Objective: To evaluate the impact of unilateral spatial neglect (USN) on the rehabilitation outcome and long-term functioning in activities of daily living (ADL) and instrumental ADL (IADL) of right hemisphere damaged (RHD) stroke patients. Design: Assessments of sensory-motor and cognitive impairment and of functional disability were conducted upon admission to rehabilitation, upon discharge from the rehabilitation hospital, and 6 months after discharge, up to a year postonset. Setting: The Loewenstein Rehabilitation Hospital, which receives patients from all general hospitals in Israel. Patients: Forty consecutive admissions of adult right-handed patients with a first, single, right hemispheric stroke proven by computed tomography. Based on their total score in the Behavioral Inattention Test for neglect, patients were divided into two groups: 19 with neglect (USN+) and 21 without neglect (USN-). Outcome Measures: Functional Independence Measure, for ADL; The Rabideau Kitchen Evaluation, for IADL. Results: Impairment and disability levels of RHD patients with and without USN were clearly differentiated. Neglect is associated with lower performance on measures of impairment (sensory-motor and cognitive), as well as on measures of disability in ADL and IADL. Differences were significant in all testing periods. The recovery pattern of USN+ patients is slower and more attenuated. In both groups, most improvement occurs in the first 5 months after onset. USN is the major predictor of rehabilitation outcome from admission to follow-up. Conclusions: The significance of neglect as a major source of stroke-related long-term disability justifies further research efforts to develop appropriate therapeutic modalities for this complex, multifactorial syndrome.
Bibliographical noteFunding Information:
From the School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem (Dr. Katz, Ms. Hartman-Ma&), and Loewenstein Rehabilitation Hosoital. Raanana. and Sackler School of Medicine. Tel-Aviv Universitv. ~. Tel Aviv (Dr.% Rihg, S&oker), I&ael. Submitted for publication June 22,199X. Accepted in revised form November 13,199X. Supported by a grant from the Fleischman Research Fund, Loewenstein Rehabilitation Hospital, Raanana, Israel. Presented in part at the American Occupational Therapy Association Conference, April 1997, Orlando, FL. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Reprint requests to Noomi Katz, PhD, OTR, Hebrew University of Jerusalem, School of Occupational Therapy, Mt. Scopus, PO Box 24026, Jerusalem 91240, Israel. 0 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003.9993/99/8004-5088$3.00/O