hemispheric stroke (RHS) were prospectively included in the study. They were assessed twice in the acute/subacute and in the subacute/chronic phases (mean time interval of 45 days) after stroke. The Catherine Bergego Scale (CBS) was used to quantify the influence of spatial neglect on the ADL. Contralesional upper limb use in the ADL was evaluated with the Lucerne international classification of function, disability and health-based Multidisciplinary Observation Scale. Hand strength was measured using the Jamar, dexterity with the Nine Hole Peg test, and tactile perception using the stereognosis subtest of the Nottingham Sensory Assessment. Cognitive functions were assessed with the Montreal Cognitive Assessment. Results: Regression analyses revealed that spatial neglect is an independent and a significant predictor of upper limb outcome. A CBS score of ≤5 at the time of admission to neurorehabilitation care was highly predictive for good upper limb use in the ADL 45 days later. Conclusions: This study demonstrates that spatial neglect severity, as observed in the ADL, is a significant and an independent predictor of upper limb outcome. Neglect therapy is thus needed to further improve contralesional upper limb use in the ADL in RHS patients.

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Section: Introductionmentioning

confidence: 99%

Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living

Vanbellingen

Ottiger²,

Maaijwee³

et al. 2017

Cerebrovasc Dis

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“…Previous researchers have found a negative association between severity of neglect and function, and some have reported a slower rate of recovery for individuals with neglect. 41–43 Our study is the first to provide evidence that neglect slows recovery of the ability to bear weight through the paretic lower extremity for symmetrical performance of STS.…”

Section: Discussionmentioning

confidence: 77%

“…The incidence of unilateral visuospatial neglect among study participants was high, but consistent with reports in the literature. 41,42 Individuals with the most severe neglect, who scored in the lowest quartile on star cancellation, had lower rates of recovery for the ability to bear weight through the paretic leg when standing up from a chair. There also was a trend toward a positive association between star cancellation score and post-stroke GS.…”

Section: Discussionmentioning

confidence: 99%

Recovery of Paretic Lower Extremity Loading Ability and Physical Function in the First Six Months After Stroke

Mercer

Freburger

Yin

et al. 2014

Archives of Physical Medicine and Rehabilitation

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Objective To evaluate post-stroke recovery of paretic lower extremity loading, walking ability, and self-reported physical function, and to identify subject characteristics associated with recovery. Design Inception cohort study, with testing at monthly intervals from one to six months post stroke. Setting University medical center and research laboratory. Participants Volunteer sample of individuals with first-ever, unilateral, non-cerebellar stroke. A total of 78 individuals underwent screening, and 45 were found to be eligible. Of these, 8 declined participation, 2 were excluded because of deteriorating cognitive status, and 2 were lost to follow-up. The remaining 33 individuals enrolled in the study, and 30 (91%) completed the study. Interventions Not applicable. Main Outcome Measures Outcomes were loading of the paretic lower extremity when standing up from a chair (PLEL), self-selected gait speed (GS), and Physical Functioning Index (PFI). Results Data analyses using linear mixed models indicated that subjects improved over time for all outcomes. Baseline Fugl-Meyer lower extremity motor scale score was a predictor of immediate post-stroke performance for PLEL and GS, and of recovery rate for PLEL. Factors identified as having significant effects on performance at 6 months post stroke were baseline Fugl-Meyer lower extremity motor scale score for PLEL and GS, and baseline star cancellation score (from the Behavioral Inattention Test) for PLEL. Conclusion Individuals with better baseline paretic lower extremity motor function have better ability to load that extremity during functional activities and faster walking speeds, and these advantages are still present at 6 months post stroke. Individuals with severe visuospatial neglect demonstrate less ability to load the paretic leg during functional activities at 6 months post stroke.

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“…For example public health services could combine rehabilitation interventions using pursuit eye movements with the assessment of neglect in order to improve outcomes in stroke patients. In addition to the potential benefits at a patient level, using these rehabilitation interventions can reduce the length of time patients spend in hospital following a stroke (Di Monaco et al, 2011) which can create significant costs for the public health service (Paolucci, Antonucci, Grasso, & Pizzamiglio, 2001). …”

Section: Discussionmentioning

confidence: 99%

A Systematic Research Review Assessing the Effectiveness of Pursuit Interventions in Spatial Neglect Following Stroke

Hill

Coats

Halstead

et al. 2015

Transl. Stroke Res.

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BACKGOUND: Rehabilitation after stroke is imperative for patients with spatial neglect as it can help improve behavioural, social and cognitive outcomes in these patients, and therefore reduce the financial burden on public health services. The main aim of this review is to investigate the effectiveness of active pursuit eye movements for rehabilitation interventions in patients with spatial neglect following stroke. METHODS:Potential papers for inclusion were gathered by searching key terms in four main databases (AMED, Global Health, Pubmed/Medline and PsychInfo) in addition to screening relevant reference lists. Two reviewers independently selected papers for inclusion based on agreed inclusion criteria (n = 9 with 147 participants). Risk of bias was assessed using the QUADAS-2 tool. RESULTS:All papers reported a statistically significant result in patients who received an intervention which used pursuit eye movements, and this was reported both as a short term (immediate) effect and as a sustained effect up to eight weeks after treatment. These effects were also reported in comparison with interventions using saccadic eye movements. One study also reported increased neural activity in a number of brain regions following pursuit based intervention. CONCLUSIONS:Overall, there is good evidence in support of pursuit intervention used in the rehabilitation of stroke and spatial neglect over and above traditional interventions based on saccadic eye movements. Future research should aim to increase sample sizes, provide information on statistical power, record accurate eye movement responses, and use randomised designs to reduce selection bias.

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Severity of Unilateral Spatial Neglect Is an Independent Predictor of Functional Outcome After Acute Inpatient Rehabilitation in Individuals With Right Hemispheric Stroke

Cited by 117 publications

References 39 publications

Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living

Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living

Recovery of Paretic Lower Extremity Loading Ability and Physical Function in the First Six Months After Stroke

A Systematic Research Review Assessing the Effectiveness of Pursuit Interventions in Spatial Neglect Following Stroke

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