Is Unilateral Spatial Neglect Associated With Motor Recovery of the Affected Upper Extremity Poststroke? A Systematic Review

Abstract

Background and Purpose. Individuals with stroke often present symptoms of multiple domains, such as weakness of the affected upper extremity (UE) and unilateral spatial neglect (USN), which are both associated with poor functional outcome. The aims of this systematic review were to search and review studies that investigated (1) the relationship between USN and affected UE sensorimotor recovery poststroke and (2) the effectiveness of sensorimotor interventions to improve the affected UE in patients with USN. Methods. An electronic search of databases (MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL) was conducted using a combination of the following terms: stroke, USN, and affected UE. Studies meeting the inclusion criteria were rated using a modified version of the Quality Index, and relevant data were extracted. Results. A total of 850 studies were identified, and 14 were included; 13 studies assessed correlations between USN and the affected UE capacity/recovery, and 1 study assessed an intervention to improve the UE of individuals with USN. An association between presence of USN and UE capacity/recovery was found in most studies and USN did not interfere with recovery of the affected UE in the single experimental study. Conclusions. USN is associated with poor UE motor capacity and less UE recovery poststroke. Therefore, these impairments should be considered when planning rehabilitation and discharge. Because USN is a well-researched phenomenon, the lack of studies and insufficient evidence related to UE interventions in individuals with USN was unexpected. These interventions should be developed and researched to improve UE and overall functional outcome poststroke.

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

“…We found that length of hospital stay was more than double in individuals with spatial neglect and neglect was associated with much greater dependency at discharge and death. This is in line with previous reports of the poor longer term outcome of stroke survivors with neglect [13]. People with neglect were more likely to be discharged to a care home, probably an indication of their increased dependency.…”

“…Critically for rehabilitation, many neglect patients present with anosognosia and deny difficulties with perception or control of movement, being not aware that they are experiencing these symptoms [6,7]. Therefore, it is not surprising that neglect early after stroke [8,9], as well as enduring neglect [10][11][12], is a prognostic indicator for reduced functional independence following stroke [13]. This is further impacted by the association of neglect with more severe sensory impairment [14] which is in itself a prognostic indicator of poorer recovery after stroke [15].…”

Unilateral neglect is associated with poor proprioception after stroke – a systematic review

“…The issue of inconsistent assessment of UN has previously been identified and is echoed in the results of this review [15,22]. At present, there is only a single assessment tool that covers all three hemi-spaces, the CBS.…”

“…Reviews of UN report an association with poor motor recovery after stroke [22][23][24]. A critical contributor to the ability to control movement during functional tasks is proprioception [25][26][27].…”

“…A recent review of UN and upper limb function identified a lack of research in sensorimotor interventions for the affected upper limb in patients with UN [22]. However, in order to develop these interventions, it is important to first identify the specific underlying sensorimotor impairments driving poor outcomes in this population.…”