ABSTRACT
OBJECTIVES: To confront motor awareness in anosognosia for hemiplegia (AHP), where paralyzed patients deny their motor impairment, and in motor neglect (MN), where non-paralyzed patients behave as if they were paretic. METHODS: Eight right-brain-damaged-patients, 4 hemiplegic (2 with and 2 without AHP) and 4 non-hemiplegic (2 with only perceptual-neglect and 2 with also MN) were evaluated with a bimanual motor battery, before and after examiner's reinforcement to use the contralesional limb. The requested bimanual movements could be either symmetric or asymmetric, either intransitive or transitive (with/without objects). We compared the examiner's evaluation of patients' performance with the patients' self-evaluation of their own motor capability (explicit knowledge). We also evaluated the presence/absence of compensatory unimanual strategies that, if present, suggests implicit knowledge of the motor deficit. RESULTS: We found significant differences between conditions only in MN patients, whose performance was better after the examiner's reinforcement than before it, during symmetric than asymmetric movements and during intransitive than transitive movements. As for motor awareness, we found a lack of explicit and implicit knowledge in both AHP and MN patients. CONCLUSION: Although different in terms of motor intention and motor planning, AHP and MN are both characterised by anosognosia for the motor impairment.
Subject(s)
Agnosia/psychology , Awareness/physiology , Hemiplegia/psychology , Intention , Movement/physiology , Perceptual Disorders/psychology , Agnosia/etiology , Functional Laterality/physiology , Hemiplegia/complications , Humans , Motor Skills/physiology , Movement Disorders/etiology , Movement Disorders/psychology , Neuropsychological Tests , Perceptual Disorders/complications , Psychomotor Performance/physiologyABSTRACT
OBJECTIVE: To investigate the relationship between severity of unilateral spatial neglect (USN) and functional recovery in activities of daily living after a right-hemisphere stroke. DESIGN: Observational study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: We investigated 107 of 131 inpatients with right-hemisphere stroke who were consecutively admitted to our rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To assess USN severity, conventional and nonconventional Behavioral Inattention Tests (BITs) were performed at admission to inpatient rehabilitation at a median of 19 days after stroke occurrence. FIM was performed both on admission to and discharge from inpatient rehabilitation to assess functional autonomy. FIM efficiency (improvement of FIM score per day of stay length) and FIM effectiveness (proportion of potential improvement achieved) were calculated. RESULTS: Fifty-four (50.5%) of the 107 patients were affected by USN. In these 54 patients, both conventional and nonconventional BIT scores were significantly correlated with FIM scores assessed at discharge from rehabilitation: ρ values were .385 (P=.004) and .396 (P=.003), respectively. After adjustment for 7 potential confounders, including FIM scores before rehabilitation, we found a significant positive association between either conventional or nonconventional BIT scores and FIM scores after rehabilitation (r=.276, P=.047 and r=.296, P=.033, respectively), FIM efficiency (r=.315, P=.022 and r=.307, P=.025, respectively), and FIM effectiveness (r=.371, P=.006 and r=.306, P=.026, respectively). CONCLUSIONS: Data support the independent prognostic role of USN severity assessed at admission to inpatient rehabilitation after a right-hemisphere stroke. Models aimed at predicting the functional outcome in stroke survivors may benefit from inclusion of USN severity.
