Advertisement

Journal of Neurology

, Volume 243, Issue 4, pp 308–314 | Cite as

Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: A cross-over study

  • Stefano Paolucci
  • Gabriella Antonucci
  • Cecilia Guariglia
  • Luisa Magnotti
  • Luigi Pizzamiglio
  • Pierluigi Zoccolotti
Original Communication

Abstract

A study of the effect of specific training for visual neglect on the recovery of motor and functional impairment in stroke patients is reported. Two groups of right hemisphere stroke patients with hemispatial neglect and one group without neglect were assessed by means of three functional and neurological scales (Rivermead Mobility Index, Barthel Index, Canadian Neurological Scale). Three evaluations were made at 0, 2 and 4 months from the beginning of physical rehabilitation. During the first 2 months of physical rehabilitation one of the two groups of neglect patients was randomly assigned to specific training for neglect, and the second group to a general cognitive intervention; during the final 2 months of rehabilitation the types of training were switched in the two groups. The non-neglect patients improved steadily during physical rehabilitation. In contrast, the functional recovery of the two neglect groups was time-locked to the period of the specific training for neglect. At the time of admission, the two neglect groups performed at the same level; after 2 months of rehabilitation, the group with neglect training showed higher functional recovery than the group with only general cognitive intervention. When the latter group received neglect training, there was no longer any difference between the two neglect groups. This pattern was present for both of the functional scales used but not for the neurological scale. Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect.

