Awareness of deficits in stroke rehabilitation

The aim of this study was to evaluate the awareness of deficit profiles of stroke patients undergoing rehabilitation, and examine the impact of unawareness on rehabilitation functional outcomes. Sixty first-event stroke patients, 36 after right hemisphere damage and 24 after left hemispheric damage were included. The Awareness Interview was administered at admission to rehabilitation, and patients' responses were compared with standardized cognitive and neurological evaluations. The FIM motor scale and a safety rating were used to measure functional outcomes at discharge from rehabilitation and at 1-year follow up. The frequency of unawareness for motor and sensory deficits was low, whereas unawareness of cognitive deficits was much higher. Unawareness was not associated with a specific lesion site, however a significant association was found with cortical involvement, and with lesion size. In the right hemispheric damage group a significant negative correlation was found between total unawareness scores and discharge functional outcomes. Multiple regression revealed that unawareness at admission was a significant predictor of discharge FIM motor scores in the right hemispheric damage group, beyond the contribution of cognitive and demographic variables. Findings delineate the multifaceted nature of unawareness phenomenon, and highlight the significance of unawareness in post-stroke rehabilitation.