Impact of Spatial Neglect on Stroke Rehabilitation: Evidence from the Setting of an Inpatient Rehabilitation Facility

Peii Chen, Kimberly Hreha, Yekyung Kong, A. M. Barrett

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1458-1466
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume96
Issue number8
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Process Assessment (Health Care)
Inpatients
Rehabilitation
Length of Stay
Stroke
Survivors
Stroke Rehabilitation
Demography
Outcome Assessment (Health Care)
Brain

Keywords

  • Accidental falls
  • Hemispatial neglect
  • Outcome assessment
  • Patient discharge
  • Rehabilitation
  • Symptom assessment

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Impact of Spatial Neglect on Stroke Rehabilitation : Evidence from the Setting of an Inpatient Rehabilitation Facility. / Chen, Peii; Hreha, Kimberly; Kong, Yekyung; Barrett, A. M.

In: Archives of Physical Medicine and Rehabilitation, Vol. 96, No. 8, 01.08.2015, p. 1458-1466.

Research output: Contribution to journalArticle

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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.

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