Impact of unilateral spatial neglect on chronic patient's post-stroke quality of life

Background and aims Poststroke shoulder pain is a common complication. We aimed to investigate the prevalence of poststroke shoulder pain, with attention to the neuropathic component, and the relationship between poststroke shoulder pain and upper limb improvement in motor function, strength, disability, and quality of life after upper limb rehabilitation. Methods This is a secondary analysis of a multicenter randomized controlled trial to compare upper limb conventional or robotic rehabilitation on 224 patients enrolled in eight rehabilitation centers. We assessed poststroke shoulder pain (using the Numerical Rating Scale and the Douleur Neuropathique 4), and upper limb motor function, strength, disability, and quality of life at baseline (T0), after 30 rehabilitation sessions (T1), and three months after the end of rehabilitation (T2). Results A moderate/severe poststroke shoulder pain was reported by 28.9% of patients, while 19.6% of them showed a neuropathic component. At T0, the intensity of pain was higher in women and in patients with neglect syndrome, positively correlated with the time since stroke and disability and negatively correlated with motor function, strength, and the physical aspects of the quality of life. Moderate/severe pain and neuropathic component significantly reduced after both treatments and this reduction was maintained at T2. Finally, the intensity of pain at baseline was negatively correlated with the improvement of upper limb motor function. Conclusions Poststroke shoulder pain negatively impact on motor performance, strength, disability, and physical aspects of the quality of life as well as on upper limb motor recovery; however, it can be reduced after a robotic or a conventional rehabilitation. Therefore, we suggest considering poststroke shoulder pain when planning the rehabilitation intervention.

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“…Our results are in agreement with those of Sobrinho et al. 36 Conversely, Ratmansky et al. 37 found that neglect can attenuate pain perception.…”

Section: Discussionsupporting

confidence: 94%

Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial

Aprile

Germanotta

Cruciani

et al. 2020

International Journal of Stroke

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“…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…”

Section: Introductionmentioning

confidence: 99%

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

Bazan

Fonseca

Miranda

et al. 2022

Neurorehabil Neural Repair

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Background Several studies have shown that robotic devices can effectively improve motor function in stroke patients through limb activation. However, the effects of robot-assisted therapy on perceptual deficits after stroke is unclear. Objective This review aimed to evaluate the effectiveness of robotic limb activation in patients with unilateral spatial neglect (USN) after stroke. Methods In this systematic review, a literature search was performed using MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS databases without language restrictions. Randomized controlled trials (RCTs) and quasi-RCTs of robot-assisted therapy for USN after stroke were selected. Two reviewers independently assessed the risk of bias and certainty of the evidence of the included studies. Results A total of 630 studies were identified, including five studies for qualitative synthesis and four meta-analyses. The results of RCTs comparing robotic limb activation with a control group suggested an improvement in the degree of USN measured by the line bisection test (standardized mean difference [SMD], −0.64; 95% confidence interval [CI], −1.13 to −0.15; P = .01). There were no differences between the groups in the motor-free visual perception test 3rd edition (SMD, 0.27; 95% CI, −0.25–0.79; P = .31), star cancellation test (SMD, 0.26; 95% CI, −0.42−0.94; P = .54), Albert’s test (SMD, −0.67; 95% CI, −2.01−0.66; P = .32), and Catherine Bergego Scale (SMD, −0.81; 95% CI, −2.07−0.45; P = .21). Conclusion The study demonstrated that limb activation through robotic therapy can improve midline perception. However, there was no impact on tasks assessing visual scanning, functionality, or activities of daily living.

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“…Visuospatial neglect has been associated with lower performance in sensory and motor abilities [31][32][33][34] in both, stroke patients and TBI survivors. 30,35,36 Apart from the impairment itself, neglect complicates treatment, as the syndrome is associated with behavioural and cognitive disabilities that affect the rehabilitation strategies.…”

Section: Introductionmentioning

confidence: 99%

“…Visuospatial neglect has been associated with lower performance in sensory and motor abilities in both stroke patients and TBI survivors .…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Brain Stimulation and Noninvasive Peripheral Stimulation for Neglect Syndrome Following Acquired Brain Injury

Lucente

Valls‐Solé

Murillo

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Background: Hemispatial neglect is a frequent condition usually following non-dominant hemispheric brain injury. It strongly affects rehabilitation strategies and everyday life activities. It is associated with behavioural and cognitive disability with a strong impact on patient's life. Methods: We reviewed the published literature on the use of noninvasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), and of non-invasive peripheral muscle stimulation, as therapeutic strategies for rehabilitation of neglect after acquired brain injury (ABI), such as in stroke or in traumatic injuries. The studies were grouped as controlled or uncontrolled studies in each stimulation technics. Results: Thirty-four studies were identified and 16 on rTMS, 10 on tDCS and 8 on vibration. All studies were conducted in adult patients who suffered a stroke, except for one that was conducted in a patient suffering traumatic ABI and another that was conducted in a patient with brain tumour. In spite of significant variability in treatment protocols, patients' features and assessment of neglect, improvement was reported in almost all studies with no side effects. Conclusion: Non-invasive brain stimulation and neuromuscular vibration are promising therapeutic neuromodulatory approaches for treatment of neglect. Further randomized-controlled studies are needed to corroborate their effectiveness as separate and combined techniques.

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Impact of unilateral spatial neglect on chronic patient's post-stroke quality of life

Cited by 19 publications

References 29 publications

Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial

Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial

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

Noninvasive Brain Stimulation and Noninvasive Peripheral Stimulation for Neglect Syndrome Following Acquired Brain Injury

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