Functional Outcome after Stroke in Patients with Aphasia and Neglect: Assessment by the Motor and Cognitive Functional Independence Measure Instrument

Gialanella, Bernardo; Ferlucci, Cristina

doi:10.1159/000317080

Cited by 50 publications

(34 citation statements)

References 61 publications

(48 reference statements)

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“…7 This is not surprising because hemineglect has been found to impact motor independence as measured by the Functional Independence Measure (FIM) and aphasia has been found to impact cognitive FIM in stroke patients. 17 Severity of the disability and need for help or assistance distinguishes between patients with mRS 2 (significant disability, yet independent) and 3 (moderate disability, needing some help). This explains how cortical symptoms may impact the clinical outcome when the mRS score, dichotomized as 0–2 (good outcome) and 3–6 (poor outcome) is used in stroke research involving aLVOs.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) sequences is significantly more sensitive than CT with a higher inter-rater reliability for the detection of early ischemia. 17–19 DWI ASPECTS on MRI performed more than 12 hours from time stroke onset captures both topologic information and the completed infarct size. This study utilized DWI ASPECTS measured 12–72 hours post-treatment in an endovascular cohort of aLVOs to evaluate the association between lesion topology, infarct volume, stroke laterality and clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

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Relationship Between Lesion Topology and Clinical Outcome in Anterior Circulation Large Vessel Occlusions

Rangaraju

Streib

Aghaebrahim

et al. 2015

Stroke

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Background and purpose Diffusion-weighted imaging (DWI) ASPECTS, a surrogate of infarct volume, predicts outcome in anterior large vessel occlusion (LVO) strokes. We aim to determine whether topological information captured by DWI ASPECTS contributes additional prognostic value. Methods Adults with intracranial ICA, M1 or M2 MCA occlusions who underwent endovascular therapy were included. The primary outcome measure was poor clinical outcome (3-month modified Rankin Scale score 3–6). Prognostic value of the 10 DWI ASPECTS regions in predicting poor outcome was determined by multivariable logistic regression, controlling for final infarct volume, age and laterality. Results 213 patients (mean age 66.1±14.5 years, median NIHSS 15) were included. Inter-rater reliability was good for DWI ASPECTS (Deep regions: Kappa=0.72, Cortical regions: Kappa=0.63). All DWI ASPECTS regions with the exception of the putamen were significant predictors (p<0.05) of poor outcome in univariate analyses. Statistical collinearity among ASPECTS regions was not observed. Using penalized multivariable logistic regression, only M4 (OR=2.82 95%CI 1.39–5.76) and M6 (OR=2.45, 95%CI 1.15–5.3) involvement were associated with poor outcome. M6 involvement independently predicted poor outcome in right hemispheric strokes (OR=5.8, 95%CI 1.9–20.3) whereas M4 (OR=4.3, 95%CI 1.3–15.0) involvement predicted poor outcome in left hemispheric strokes adjusting for infarct volume. Topologic information modestly improved the predictive ability of a prognostic score that incorporates age, infarct volume and hemorrhagic transformation. Conclusions Involvement of the right parieto-occipital (M6) and left superior-frontal (M4) regions impact clinical outcome in anterior LVOs over and above the effect of infarct volume and should be considered during prognostication.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship Between Lesion Topology and Clinical Outcome in Anterior Circulation Large Vessel Occlusions

Rangaraju

Streib

Aghaebrahim

et al. 2015

Stroke

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“…Among them, the orientation of visual attention is crucial for the execution of the ADL [10]. Disturbed attentional orienting, for instance, in patients with spatial neglect, may have a negative impact on the functional outcome after stroke [11,12]. Until now it is not known how the functional recovery of upper limb use in the ADL is influenced by spatial neglect.…”

