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

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 lyr) and onset admission interval (within 3d), and difference because of the presence of U SN, 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 ho urs of admission. USN-positive (USN+) patients received specific treatment of 5, 1-hour sessions per week, for 8 consecutive weeks: (1) visual scannin g, (2) reading and copying, (3) copying of line drawings on a dot matrix, a nd (4) describing a scene. Patients were assessed with neurologic (Canadian Neurological Scale), neuropsychiatric (Hamilton Depression Raring Scale), neuroradiologic, and functional (Barthel Index, Rivermead Mobility Index [R MI]) examinations. Main Outcome Measures: Length of stay, efficiency (average daily increase i n Barthel Index), effectiveness (amount of potential improvement achieved d uring rehabilitation) of treatment and percentage of low- and high-response patients calculated on the Barthel Index and the RMI, and percentage of ur inary incontinence and return home were evaluated. Odds ratios (ORs) of dro pouts and of low and high therapeutic response were also quantified. Results: Compared with USN-negative patients, USN+ patients had significant ly more severe baseline neurologic and functional status at admission, less effectiveness and efficiency on activities of daily living (ADLs) and mobi lity, a higher percentage of low responders, longer hospitalization, a high er percentage of persistent incontinence at discharge (20.5% vs 4.9%), and a lower percentage of high responders and patients returning home. The pres ence of USN was incompatible with a high therapeutic response, for both ADL s (OR = 2.94, 95% confidence interval [CI] = 1.05-8.20, b +/- standard erro r = 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 instit utional discharge (OR = 5.62, 95% CI = 1.63-19.38; b = 1.73 +/- .63, p < .0 1, accuracy 88.41%). Conclusions: The results of this study provide further strong evidence of t he relationship between USN and disability in right brain-damaged patients and of its unfavorable impact on rehabilitation, despite the cognitive trai ning per-formed by all USN+ patients. (C) 2001 by the American Congress of Rehabilitation Medicine and the Americ an Academy of Physical Medicine and Rehabilitation.