Impact of Spatial Neglect on Stroke Rehabilitation: Evidence From the Setting of an Inpatient Rehabilitation Facility
Impact of Spatial Neglect on Stroke Rehabilitation: Evidence From the Setting of an Inpatient Rehabilitation Facility
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DOI：
10.1016/j.apmr.2015.03.019
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发表时间：
2015-08-01
影响因子：
4.3
通讯作者：
Barrett, A. M.
中科院分区：
文献类型：
--
作者：
Chen, Peii;Hreha, Kimberly;Barrett, A. M.
目的：探讨空间忽视对脑卒中幸存者康复结局、跌倒风险和出院处置的影响。设计：初始队列。环境：住院康复设施（IRF）。参与者：首次中风后单侧脑损伤的个体（N=108）在IRF入院和出院时进行评估。入院时，74人（68.5%）表现出空间忽视症状，采用Kessler基金会忽视评估过程（KF-NAP）进行测量。干预措施：常规和标准的IRF护理。主要观察指标：FIM、康利量表、跌倒次数、住院时间（LOS）和出院处置。结果：IRF入院时空间忽视程度越严重（KF-NAP得分越高），入院和出院时FIM得分越低。KF-NAP得分越高，LOS越大，FIM改善率越低。空间忽视的存在（KF-NAP得分为bb00 - 0），而不是康利量表得分，预示着有空间忽视的参与者比没有症状的参与者摔倒的次数多6.5倍。IRF入院时的KF-NAP评分表明，更严重的忽视降低了出院时回家的可能性。一个将空间忽视和其他人口、社会经济和临床因素考虑在内的模型预测了家庭出院。在IRF逗留期间快速改善的FIM和较低的年收入水平是家庭出院的显著预测因子。结论：卒中后空间忽视是一个普遍存在的问题，可能对康复结果、跌倒风险和LOS产生负面影响。(C) 2015年由美国康复医学大会发布
Objective: To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors.Design: Inception cohort.Setting: Inpatient rehabilitation facility (IRF).Participants: Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP).Interventions: Usual and standard IRF care.Main Outcome Measures: The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition.Results: The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge.Conclusions: Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS. (C) 2015 by the American Congress of Rehabilitation Medicine