Section: Introductionmentioning

confidence: 99%

Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living

Vanbellingen

Ottiger²,

Maaijwee³

et al. 2017

Cerebrovasc Dis

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Background and Purpose: Motor tests performed at stroke onset have been shown to predict the recovery of upper limb motor impairment. Less is known about upper limb recovery at the level of functional activity or of participation and how spatial neglect may influence the integration of the upper limb in the activities of daily living (ADL). Our objective was to investigate whether the initial severity of spatial neglect may predict upper limb use in ADL. Methods: Eighty-two patients with a right-hemispheric stroke (RHS) were prospectively included in the study. They were assessed twice in the acute/subacute and in the subacute/chronic phases (mean time interval of 45 days) after stroke. The Catherine Bergego Scale (CBS) was used to quantify the influence of spatial neglect on the ADL. Contralesional upper limb use in the ADL was evaluated with the Lucerne international classification of function, disability and health-based Multidisciplinary Observation Scale. Hand strength was measured using the Jamar, dexterity with the Nine Hole Peg test, and tactile perception using the stereognosis subtest of the Nottingham Sensory Assessment. Cognitive functions were assessed with the Montreal Cognitive Assessment. Results: Regression analyses revealed that spatial neglect is an independent and a significant predictor of upper limb outcome. A CBS score of ≤5 at the time of admission to neurorehabilitation care was highly predictive for good upper limb use in the ADL 45 days later. Conclusions: This study demonstrates that spatial neglect severity, as observed in the ADL, is a significant and an independent predictor of upper limb outcome. Neglect therapy is thus needed to further improve contralesional upper limb use in the ADL in RHS patients.

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“…An association between cognition and FIM scores (Motor and Cognitive subscales) has previously been reported for patients with traumatic brain injury [15, 16], cardiac arrest [17], and stroke [18, 19]. In studies of stroke patients, improvement in FIM mobility scores (FIM Motor Gain) has been associated with higher cognitive function [8, 10–12, 30].…”

Section: Discussionmentioning

confidence: 90%

“…FIM ratings represent a subjective estimate of the amount of assistance the patient requires to complete a task. An association between Motor and Cognitive FIM subscales has been found in patients with traumatic brain injury [15, 16], cardiac arrest [17], and stroke [18, 19]. …”

Section: Introductionmentioning

confidence: 99%

Understanding the Connection between Cognitive Impairment and Mobility: What Can Be Gained from Neuropsychological Assessment?

Pavol

Stein

Kabir

et al. 2017

Rehabilitation Research and Practice

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The ability of neuropsychological tests to predict rehabilitation outcome is unclear, particularly when other ratings of cognition are available. Neuropsychological test scores and functional ratings of cognition (Functional Independence Measure (FIM) Cognition score) were used to predict improvement in patient mobility and self-care skill, as measured by the FIM Motor score. Regression models used both raw neuropsychology test scores and age-adjusted scores. Retrospective chart review was performed for patients on an inpatient rehabilitation unit and referred for neuropsychological assessment. The group included 126 subjects (average age 64.2 ± 17.1 years) and a variety of medical diagnoses. Neuropsychological tests included the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). After forcing the Admission FIM Cognition score into the model, RBANS scores and duration of rehabilitation predicted FIM Motor improvements (F = 11.42, p < 0.0001). Raw neuropsychological test scores performed better than the model with age-adjusted test scores. FIM Cognition alone did not predict FIM Motor improvements. Neuropsychological tests, combined with duration of rehabilitation, predicted mobility gains for patients undergoing inpatient rehabilitation beyond what was predicted by another, readily available, assessment of cognition. Neuropsychology raw scores performed better than age-adjusted scores, raising questions about the standard use of demographic adjustments for predicting real-world function.

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Functional Outcome after Stroke in Patients with Aphasia and Neglect: Assessment by the Motor and Cognitive Functional Independence Measure Instrument

Cited by 50 publications

References 61 publications

Relationship Between Lesion Topology and Clinical Outcome in Anterior Circulation Large Vessel Occlusions

Relationship Between Lesion Topology and Clinical Outcome in Anterior Circulation Large Vessel Occlusions

Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living

Understanding the Connection between Cognitive Impairment and Mobility: What Can Be Gained from Neuropsychological Assessment?

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