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