Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity

Abstract

OBJECTIVE:The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence.METHODS:This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors.RESULTS:We studied 60 patients with a median age of 68 (34–89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03–1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13–2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78–0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48–0.92], p=0.017).CONCLUSION:The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.

Spatial Neglect in Stroke: Identification, Disease Process and Association with Outcome During Inpatient Rehabilitation

“…An unexpected finding was that neglect was observed more frequently in women, as previous studies found the incidence to be equal across genders when performing drawing tasks [31]. As previously reported, we confirm that neglect is associated with a more severe stroke [30,32] but the extent of this is very marked in our data, ranging from 4% of those with mild strokes through to 84% of those with severe strokes. We found that neglect was more common in individuals who were dependent before their admission, but co-morbidities such as diabetes and previous stroke/Transient Ischemic Attach (TIA) although present were curiously less frequent.…”

“…The assessment for neglect is conducted on arrival in the very acute phase of stroke. As impairments resolve quickly in the acute stage, it could be that some of these resolve [32]. The data are also subject to data entry error as quality control for a national database is not feasible.…”

Non‐invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial

“…Unilateral spatial neglect (USN) consists of an exaggerated spatial asymmetry in processing information in bodily and/or extrabodily space due to a cerebral lesion, which cannot be explained by primary motor or sensory deficits 1 . USN occurs in approximately 50% of individuals after right hemisphere stroke, and may persist in 75% of cases in the chronic phase, 2 leading to poor functional outcome 3 and low quality of life 4 . Some evidence suggests that top‐down and bottom‐up USN treatment can help effectively improve spatial attention and alleviate right‐hemisphere bias after stroke 5 .…”

Effect of Robot-Assisted Training on Unilateral Spatial Neglect After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…4 Moreover, USN has important clinical implications, as it leads to prolonged periods of hospitalization, impaired functional recovery, and worsening quality of life. 5,6…”