Is visuospatial hemineglect really a determinant of postural control following stroke? An acute-phase study.
OBJECTIVE
The purpose of this study was to determine the independent contribution of visuospatial hemineglect to impaired postural control in the acute phase (<2 weeks) of stroke compared with other possible clinical and biological determinants.


METHODS
This study was conducted in 4 hospitals in the mid-east region of the Netherlands. A total of 78 consecutive patients with a first-ever acute supratentorial stroke was included. Functional balance was measured with the Trunk Impairment Scale, the Trunk Control Test, the Berg Balance Scale, and the Functional Ambulation Categories. Visuospatial hemineglect was assessed by means of an asymmetry index obtained from the Behavioral Inattention Test. The Motricity Index, vibration threshold, sustained attention, and the presence of hemianopia were registered as other possible clinical determinants. Stepwise backward multiple linear regression analysis was performed introducing all selected clinical determinants as well as age and poststroke time as possible biological determinants.


RESULTS
Hemineglect was present in 17 patients (21.8%). The groups with and without hemineglect were different for gender and the proportion of right hemisphere strokes, but not for age, type of stroke, or poststroke time. Neglect patients had on average lower scores on all functional balance tests as well as on the clinical assessments. Multivariate linear regression showed that, besides hemineglect, only muscle strength and age independently contributed to impaired balance explaining 65% to 72% of variance of the selected outcomes.


CONCLUSIONS
This study showed that hemineglect independently contributes to impaired postural control in the acute phase of stroke.
van Nes
Ilse J W
IJ
Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. i.vannes@maartenskliniek.nl
van der Linden
Saskia
S
Hendricks
Henk T
HT
van Kuijk
Annette A
AA
Rulkens
Marc
M
Verhagen
Wim I M
WI
Geurts
Alexander C H
AC
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000377:Agnosia / Q000209:etiology / Q000503:physiopathology*; D001288:Attention; D005260:Female; D007839:Functional Laterality; D006423:Hemianopsia / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D004856:Postural Balance; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D013997:Time Factors; D014732:Vibration