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Published in: Neurological Research and Practice 1/2022

Open Access 01-12-2022 | Stroke | Research article

The impact of apraxia and neglect on early rehabilitation outcome after stroke

Authors: S. Latarnik, J. Stahl, S. Vossel, C. Grefkes, G. R. Fink, P. H. Weiss

Published in: Neurological Research and Practice | Issue 1/2022

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Abstract

Background

This study aims to characterize the impact of apraxia and visuospatial neglect on stroke patients’ cognitive and functional outcomes during early rehabilitation. Prior work implies an unfavorable effect of visuospatial neglect on rehabilitation; however, previous findings remain ambiguous and primarily considered long-term effects. Even less is known about the impact of apraxia on rehabilitation outcomes. Although clinicians agree on the significance of the first few weeks after stroke for the course of rehabilitation, studies exploring the impact of neglect and apraxia in this early rehabilitation period remain scarce.

Methods

Based on a screening of 515 hospitalized stroke patients from an early rehabilitation ward, 150 stroke patients (75 left-hemispheric strokes, 75 right hemispheric strokes) fulfilled the inclusion criteria and were enrolled in this observational, longitudinal study. The patients’ cognitive and functional statuses were documented at admission to the early rehabilitation ward and discharge. Also, detailed apraxia and neglect assessments were performed at midterm. The predictive values of age and apraxia and neglect severity (as reflected in two components from a principal component analysis of the neglect and apraxia assessments) for cognitive and functional outcomes at discharge were evaluated by multiple regression analyses.

Results

Besides the expected influence of the respective variables at admission, we observed a significant effect of apraxia severity on the cognitive outcome at discharge. Moreover, neglect severity predicted the Early Rehabilitation Barthel Index (Frühreha-Barthel-Index) at discharge. Supplementary moderator analysis revealed a differential effect of neglect severity on the cognitive outcome depending on the affected hemisphere.

