Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect

Objective: To evaluate the impact of unilateral spatial neglect (USN) on th e rehabilitation outcome and long-term functioning in activities of daily l iving (ADL) and instrumental ADL (IADL) of right hemisphere damaged (RHD) s troke patients. Design: Assessments of sensory-motor and cognitive impairment and of functi onal disability were conducted upon admission to rehabilitation, upon disch arge from the rehabilitation hospital, and 6 months after discharge, up to a year postonset. Setting: The Loewenstein Rehabilitation Hospital, which receives patients f rom all general hospitals in Israel. Patients: Forty consecutive admissions of adult right-handed patients with a first, single, right hemispheric stroke proven by computed tomography, Ba sed on their total score in the Behavioral Inattention Test for neglect, pa tients were divided into two groups: 19 with neglect (USN+) and 21 without neglect (USN-). Outcome Measures: Functional Independence Measure, for ADL; The Rabideau Ki tchen Evaluation, for IADL. Results: Impairment and disability levels of RHD patients with and without USN were clearly differentiated. Neglect is associated with lower performan ce on measures of impairment (sensory-motor and cognitive), as well as on m easures of disability in ADL and IADL. Differences were significant in all testing periods. The recovery pattern of USN+ patients is slower and more a ttenuated. In both groups, most improvement occurs in the first 5 months af ter onset. USN is the major predictor of rehabilitation outcome from admiss ion to follow-up. Conclusions: The significance of neglect as a major source of stroke-relate d long-term disability justifies further research efforts to develop approp riate therapeutic modalities for this complex, multifactorial syndrome. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.