title: The impact of recovery of visuo-spatial neglect on motor recovery of the upper paretic limb after stroke.
abstract: The aim of the current study was to investigate the longitudinal relationship between improvements of synergism and strength of the upper paretic limb and severity of visuo-spatial neglect during the first 52 weeks post-stroke. The longitudinal association between severity of VSN and motor impairment using Fugl Meyer motor score and Motricity Index of the arm was measured in an intensive repeated measurement design including 18 measurement sessions for each subject. Neglect was assessed using the letter cancellation test applied in a prospective cohort of 101 ischemic, first-ever, hemispheric stroke patients. All time-dependent measures were taken weekly, starting within 14 days post-stroke. From week 10 to 20 biweekly measurements are obtained. The longitudinal relationship of (bi)weekly time on improvement of motor functions and severity of neglect was investigated using random coefficient analysis and trend analyses. Fifty-one of the 101 stroke patients showed neglect at stroke onset. Less improvement of synergism and strength of the upper paretic limb was associated with more severe neglect. This association was most pronounced in the first 10 weeks post-stroke. The seemingly suppressive effect of neglect on upper-limb motor recovery appears to take place mainly during spontaneous neurological recovery of first 10 weeks post-stroke. This finding suggests that damage to large-scale white matter tracts of especially the perceptual-attention networks suppress recovery of other networks at distance in the brain suggesting a common underlying mechanism.
authors.affiliation: Utrecht University, Experimental Psychology, Utrecht, the Netherlands; Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and de Hoogstraat Rehabilitation Center, Utrecht, the Netherlands.
authors.forename: Tanja C W
authors.initials: TC
authors.lastname: Nijboer
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Kollen
authors.affiliation: VU University Medical Center, Department of Rehabilitation Medicine, Research Institute MOVE, Amsterdam, the Netherlands; Department of Neurorehabilitation, Centre of Rehabilitation and and Rheumatology READE, Amsterdam, the Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D010291:Paresis / Q000150:complications* / Q000503:physiopathology*; D010468:Perceptual Disorders / Q000150:complications* / Q000503:physiopathology*; D020127:Recovery of Function; D020521:Stroke / Q000150:complications*; D034941:Upper Extremity / Q000503:physiopathology