Impact of unilateral spatial neglect with or without other cognitive impairments on independent gait recovery in stroke survivors
Yosuke Kimura, Minoru Yamada, Daisuke Ishiyama, Naohito Nishio, Yota Kunieda, Shingo Koyama, Atsushi Sato, Yuhei Otobe, Shunsuke Ohji, Mizue Suzuki, Hideyuki Ogawa, Daisuke Ito, Takeo Ichikawa, Koji Hamanaka, Naoki Tanaka, Yasushi Muroh
Department of Rehabilitation, Tokyo Shinjuku Medical Center, Japan Community Health care Organization, Tokyo, Japan
Objective: To investigate the impact of unilateral spatial neglect with or without other cognitive impairments on recovery of independent gait in stroke survivors.
Design: A prospective cohort study.
Subjects: Ninety-four stroke survivors in an inpatient rehabilitation ward.
Methods: The presence of unilateral spatial neglect was assessed by the visuospatial perception score of the Stroke Impairment Assessment Set, and other cognitive impairments were assessed by Mini-Mental State Examination. Participants were categorized into 3 groups: group 1, unilateral spatial neglect with other cognitive impairments; group 2, unilateral spatial neglect without other cognitive impairments; and group 3, non-unilateral spatial neglect. The outcome was the walking score of the Functional Independence Measure (FIM) at discharge (score ≥ 6 or ≤ 5).
Results: Multivariate logistic regression analysis (reference, group 3) showed that the presence of unilateral spatial neglect with other cognitive impairments (group 1) had a significant association with dependence of gait (p = 0. 003), and the odds ratio (95% confidence interval) was 5. 55 (1. 19–23. 04). In contrast, there was no significant relationship between the presence of unilateral spatial neglect without other cognitive impairments (group 2) and dependence of gait (p = 0. 207).
Conclusion: The presence of unilateral spatial neglect without other cognitive impairments is not a significant factor for regaining independent gait. In contrast, unilateral spatial neglect becomes a strong negative factor when combined with other cognitive impairments.
Unilateral spatial neglect is characterized by reduced awareness of stimuli on one side of the body. Spatial neglect is a common cognitive impairment in stroke patients with damage to the right side of their brain. In addition, stroke often causes other cognitive impairments, such as memory deficits and non-spatial attention deficits. These neurological symptoms may affect recovery from stroke. This study investigated whether the presence of spatial neglect in combination with other cognitive impairments negatively affects the recovery of gait ability in stroke patients. It was found that, in the absence of other cognitive impairments, spatial neglect did not have a negative impact on recovery of gait ability. In contrast, if associated with other cognitive impairments, spatial neglect was found to exacerbate recovery. This information will be helpful in developing optimal rehabilitation programmes for the recovery of gait ability in stroke patients.
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