ABSTRACT
Unilateral visual neglect occurs frequently after right-hemisphere stroke. This longitudinal study assessed the performance pattern of 54 individuals with unilateral right-hemisphere stroke on the Behavioural Inattention Test (BIT), a measure of unilateral neglect. Eighteen subjects returned for retesting between 6-26 months post-onset. Results confirmed the frequent occurrence of unilateral visual neglect in patients with right-hemisphere damage. A high correlation was found between the Conventional and Behavioural Subtests of the BIT, indicating that the shorter subtest may be sufficient to identify neglect. Longitudinal data revealed two subgroups, those with transient neglect that resolved within 6 months and those with neglect that persisted over time. No differences in aetiology and lesion location distinguished patients with and without neglect or patients with transient or persistent neglect. Further research is needed to confirm these results and identify other characteristics that would predict the nature of the neglect.
Subject(s)
Perceptual Disorders/diagnosis , Perceptual Disorders/etiology , Stroke/complications , Aged , Female , Functional Laterality , Humans , Longitudinal Studies , Male , Middle Aged , Neuropsychological Tests , Remission, Spontaneous , Visual PerceptionABSTRACT
OBJECTIVE: To evaluate relationships between unilateral spatial neglect and both overall and cognitive-communicative functional outcomes in patients with right hemisphere stroke. DESIGN: Assessment of overall and cognitive-communicative function was conducted on admission to acute rehabilitation, at discharge, and at 3-month follow-up. SETTING: Urban, acute inpatient rehabilitation facility. PATIENTS: Fifty-two consecutive admissions of adult right-handed patients with a single, right hemispheric stroke, confirmed by computed tomography scan. MAIN OUTCOME MEASURES: The FIM instrument and reading comprehension and written expression items of the Rehabilitation Institute of Chicago Functional Assessment Scale(R). RESULTS: Patients made significant functional gains between admission and discharge, and between discharge and follow-up on the FIM. Severity of neglect was correlated with total, motor, and cognitive FIM scores at admission, discharge, and follow-up. Subjects with neglect had significantly more days from onset to admission and a longer length of rehabilitation stay than subjects without neglect. FIM outcomes were significantly different for subject groups with more severe neglect. Both the presence of neglect and its severity were significantly related to functional outcomes for reading and writing. CONCLUSIONS: Patients with neglect show reduced overall and cognitive-communicative functional performance and outcome than patients without neglect. Further studies are needed to explore causal relationships between these factors.
Subject(s)
Agnosia/rehabilitation , Cognition Disorders/rehabilitation , Communication Disorders/rehabilitation , Stroke Rehabilitation , Visual Perception , Adult , Aged , Aged, 80 and over , Agnosia/diagnosis , Agnosia/etiology , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Communication Disorders/diagnosis , Communication Disorders/etiology , Disability Evaluation , Functional Laterality , Humans , Length of Stay , Middle Aged , Reading , Recovery of Function , Severity of Illness Index , WritingABSTRACT
This article discusses the impact of cognitive-communicative and behavior problems on oral intake. Data on the swallowing outcomes of a group of patients in an acute rehabilitation facility are presented. These data illustrate the relationships among severity of dysphagia, admission and discharge Functional Independence Measure (FIM) scores, admission and discharge cognitive FIM scores and length of stay. Two case studies that describe the effect of cognitive-communicative disorders on dysphagia are provided.
Subject(s)
Activities of Daily Living , Cognition Disorders/etiology , Communication Disorders/etiology , Craniocerebral Trauma/complications , Craniocerebral Trauma/rehabilitation , Deglutition Disorders/etiology , Severity of Illness Index , Adolescent , Adult , Aged , Aged, 80 and over , Cognition Disorders/diagnosis , Cognition Disorders/physiopathology , Communication Disorders/diagnosis , Communication Disorders/physiopathology , Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Energy Intake , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Rehabilitation Centers , Retrospective Studies , Treatment OutcomeABSTRACT
In patients with traumatic brain injury, the anatomic and physiologic status of the swallowing mechanism may be impaired. Patients typically compensate for these impairments by learning and using compensatory strategies to ensure safe and efficient food intake. However, when cognitive-communicative and behavioral impairments are also present, the rehabilitation of dysphagia is more complex and challenging. To facilitate maximum recovery from dysphagia, an interdisciplinary team approach is essential. Teams may include several medical and allied healthcare professionals such as the physician, nurse, speech-language pathologist, clinical dietitian, and physical and occupational therapist. The psychologist may be consulted to provide expertise in behavioral management strategies. The patient and caregiver also are integral members of this treatment team. Each team member needs to be aware of the food consistencies that are appropriate and the specific feeding techniques that are required. It is critical that all team members be consistent in their approach to feeding for the patient to learn and generalize the use of compensatory strategies. This article has presented a review of the literature on swallowing problems in traumatic brain injury. It is apparent that there are relatively few data-based studies that describe the impairments and even fewer that discuss the efficacy of treatment for dysphagia in these patients. In view of the frequency of oral intake problems in individuals with traumatic brain injury, and the added challenge of the cognitive-communicative problems, further studies are needed to increase our understanding of swallowing problems, their treatment, and recovery in this patient population.
