Influence of right versus left unilateral spatial neglect on the functional recovery after rehabilitation in sub-acute stroke patients

ABSTRACT

Unilateral spatial neglect (USN) may lead to poor functional rehabilitation outcomes. However, studies investigating the rehabilitation outcomes of right-sided USN are lacking. We aimed to investigate (1) the clinical impacts of USN, including right-sided USN, for stroke patients in sub-acute rehabilitation, and (2) evaluate the differences in clinical characteristics and rehabilitation outcomes between right- and left-sided USN patients. We retrospectively screened the medical records of 297 inpatients at the Tokyo-Bay Rehabilitation Hospital who experienced a cerebrovascular accident with supratentorial lesions between January 1st, 2014 and December 31st, 2016. We performed independent multiple regression analysis in patients with left and right hemisphere damage. The Behavioral Inattention Test was a significant independent variable for predicting the motor, cognitive, and total functional independence measure (FIM), compared to the Stroke Impairment Assessment Set and Mini-Mental State Examination. USN affects motor FIM recovery more than cognitive FIM recovery regardless of the damaged hemisphere. Our study results confirm that both right- and left-sided USN influence the functional recovery of stroke patients. USN occurs, slightly less frequently, following a left hemisphere stroke. However, USN negatively affected rehabilitation outcomes, regardless of the neglected side. Therefore, USN treatment is necessary for patients with left and right hemisphere damage.

KEYWORDS:

• Hemispatial neglect
• Assessment of neglect
• Functional outcomes
• Stroke rehabilitation
• Sub-acute Rehabilitation unit

Acknowledgments

This dissertation is supported by Tokyo-Bay Rehabilitation Hospital and we would like to give thanks to many supportive people. Firstly, I am deeply grateful to my dissertation committee and Dr. Eiji Shimizu for their constant advice and encouragement. We also thank Dr. Hisateru Tachimori (a clinical statistician in Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry) who reviewed and verified the statistical analysis of this study. Finally, we would like to thank Editage (www.editage.com) for English language editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was partially supported by the Japan Society for the Promotion of Science (JSPS KAKENHI) under [grant number 19K11331].