RIGHTWARD ORIENTING BIAS, WHEELCHAIR MANEUVERING, AND FALL RISK

Objective: To investigate whether rightward orienting bias, without ne glect of left hemispace, increased accident risk. Design: Case-control study. Setting: Inpatient rehabilitation unit of department of govern ment medical center. Patients: Successive right-cerebrovascular accide nt (CVA) admissions were reviewed over a 2-year period. Only patients with left hemisphere damage, recent abusive drinking, dementia, or inp atient stays of less than 3 weeks were excluded. Fifty-five right-CVA subjects were divided into three groups, based on starting point and o missions in left hemispace on the Rey Osterreith Complex Figure Drawin g and Random Letter Cancellation test. Thirty-two patients were placed in the L-OMIT group (omitted stimuli in left hemispace), 11 patients were placed in the R-BIAS group (began tasks to the right without omis sions), and 12 patients were placed in the Non-Neglect Stroke group (n o evidence of unilateral neglect). Twenty male inpatients with no hist ory of brain damage served as controls (Normal Control). Main Outcome Measures: Frequency of hospital falls and wheelchair obstacle course c ontacts. Results: Both the L-OMIT and the R-BIAS groups had more inpat ient falls than the other groups F(3, 71) = 6.11, p < .001, On the whe elchair obstacle course, the L-OMIT group made mon left-sided wheelcha ir collisions than any other group. However, the R-BIAS group also mad e more errors than the Non-Neglect Stroke and the Normal Control group s, F(3, 55) = 5.72, p < .01). Conclusions: Results suggest that rightw ard orienting bias has clinical significance, even without more seriou s symptoms of unilateral neglect.