Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 32

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Spatial neglect and cognitive impairment
and 50 (53.2%) had had a haemorrhagic stroke. Group
1 (USN with other CIs) consisted of 30 participants
(31.9%); group 2 (USN without other CI), 26 partici-
pants (27.7%); and group 3 (non-USN), 38 participants
(40.4%). With regard to baseline characteristics, sig-
nificant differences in the length of stay (p = 0.002),
BRS of the lower limb (p = 0.033), and FIM scores
on admission (p < 0.001) were observed among the
3 groups. The prevalence of USN at discharge was
76.7% (n = 23) in group 1 and 53.8% (n = 14) in group
2 (p = 0.072). The frequency of regaining independent
gait upon discharge was 35.1% (n = 33) overall, 10.0%
(n = 3) in group 1, 50.0% (n = 13) in group 2, and 44.7%
(n = 17) in group 3 (p < 0.001).
The results of the logistic regression analysis for the
3 groups (reference, group 3) in regaining independent
gait are shown in Table II. In Model 1 (Crude model),
the presence of USN with other CIs (group 1) showed
a significant association with dependence of gait upon
discharge (p = 0.004), and the odds ratio (OR) (95%
confidence interval (95% CI)) for dependence of gait
was 7.29 (1.18–28.20). In contrast, there was a non-
significant relationship between the presence of USN
without other CIs (group 2) and dependence of gait at
discharge (p = 0.679). After adjustment for covariates
(Model 2), the presence of USN with other CIs (group
1) still showed a significant association with depen-
dence of gait (p = 0.003), and the OR (95% CI) for
dependence of gait was 5.55 (1.19–23.04). There was
a non-significant relationship between the presence of
USN without other CIs (group 2) and dependence of
gait at discharge (p = 0.207).
Table II. Logistic regression analysis for dependence of gait at
discharge
Model 1
Factors
OR (95% CI)
  Model 2
  OR (95% CI)
p
p
Groups according to USN and other cognitive impairments
Group 1
7.29 (1.18–28.20) 0.004   5.55 (1.19–23.04)
Group 2
0.81 (0.29–2.20) 0.679   2.06 (0.58–8.27)
Group 3
1.00 ref.
  1.00 ref.
Age
  1.07 (0.99–1.14)
Motor FIM on admission
  0.91 (0.85–0.97)
Brunnstrom recovery stage of lower extremities
Severe (1–2)
  1.44 (0.25–8.36)
Moderate (3–4)
  0.43 (0.11–1.71)
Mild (5–6)
  1.00 ref.
0.003
0.207
0.065
0.002
0.687
0.232
Group 1: USN with other CIs; Group 2: USN without other CIs; Group 3:
non-USN. Model 1: Crude model. Model 2: Multivariate model adjusted for
covariates that p < 0.05 in univariate analysis. OR: odds ratio; 95% CI: 95%
confidence interval; ref: reference; USN: unilateral spatial neglect; FIM:
Functional Independence Measure.
DISCUSSION
Right hemisphere stroke survivors were assigned to 3
groups based on the presence or absence of USN and on
MMSE score at admission to the convalescent inpatient
rehabilitation ward and their association with recovery
of independent gait was investigated. The results show-
ed that the presence of USN without other CIs (group 2)
was not significantly related to recovery of independent
gait during hospitalization. However, the presence of
USN with other CIs (group 1) had a significant negative
impact on the recovery of independent gait, even after
adjustment for covariates such as age, motor-FIM score
on admission, and severity of hemiplegia of the lower
limb. Thus, the presence of USN becomes a strong
negative predictor of independent gait recovery when
combined with other cognitive dysfunctions.
Table I. Characteristics of the participants
Age, years, mean (SD)
Gender, men, n (%)
BMI, kg/m 2 , mean (SD)
Type of stroke (cerebral infraction), n (%)
Days between stroke onset and admission, median (IQR)
Length of stay, days, median (IQR)
Charlson comorbidity index, median (IQR)
Medication
Antidepressant, n (%)
Anxiolytic, n (%)
Brunnstrom recovery stage of lower extremities
Severe (1–2), n (%)
Moderate (3–4), n (%)
Mild (5–6), n (%)
MMSE score on admission, points, median (IQR)
FIM on admission, points, mean (SD)
Motor FIM on admission, points, mean (SD)
Cognitive FIM on admission, points, mean (SD)
Walk item of FIM on admission, points, median (IQR)
Walk item of FIM at discharge, points, median (IQR)
Presence of USN at discharge, yes, n (%)
Gait ability at discharge, independence, yes, n (%)
Overall
(n = 94) Group 1
(n = 30) Group 2
(n = 26) Group 3
(n= 38)
69.9 (9.3)
57 (62.8)
22.2 (3.7)
44 (46.8)
32.0 (22.0–43.5)
140.5 (103.3–165.0)
2.0 (2.0–3.0)

9 (9.6)
22 (23.4)

28 (29.8)
43 (45.7)
23 (24.5)
25.0 (19.3–28.0)
59.6 (14.9)
36.9 (11.6)
22.6 (4.9)
1.0 (1.0–1.0)
5.0 (1.0–6.0)
37 (39.4)
33 (35.1) 71.1 (10.4)
17 (56.7)
21.7 (3.8)
14 (46.7)
36.5 (28.3–45.5)
162.5 (123.3–170.0)
2.0 (2.0-3.0)

3 (10.0)
8 (26.7)

15 (30.0)
11 (36.7)
4 (13.3)
19.0 (15.0–21.8)
50.1 (14.1)
31.0 (11.7)
19.0 (5.2)
1.0 (1.0–1.0)
1.0 (1.0–3.5)
23 (76.7)
3 (10.0) 66.8 (8.6)
20 (76.9)
22.0 (3.0)
8 (30.8)
33.0 (24.8–48.0)
160.0 (130.0–170.3)
2.0 (2.0–3.0)

5 (19.2)
9 (34.6) 71.1 (8.6)
22 (57.9)
22.5 (3.7)
22 (57.9)
30.0 (17.8–42.0)
134.5 (105.0–148.0)
3.0 (2.0–4.0)

1 (2.6)
5 (13.2)

6 (15.8)
19 (50.0)
13 (34.2)
28.0 (21.0–29.0)
63.3 (13.4)
39.4 (10.2)
23.8 (4.4)
1.0 (1.0-1.0)
5.0 (3.0-6.0)
–
17 (44.7)
7 (26.9)
13 (50.0)
6 (23.1)
28.0 (26.0–28.0)
65.1 (12.9)
40.1 (11.3)
25.0 (2.5)
1.0 (1.0–1.0)
5.0 (5.0–6.0)
14 (53.8)
13 (50.0)
p
0.135
0.357
0.667
0.102
0.121
0.002
0.105

0.082
0.113
0.033

< 0.001
< 0.001
0.002
< 0.001
0.687
< 0.001
0.072
0.002
Group 1: USN with other CIs; Group 2: USN without other CIs; Group 3: non-USN. Each variables were compared among three groups by Analysis of variance,
Kruskal-Wallis test, Chi-square test, and Fisher's exact test, respectively. Only the presence of USN at discharge was compared between group 1 and group 2.
SD: standard deviation; IQR: interquartile range; BMI: body mass index; MMSE: Mini-Mental State Examination; FIM: Functional Independence Measure; USN:
unilateral spatial neglect; CIs: cognitive impairments.
J Rehabil Med 51, 2019