Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility.

OBJECTIVE: To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors.

DESIGN: Inception cohort.

SETTING: Inpatient rehabilitation facility (IRF).

PARTICIPANTS: Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP).

INTERVENTIONS: Usual and standard IRF care.

MAIN OUTCOME MEASURES: The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition.

RESULTS: The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge.

CONCLUSIONS: Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS.