Functional outcomes in patients with right hemisphere brain damage

Abstract

Background : In this era of accountability in health care, the need to document treatment-related changes in health status is critical. However, few studies report outcomes in people with right cerebral hemisphere damage (RHD). Aims : The objective of this study was to document, in a single population of patients with RHD, selected functional outcomes at the termination of inpatient treatment. Of particular interest were cognitive performance and its influence on motor and overall recovery. Methods & Procedures : Functional outcomes were retrospectively examined in 101 RHD patients, at discharge from an in-patient rehabilitation programme. The Functional Independence Measure (FIM; Center for Functional Assessment Research, 1993) was the measurement tool. The five outcomes examined were: final functional status, amount of gain, efficiency of gain, length of stay (LOS), and discharge placement. FIM scores, produced on an ordinal rating scale, were statistically transformed by the Rasch method (Rasch, 1960) to generate interval-level data for regression analyses. Outcomes & Results : Summary by outcomes: Gains were evident in cognitive and motor realms, with greater and more efficient improvement in the latter. Regression analysis indicated that final functional status was best predicted by age, initial motor severity (FIM motor score), and initial total cognitive severity (FIM cognitive scores); amount of gain was best predicted by age, evidence of previous neurological incident, and gender; efficiency of gain by initial cognitive item scores, initial motor severity (FIM score) and age; LOS by initial motor severity (FIM score); and discharge placement by age, marital status, and initial severity (FIM status). Major predictors tended to be age and the family of cognitive FIM scores, especially Problem Solving (PS). Memory and PS were the most challenging cognitive items for these patients, as indicated by scores on admission and discharge reflecting less than functional ability. A sizeable number of patients began and ended rehabilitation with functional levels of ability in comprehension, expression, and social interaction. Significant differences existed between patients with neglect and those without, but neglect was not a significant predictor of any outcome measure. Low initial cognitive FIM scores, presence of neglect, and older age were associated with poorer performance in motor and cognitive realms. Previous neurological episodes were negatively associated with amount of gain. Number of comorbidities was not statistically associated with outcomes. Conclusions : Initial severity levels and age were the most influential factors on these outcomes. The presence of neglect had a relatively minor impact on most outcomes. Performance on the cognitive items was less impaired than motor items, and registered less gain and less efficient gain than motor items, but did predict various final status and gain-related measurements in overall and motor realms. Analyses in this study revealed that the FIM scale is less sensitive to cognitive change than to motor change.