ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2020 February;56(1):5-13

DOI: 10.23736/S1973-9087.19.05595-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Right as well as left unilateral spatial neglect influences rehabilitation outcomes and its recovery is important for determining discharge destination in subacute stroke patients

Kengo TSUJIMOTO ¹, Katsuhiro MIZUNO ¹ ✉, Yukiko KOBAYASHI ^{1, 2}, Akira TANUMA ^{1, 3}, Meigen LIU ¹

¹ Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; ² Ichikawa City Rehabilitation Hospital, Ichikawa, Japan; ³ Shizuoka Cancer Center, Shizuoka, Japan

BACKGROUND: Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome.
AIM: To investigate the influence of left and right USN on rehabilitation outcomes using Catherine Bergego Scale (CBS) in stroke patients and the relationships among improvement of USN, improvement of motor autonomy (measured by functional independence measure [FIM] gain), length of stay and discharge destination.
DESIGN: Observational study.
SETTING: Rehabilitation hospital in Japan.
POPULATION: We investigated 60 first-ever stroke patients who were admitted to a rehabilitation hospital within 3 months after stroke onset (27 patients with neglect and 33 without neglect).
METHODS: Multiple regression analyses were used to explain FIM gain, FIM effectiveness and length of stay. Independent variables were motor and cognitive FIM, CBS, Stroke Impairment Assessment Set Motor Score (SIAS-M) and time after stroke onset at admission.
RESULTS: The incidences of USN in patients with right and left hemisphere damage were 55.6% and 37.1%, respectively. CBS predicted motor FIM, motor FIM gain, motor FIM effectiveness and length of stay. On the other hand, SIAS-M did not predict either FIM nor length of stay. CBS Score decreased significantly in patients with USN who retuned their home, while it did not change in patients who did not. Cognitive FIM Score at admission was significantly lower in patients who did not return home than in patients who returned home.
CONCLUSIONS: CBS is more useful than SIAS-M for prediction of functional outcomes in patients with both left and right hemisphere damages. Improvement of USN is important for returning home. Cognitive impairment may interfere with recovery of USN.
CLINICAL REHABILITATION IMPACT: Improvements of USN are important for planning the rehabilitation goal and determination of discharge destination.

KEY WORDS: Stroke; Treatment outcome; Patient discharge; Length of stay