TY - JOUR
T1 - Impact of Spatial Neglect on Stroke Rehabilitation
T2 - Evidence from the Setting of an Inpatient Rehabilitation Facility
AU - Chen, Peii
AU - Hreha, Kimberly
AU - Kong, Yekyung
AU - Barrett, A. M.
N1 - Publisher Copyright:
© 2015 American Congress of Rehabilitation Medicine.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Objective To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Design Inception cohort. Setting Inpatient rehabilitation facility (IRF). Participants Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP). Interventions Usual and standard IRF care. Main Outcome Measures The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition. Results The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. Conclusions Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS.
AB - Objective To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Design Inception cohort. Setting Inpatient rehabilitation facility (IRF). Participants Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP). Interventions Usual and standard IRF care. Main Outcome Measures The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition. Results The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. Conclusions Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS.
KW - Accidental falls
KW - Hemispatial neglect
KW - Outcome assessment
KW - Patient discharge
KW - Rehabilitation
KW - Symptom assessment
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U2 - 10.1016/j.apmr.2015.03.019
DO - 10.1016/j.apmr.2015.03.019
M3 - Article
C2 - 25862254
AN - SCOPUS:84937970973
SN - 0003-9993
VL - 96
SP - 1458
EP - 1466
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 8
ER -