Research Reports - Spatial neglect hinders success of inpatient rehabilitation in individuals with traumatic brain injury

Neurorehabil Neural Repair. 2015 Sep 3. pii: 1545968315604397. [Epub ahead of
print]

Chen P(1), Ward I(2), Khan U(3), Liu Y(3), Hreha K(4).

BACKGROUND: Current knowledge about spatial neglect and its impact on
rehabilitation mostly originates from stroke studies.
OBJECTIVE: To examine the impact of spatial neglect on rehabilitation outcome in
individuals with traumatic brain injury (TBI).
METHODS: The retrospective study included 156 consecutive patients with TBI (73
women; median age = 69.5 years; interquartile range = 50-81 years) at an
inpatient rehabilitation facility (IRF). We examined whether the presence of
spatial neglect affected the Functional Independence Measure (FIM) scores, length
of stay, or discharge disposition. Based on the available medical records, we
also explored whether spatial neglect was associated with tactile sensation or
muscle strength asymmetry in the extremities and whether specific brain injuries
or lesions predicted spatial neglect.
RESULTS: In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age,
severity of TBI, or time postinjury did not differ between patients with and
without spatial neglect. In comparison to patients without spatial neglect,
patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at
discharge, improved slower in both Cognitive and Motor FIM scores, and might have
less likelihood of return home. In addition, left-sided neglect was associated
with asymmetric strength in the lower extremities, specifically left weaker than
the right. Finally, brain injury-induced mass effect predicted left-sided
neglect.
CONCLUSIONS: Spatial neglect is common following TBI, impedes rehabilitation
progress in both motor and cognitive domains, and prolongs length of stay. Future
research is needed for linking specific traumatic injuries and lesioned networks
to spatial neglect and related impairment. 

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