Comparing consequences of right and left unilateral neglect in a stroke rehabilitation population.

OBJECTIVE: This article details right and left unilateral neglect (UN) in a stroke rehabilitation population. DESIGN: This prospective observational cohort study documented hemipersonal neglect and hemispatial neglect in 309 of 325 stroke rehabilitation patients consecutively admitted over a 28-month period. Shoulder-hand complications, safety concerns, length of stay, discharge function, and discharge destination were documented. RESULTS: Of the 85 with right UN and 113 with left UN, 17.7% had expressive aphasia, and 17.7% had mixed or receptive aphasia. Hemispatial neglect was associated with hemianopsia (29.2% and 31.8% for right and left, respectively). Having both hemipersonal neglect and hemispatial neglect was related to greater safety risk (46.9% vs. 24.3%), greater incidence of shoulder-hand complications (28.3% vs. 9.9%), lower FIM scores (>10 points lower), longer length of stay (8 days), and less likelihood of discharge to home (67.3% vs. 87.4%) than subjects without UN. Results were similar for those with right and left UN. CONCLUSIONS: Right and left UN occur after stroke, can be detected even in the presence of aphasia, and are associated with shoulder-hand problems, lower discharge function, and lower likelihood of discharge home. Having both hemispatial neglect and hemipersonal neglect impacts people more than having either type of UN alone.

Adjusting expectations after spinal cord injury across global settings: a commentary.

PURPOSE: The objective of this paper is to stimulate thought and discussion as to how best to set rehabilitation goals to maximize activities and participation of persons with spinal cord injury, across global settings where circumstances and environments may be widely different. METHOD: A review of literature and commentary are presented. Three points are articulated: (1) rehabilitation professionals need to understand factors that impact upon activities and participation, and need measurement tools that report these factors, in order to better appreciate outcomes in different settings, (2) rehabilitation professionals generally set goals with patients, but current measures of activities and participation do not indicate when or why maximal achievable function is sometimes not chosen, and (3) we need to develop realistic expectations for activities and participation after SCI in settings where current standard outcome chart targets are not feasible, due to socio-economic circumstances. CONCLUSIONS: A standardized approach to reporting measures of activities and participation, along with factors that influence these scores, is required for purposes of comparing rehabilitation outcomes in settings of differing socio-economic environments. In regards to spinal cord injury rehabilitation, an accepted standard of setting achievable rehabilitation goals is required for each level of complete spinal cord injury that could apply in various global settings.

Stroke impairment predictors of discharge function, length of stay, and discharge destination in stroke rehabilitation.

OBJECTIVES: This article presents analytic results from a prospective study of 313 stroke rehabilitation patients, looking at the relative contributions of different stroke impairments toward prediction of discharge function, rehabilitation length of stay, and discharge destination after inpatient rehabilitation. The relationship between number of stroke risk factors and recurrence of strokes during rehabilitation was also evaluated. METHODS: A total of 313 subjects were enrolled consecutively. Information on type of stroke and individual stroke-related impairment was collected prospectively. Recurrent stroke, rehabilitation length of stay, discharge destination, discharge function, and available family support at discharge were documented. RESULTS: Rates of impairment occurrence and coexistence are presented. Analysis using linear (length of stay, discharge function) and logistic (discharge destination) regression revealed significant contributory predictive effects of admission balance, aphasia, number of impairments, and family support on length of stay; admission balance and number of impairments on discharge function; and admission balance, body neglect, and presence of family support on discharge destination. CONCLUSION: In addition to admission function and balance, other factors to consider in predicting length of stay for patients should include the number of stroke-related impairments and family support. For discharge destination prediction, the presence of body neglect should be considered in addition to balance and family support. Evaluation of patients for right-sided neglect and left-sided neglect is important.