RESEARCH REPORT POSTER DISPLAY

FUNCTIONAL OUTCOME IN PATIENTS WITH UNILATERAL NEGLECT: IN RELATION TO SEVERITY OF NEGLECT. Watanabe S^1,2, Amimoto K²; ¹Rehabilitation Center, Kitasato Institute Medical Center Hospital: Saitama, Japan. ²Physical Therapy Program, Health Sciences Course, Graduate School of Tokyo Metropolitan University: Tokyo, Japan

PURPOSE: The characteristic of unilateral spatial neglect (USN) has reported by many authors. However, the investigation about functional outcome in relation to the severity of USN has been insufficient. This study examined the relation between the severity of USN and the area of lesion, clinical characteristics, and the functional outcome. RELEVANCE: USN has been identified as a negative predictor for rehabilitation. The data of this study are used to select effective approaches in physical therapy. PARTICIPANTS: We researched retrospectively in consecutive patients with stroke who were admitted and undertaken rehabilitation between April 2004 and March 2006 in our hospital. METHODS: The damaged area was confirmed by CT scan or MRI image. Functional status was evaluated with the severity of paralysis, the independence of sitting, locomotion and ADL, the duration from admission to the beginning of exercise and the discharge, and destination of discharge. The severity of USN was assessed with visual extinction, line bisection, line cancellation, and two-point detection. ANALYSIS: The comparison between the severity of symptoms was used with ANOVA. RESULTS: USN was present in 34 (13.3%; mean age, 70.2 years; 18 female and 16 male) of 255 patients with stroke. Severity of USN: Fourteen patients were severe, 9 were moderate, 10 were mild for USN. Area of lesion: USN occurred more frequently with cortical lesion centered on posterior brain, but less with internal capsular and basal ganglia. Twenty-seven were damaged in right hemisphere and 6 were in left. Severity of paralysis: Moderate and severe USN had severe paralysis and little improvement at the time of discharge. Functional outcome: At the time of the discharge, 4 severe and 8 mild USN had become independent of sitting, and 4 severe, 3 moderate and 6 mild USN had been able to gait. Severe USN had lower FIM total score (= 41.5) than mild USN (score = 70.5). Many severe USN needed to assist for sitting and were difficult for wheel chair navigation. Duration from admission: There were no differences in duration of hospitalization in USN. Severe USN delayed the beginning of standing exercise than mild USN. All of severe USN has changed hospital, whereas 4 mild USN returned to home. Therapy: The durations of intervention of standing exercise were different in relation to locomotion ability at discharge in severe USN. Prism adaptation had led to home discharge in 5 mild or moderate USN and become to gait in 4 of them. CONCLUSIONS: Severe USN had poor recovery of paralysis and functional ability, and were difficult for home discharge. Especially, they showed difficulty for independence of fundamental operation, and subsequently, reducing activity of day life. IMPLICATIONS: Assessment of the severity of USN helps to predict the functional outcome of patients. KEYWORDS: Unilateral neglect,Outcome,Severity. FUNDING ACKNOWLEDGEMENTS: n,a. CONTACT: watanabe-s@kitasato.or.jp