Article

Because of the loss of autonomy in daily-life activities, spatial
neglect after stroke is one of the main causes of disability. According to the
spatial domains, neglect can be divided into personal (body), peripersonal
(reaching) and extrapersonal (far) space. We evaluated the effect of these
subtypes of neglect on functional outcome of rehabilitation in stroke patients.
METHODS: A total of 1350 stroke patients were consecutively admitted into our
neurorehabilitation unit from 2002 to 2016. We analyzed data for patients with a
first ischemic or hemorrhagic right-hemispheric stroke in this observational
retrospective study. The presence of neglect was evaluated by using structured
tests for specific spatial domains. Patients underwent individual physical and
occupational therapy, and those with neglect received specific therapy for 8
consecutive weeks consisting of visual scanning, reading and copying, copying
line drawings on a dot matrix and describing scenes. The Functional Independence
Measure (FIM) instrument was administered at both admission and discharge to
assess functional autonomy. Rehabilitation effectiveness for FIM (percentage of
potential improvement achieved) was calculated. Multiple regression analyses were
performed. RESULTS: Among 359 patients with right-brain damage, 130 showed left
neglect, or unilateral spatial neglect (USN), and 229 only left hemiparesis,
without neglect. Overall, 90 patients (69%) with USN showed peripersonal neglect,
89 (68%) extrapersonal neglect and 60 (46%) personal neglect. Functional motor
and cognitive impairment was greater with than without USN as measured by FIM at
admission and discharge and the rehabilitation hospital stay was longer. USN
affected functional status at admission and rehabilitation effectiveness for FIM.
Extrapersonal and peripersonal neglect significantly affected both function at
admission and effectiveness. CONCLUSIONS:
Our data confirm the negative
prognostic effect of neglect on functional outcome in a large sample. We also
show the importance of evaluating and training according to neglect subtype to
improve functional independence.
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Langue : ANGLAIS