Key words

Hemi-neglect Functional recovery Rehabilitation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adams RD, Victor M (1993) Principles of neurology, 5th edn. McGraw-Hill, New YorkGoogle Scholar
  2. 2.
    Albert ML (1972) A simple test of visual neglect. Neurology 23: 658–664Google Scholar
  3. 3.
    Antonucci G, Guariglia C, Judica A, Magnotti L, Paolucci S, Pizzamiglio L, Zoccolotti P (1995) Effectiveness of neglect rehabilitation in a randomized group study. J Clin Exp Neuropsychol 17: 383–389Google Scholar
  4. 4.
    Collen FM, Wade DT, Robb DT, Bradshaw CM (1991) The Rivermead Mobility Index: a further development of the Rivennead Motor Assessment. Int Disabil Stud 13: 50–54Google Scholar
  5. 5.
    Coté R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C (1986) The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke 17: 731–737Google Scholar
  6. 6.
    Coté R, Battista RN, Wolfson C, Boucher J, Adam J, Hachinski V (1989) The Canadian Neurological Scale: validation and reliability assessment. Neurology 39: 638–643Google Scholar
  7. 7.
    Denes G, Semenza C, Stoppa E, Lis A (1982) Unilateral spatial neglect and recovery from hemiplegia — a followup study. Brain 105: 543–552Google Scholar
  8. 8.
    Diller J, Riley E (1993) The behavioural management of neglect. In: Robertson IH, Marshall JC (eds) Unilateral neglect: clinical and experimental studies. Lawrence Erlbaum, Hillsdale, pp 293–310Google Scholar
  9. 9.
    Diller J, Weinberg J (1977) Hemi-inattention in rehabilitation: the evolution of a rational remediation program. In: Weinstein EA, Friedland RP (eds) Hemi-inattention and hemispheric specialization. Advances in neurology, vol 18. Raven Press, New York, pp 63–82Google Scholar
  10. 10.
    Diller L, Ben Yishay Y, Gerstman L, Goodkin R, Gordon W, Weinberg J (1974) Studies in cognition and rehabilitation in hemiplegia. Rehabilitation monograph no. 50. New York University Medical Centre, New YorkGoogle Scholar
  11. 11.
    Dombovy ML, Sandok BA, Basford JR (1986) Rehabilitation for stroke: a review. Stroke 17: 363–369Google Scholar
  12. 12.
    Ernst E (1990) A review of stroke rehabilitation and physiotherapy. Stroke 21: 1081–1085Google Scholar
  13. 13.
    Feigenson JS, McDowell FH, Meese P, McCarthy ML, Greenberg SD (1977) Factors influencing outcome and length of stay in a stroke rehabilitation unit. 1. Analysis of 248 unscreened patients. Medical and functional prognostic indicators. Stroke 8: 651–656Google Scholar
  14. 14.
    Feigenson JS, McCarthy ML, Greenberg SD, Feigenson WD (1977) Factors influencing outcome and length of stay in a stroke rehabilitation unit. 2. Comparison of 318 screened and 248 unscreened patients. Stroke 8: 657–661Google Scholar
  15. 15.
    Gialanella B, Mattioli F (1992) Anosognosia and extrapersonal neglect as predictors of functional recovery following right hemisphere stroke. Neuropsychol Rehabil 2: 169–178Google Scholar
  16. 16.
    Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE (1979) Stroke rehabilitation: analysis of repeated Barthel Index measures. Arch Phys Med Rehabil 60: 14–17Google Scholar
  17. 17.
    Granger CV, Hamilton BB, Gresham GE, Kramer AA (1989) The stroke rehabilitation study. II. Relative merits of the total Barthel Index score and a four-item subscore in predicting patient outcomes. Arch Phys Med Rehabil 70: 100–103Google Scholar
  18. 18.
    Henley S, Pettit S, Todd-Pokropek A, Tupper A (1985) Who goes home? Predictive factors in stroke recovery. JNeurol Neurosurg Psychiatry 48: 1–6Google Scholar
  19. 19.
    Jangbloed L (1986) Prevision of function after stroke: a critical review. Stroke 17: 765–766Google Scholar
  20. 20.
    Kaste M, Waltimo O (1976) Prognosis of patients with middle cerebral artery occlusion. Stroke 7: 482–486Google Scholar
  21. 21.
    Kotila M, Waltimo O, Niemi ML, Laaksonen R, Lempinen M (1984) The profile of recovery from stroke and factors influencing outcome. Stroke 15: 1039–1044Google Scholar
  22. 22.
    Mahoney F, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J Rehabil 14: 61–65Google Scholar
  23. 23.
    Massironi M, Antonucci G, Pizzamiglio L, Vitale MV, Zoccolotti P (1988) The Wundt-Jastrow illusion in the study of spatial hemi-inattention. Neuropsychologia 26: 161–166Google Scholar
  24. 24.
    Michell J (1986) Measurement scales and statistics: a clash of paradigms. Psychol Bull 100: 398–407Google Scholar
  25. 25.
    Pizzamiglio L, Judica A, Razzano C, Zoccolotti P (1989) Toward a comprehensive diagnosis of visual-spatial disorders in unilateral brain damaged patients. Psychol Assess 5: 199–218Google Scholar
  26. 26.
    Pizzamiglio L, Antonucci G, Judica A, Montenero P, Razzano C, Zoccolotti P (1992) Cognitive rehabilitation of the hemineglect disoder in chronic patients with unilateral brain damage. J Clin Exp Neuropsychol 14: 901–923Google Scholar
  27. 27.
    Robertson IH (1993) Cognitive rehabilitation in neurologic disease. Curr Opin Neurol 6: 756–760Google Scholar
  28. 28.
    Robertson IH and Marshall JC (1993) Unilateral neglect: clinical and experimental studies. Lawrence Erlbaum, HoveGoogle Scholar
  29. 29.
    Sterzi R, Bottini G, Celani MG, Righetti E, Lamassa M, Ricci S, Vallar G (1993) Hemianopia, hemianaestesia, and hemiplegia after left and right hemisphere damage: a hemispheric difference. J Neurol Neurosurg Psychiatry 56: 308–310Google Scholar
  30. 30.
    Tegner R, Levander M (1990) Through the looking glass: a new technique to demonstrate directional hypokinesia in unilateral neglect. Brain 114: 1943–1952Google Scholar
  31. 31.
    Vallar G, Antonucci G, Guariglia C, Pizzamiglio L (1993) Deficits of position's sense, unilateral neglect and optokinetic stimulation. Neuropsychologia 31: 1191–1200Google Scholar
  32. 32.
    Vallar G, Guariglia C, Rusconi ML (1994) Non-sensory components of somatosensory deficits contralateral to hemispheric lesions in humans: mechanisms and assessments, progress in pain research and management. In: Boivie J, Hansson P, Lindblom U (eds) Touch, temperature and pain in health and disease. Vol 3, IASP, Seattle, pp 85–95Google Scholar
  33. 33.
    Wade DT, Wood VA, Langton Hewer R (1987) Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry 50: 177–182Google Scholar
  34. 34.
    Wade DT, Collen FM, Robb GF, Warlow CP (1992) Physiotherapy intervention late after stroke and mobility. BMJ 304: 609–613Google Scholar
  35. 35.
    Webster J, Jones S, Blanton P, Gross R, Beissel GF, Wofford JD (1984) Visual scanning training with stroke patients. Behav Ther 15: 129–143Google Scholar
  36. 36.
    Weinberg J, Diller L, Gordon W, Gerstman L, Lieberman A, Lakin P, Hodges G, Ezrachi O (1979) Training sensory awareness and spatial organization in people with right brain damage. Arch Phys Med Rehabil 60: 491–496Google Scholar
  37. 37.
    Zoccolotti P, Antonucci G, Judica A, Montenero P, Pizzamiglio L, Razzano C (1989) Incidence and evolution of the hemineglect disorder in chronic patients with unilateral right brain damage. Int J Neurosci 47: 209–216Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Stefano Paolucci
    • 1
  • Gabriella Antonucci
    • 1
    • 2
    • 3
  • Cecilia Guariglia
    • 1
    • 2
  • Luisa Magnotti
    • 1
  • Luigi Pizzamiglio
    • 1
    • 2
  • Pierluigi Zoccolotti
    • 1
  1. 1.IRCCS S. LuciaRomeItaly
  2. 2.Dipartimento di PsicologiaUniversità “La Sapienza”RomeItaly
  3. 3.Istituto di PsicologiaUniversità degli StudiCagliariItaly

Personalised recommendations