Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 29

J Rehabil Med 2019: 51: 26–31 ORIGINAL REPORT IMPACT OF UNILATERAL SPATIAL NEGLECT WITH OR WITHOUT OTHER COGNITIVE IMPAIRMENTS ON INDEPENDENT GAIT RECOVERY IN STROKE SURVIVORS Yosuke KIMURA, PT, MSc 1,2 , Minoru YAMADA, PT, PhD 2 , Daisuke ISHIYAMA, PT, MSc 2 , Naohito NISHIO, PT, MSc 2 , Yota KUNIEDA, PT, MSc 2 , Shingo KOYAMA, PT, MSc 2 , Atushi SATO, PT, MSc 2 , Yuhei OTOBE, PT, MSc 2 , Shunsuke OHJI, PT, MSc 2 , Mizue SUZUKI, ST 2 , Hideyuki OGAWA, PT 2 , Daisuke ITO, OT 2 , Takeo ICHIKAWA, PT 2 , Koji HAMANAKA, PT, MSc 1 , Naoki TANAKA, PT 1 and Yasushi MUROH, MD 3 From the 1 Department of Rehabilitation and 3 Department of Rehabilitation Medicine, Tokyo Shinjuku Medical Center, Japan Community Health care Organization, and 2 Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan Objective: To investigate the impact of unilateral spatial neglect with or without other cognitive im- pairments on recovery of independent gait in stroke survivors. Design: A prospective cohort study. Subjects: Ninety-four stroke survivors in an inpa- tient rehabilitation ward. Methods: The presence of unilateral spatial neglect was assessed by the visuospatial perception score of the Stroke Impairment Assessment Set, and other cognitive impairments were assessed by Mini-Men- tal State Examination. Participants were categori- zed into 3 groups: group 1, unilateral spatial neglect with other cognitive impairments; group 2, unilate- ral spatial neglect without other cognitive impair- ments; and group 3, non-unilateral spatial neglect. The outcome was the walking score of the Functional Independence Measure (FIM) at discharge (score ≥ 6 or ≤ 5). Results: Multivariate logistic regression analysis (re- ference, group 3) showed that the presence of uni- lateral spatial neglect with other cognitive impair- ments (group 1) had a significant association with dependence of gait (p  = 0.003), and the odds ratio (95% confidence interval) was 5.55 (1.19–23.04). In contrast, there was no significant relationship between the presence of unilateral spatial neglect without other cognitive impairments (group 2) and dependence of gait (p  = 0.207). Conclusion: The presence of unilateral spatial neg- lect without other cognitive impairments is not a significant factor for regaining independent gait. In contrast, unilateral spatial neglect becomes a strong negative factor when combined with other cognitive impairments. Key words: stroke; hemispatial neglect; cognitive impair- ment; gait. Accepted Oct 8, 2018; Epub ahead of print Nov 8, 2018 J Rehabil Med 2019: 51: 26–31 Correspondence address: Yosuke Kimura, Department of Rehabilita- tion, Tokyo Shinjuku Medical Center, Japan Community Health care Organization, 5-1 Tukudocho, Shinjuku-ku, Tokyo 162-8543, Japan. E-mail: [email protected] LAY ABSTRACT Unilateral spatial neglect is characterized by reduced awareness of stimuli on one side of the body. Spatial neglect is a common cognitive impairment in stroke pa- tients with damage to the right side of their brain. In ad- dition, stroke often causes other cognitive impairments, such as memory deficits and non-spatial attention de- ficits. These neurological symptoms may affect reco- very from stroke. This study investigated whether the presence of spatial neglect in combination with o ­ ther cognitive impairments negatively affects the recovery of gait ability in stroke patients. It was found that, in the absence of other cognitive impairments, spatial neg- lect did not have a negative impact on recovery of gait ability. In contrast, if associated with other cognitive impairments, spatial neglect was found to exacerbate recovery. This information will be helpful in developing optimal rehabilitation programmes for the recovery of gait ability in stroke patients. R ecovery of independent gait is one of the main goals in rehabilitation of stroke survivors (1). Inde- pendence of gait in stroke survivors is associated with ability to perform activities of daily living (ADL) (2), quality of life (3), caregiver burden (4), discharge desti- nation (5) and even prognosis of survival (6). Therefore, it is important to investigate the factors associated with recovery of independent gait in order to develop optimal rehabilitation programmes and discharge plans. Unilateral spatial neglect (USN) is thought to play a crucial role in the functional disadvantages in stroke survivors. USN leads to significantly poorer recovery of ADL ability (7, 8) and gait dependency (9, 10). However, other previous studies have indicated that the improvement in ADL ability does not differ ac- cording to the presence or absence of USN (11), and that the recovery of independent gait is not affected by the severity of USN after controlling for the severity of paresis (12). In addition, relatively recent studies have reported that there are no significant relations- hips between USN and ability in independent gait in outdoor settings, in chronic stroke survivors (13, 14). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2503 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977