title: Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility.
abstract: OBJECTIVE
  To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors.
  
  
  METHODS
  Inception cohort.
  
  
  METHODS
  Inpatient rehabilitation facility (IRF).
  
  
  METHODS
  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).
  
  
  METHODS
  Usual and standard IRF care.
  
  
  METHODS
  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.
authors: Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ. Electronic address: PChen@KesslerFoundation.org.
authors: Peii
authors: P
authors: Chen
authors: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY; Kessler Institute for Rehabilitation, West Orange, NJ.
authors: Kimberly
authors: K
authors: Hreha
authors: Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ.
authors: Yekyung
authors: Y
authors: Kong
authors: Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ.
authors: A M
authors: AM
authors: Barrett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000209:etiology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010468:Perceptual Disorders / Q000209:etiology / Q000534:rehabilitation*; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
keywords: Accidental falls; Hemispatial neglect; Outcome assessment; Patient discharge; Rehabilitation; Symptom assessment