Conclusion

Data indicate a strong association between apraxia and visuospatial neglect and early rehabilitation outcomes after stroke.
Literature
3.
go back to reference Becker, G., Kruse, A., Tronnier, J., Roepke-Brandt, B., Natus, A., Theissen, H., & Wetzel, A. (2006). Rehabilitationsverlauf und Nachhaltigkeit. Zeitschrift für Gerontologie und Geriatrie, 39(5), 365–370.CrossRef Becker, G., Kruse, A., Tronnier, J., Roepke-Brandt, B., Natus, A., Theissen, H., & Wetzel, A. (2006). Rehabilitationsverlauf und Nachhaltigkeit. Zeitschrift für Gerontologie und Geriatrie, 39(5), 365–370.CrossRef
5.
go back to reference Bowden, M. G., Woodbury, M. L., & Duncan, P. W. (2013). Promoting neuroplasticity and recovery after stroke: Future directions for rehabilitation clinical trials. Current Opinion in Neurology, 26(1), 37–42.CrossRef Bowden, M. G., Woodbury, M. L., & Duncan, P. W. (2013). Promoting neuroplasticity and recovery after stroke: Future directions for rehabilitation clinical trials. Current Opinion in Neurology, 26(1), 37–42.CrossRef
15.
go back to reference Fels, M., & Geissner, E. (1996). Neglect-test (NET). Hogrefe. Fels, M., & Geissner, E. (1996). Neglect-test (NET). Hogrefe.
19.
go back to reference Goldstein, L. B., Bertels, C., & Davis, J. N. (1989). Interrater reliability of the NIH stroke scale. Archives of Neurology, 46(6), 660–662.CrossRef Goldstein, L. B., Bertels, C., & Davis, J. N. (1989). Interrater reliability of the NIH stroke scale. Archives of Neurology, 46(6), 660–662.CrossRef
20.
go back to reference Granger, C. V., Hamilton, B. B., Linacre, J. M., Heinemann, A. W., & Wright, B. D. (1993). Performance profiles of the functional independence measure. American Journal of Physical Medicine & Rehabilitation, 72(2), 84–89.CrossRef Granger, C. V., Hamilton, B. B., Linacre, J. M., Heinemann, A. W., & Wright, B. D. (1993). Performance profiles of the functional independence measure. American Journal of Physical Medicine & Rehabilitation, 72(2), 84–89.CrossRef
21.
go back to reference Hall, K. (1997). The functional assessment measure (FAM). Journal of Rehabilitation Outcomes, 1(3), 63–65. Hall, K. (1997). The functional assessment measure (FAM). Journal of Rehabilitation Outcomes, 1(3), 63–65.
24.
go back to reference Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications. Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications.
26.
go back to reference Heruti, R. J., Lusky, A., Dankner, R., Ring, H., Dolgopiat, M., Barell, V., Levenkrohn, S., & Adunsky, A. (2002). Rehabilitation outcome of elderly patients after a first stroke: Effect of cognitive status at admission on the functional outcome. Archives of Physical Medicine and Rehabilitation, 83(6), 742–749. https://doi.org/10.1053/apmr.2002.32739CrossRefPubMed Heruti, R. J., Lusky, A., Dankner, R., Ring, H., Dolgopiat, M., Barell, V., Levenkrohn, S., & Adunsky, A. (2002). Rehabilitation outcome of elderly patients after a first stroke: Effect of cognitive status at admission on the functional outcome. Archives of Physical Medicine and Rehabilitation, 83(6), 742–749. https://​doi.​org/​10.​1053/​apmr.​2002.​32739CrossRefPubMed
27.
go back to reference Jehkonen, M., Laihosalo, M., & Kettunen, J. E. (2006). Impact of neglect on functional outcome after stroke: A review of methodological issues and recent research findings. Restorative Neurology and Neuroscience, 24(4–6), 209–215.PubMed Jehkonen, M., Laihosalo, M., & Kettunen, J. E. (2006). Impact of neglect on functional outcome after stroke: A review of methodological issues and recent research findings. Restorative Neurology and Neuroscience, 24(4–6), 209–215.PubMed
28.
go back to reference Kaesberg, S., Kalbe, E., Finis, J., Kessler, J., & Fink, G. R. (2013). Kölner neuropsychologisches screening für Schlaganfall-Patienten (KöpSS). Göttingen: Hogrefe. Kaesberg, S., Kalbe, E., Finis, J., Kessler, J., & Fink, G. R. (2013). Kölner neuropsychologisches screening für Schlaganfall-Patienten (KöpSS). Göttingen: Hogrefe.
29.
go back to reference Kalra, L., Perez, I., Gupta, S., & Wittink, M. (1997). The influence of visual neglect on stroke rehabilitation. Stroke, 28(7), 1386–1391.CrossRef Kalra, L., Perez, I., Gupta, S., & Wittink, M. (1997). The influence of visual neglect on stroke rehabilitation. Stroke, 28(7), 1386–1391.CrossRef
32.
go back to reference Latarnik, S., Wirth, K., Held, A., Kalbe, E., Kessler, J., Saliger, J., Karbe, H., Fink, G. R., & Weiss, P. H. (2020). Prevalence and characteristics of apraxic deficits after left and right hemisphere stroke. Fortschritte der Neurologie-Psychiatrie, 88(4), 232–240. https://doi.org/10.1055/a-1082-6501CrossRefPubMed Latarnik, S., Wirth, K., Held, A., Kalbe, E., Kessler, J., Saliger, J., Karbe, H., Fink, G. R., & Weiss, P. H. (2020). Prevalence and characteristics of apraxic deficits after left and right hemisphere stroke. Fortschritte der Neurologie-Psychiatrie, 88(4), 232–240. https://​doi.​org/​10.​1055/​a-1082-6501CrossRefPubMed
33.
go back to reference Luvizutto, G. J., Moliga, A. F., Rizzatti, G. R. S., Fogaroli, M. O., Moura Neto, E., Nunes, H. R. C., et al. (2018). Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity. Clinics (São Paulo, Brazil), 73, e131. https://doi.org/10.6061/clinics/2018/e131CrossRef Luvizutto, G. J., Moliga, A. F., Rizzatti, G. R. S., Fogaroli, M. O., Moura Neto, E., Nunes, H. R. C., et al. (2018). Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity. Clinics (São Paulo, Brazil), 73, e131. https://​doi.​org/​10.​6061/​clinics/​2018/​e131CrossRef
34.
go back to reference Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.PubMed Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.PubMed
38.
go back to reference Oldfield, R. C. (1971). The assessment and analysis of handedness: The Edinburgh inventory. Neuropsychologia, 9(1), 97–113.CrossRef Oldfield, R. C. (1971). The assessment and analysis of handedness: The Edinburgh inventory. Neuropsychologia, 9(1), 97–113.CrossRef
41.
go back to reference Schönle, P. (1995). Der Frühreha-Barthel-Index (FRB)–eine frührehabilitationsorientierte Erweiterung des Barthel-Index. Rehabilitation, 34(2), 69–73.PubMed Schönle, P. (1995). Der Frühreha-Barthel-Index (FRB)–eine frührehabilitationsorientierte Erweiterung des Barthel-Index. Rehabilitation, 34(2), 69–73.PubMed
42.
go back to reference Schönle, P., Busch, E., Ebke, M., Knecht, S., Riecker, A., Brand, T., Schäfer, D., & Petershofer, A. (2015). Qualitätsstandards in der Neurologisch-Neurochirurgischen Frührehabilitation. Neurologie & Rehabilitation, 21, 185–194. Schönle, P., Busch, E., Ebke, M., Knecht, S., Riecker, A., Brand, T., Schäfer, D., & Petershofer, A. (2015). Qualitätsstandards in der Neurologisch-Neurochirurgischen Frührehabilitation. Neurologie & Rehabilitation, 21, 185–194.
48.
go back to reference Weiss, P. H., Kalbe, E., Kessler, J., Fink, G. R., Binder, E., Hesse, M. D., & Scherer, A. (2013). Kölner apraxie screening. Göttingen: Hogrefe. Weiss, P. H., Kalbe, E., Kessler, J., Fink, G. R., Binder, E., Hesse, M. D., & Scherer, A. (2013). Kölner apraxie screening. Göttingen: Hogrefe.
51.
go back to reference Wilson, B., Cockburn, J., & Halligan, P. (1987). Development of a behavioral test of visuospatial neglect. Archives of Physical Medicine and Rehabilitation, 68(2), 98–102.PubMed Wilson, B., Cockburn, J., & Halligan, P. (1987). Development of a behavioral test of visuospatial neglect. Archives of Physical Medicine and Rehabilitation, 68(2), 98–102.PubMed
52.
go back to reference Wirth, K., Held, A., Kalbe, E., Kessler, J., Saliger, J., Karbe, H., Fink, G. R., & Weiss, P. H. (2016). A new diagnostic tool for apraxia in patients with right-hemisphere stroke: The revised cologne apraxia screening (KAS-R). Fortschritte Der Neurologie Psychiatrie, 84(10), 634–640. https://doi.org/10.1055/s-0042-115843CrossRef Wirth, K., Held, A., Kalbe, E., Kessler, J., Saliger, J., Karbe, H., Fink, G. R., & Weiss, P. H. (2016). A new diagnostic tool for apraxia in patients with right-hemisphere stroke: The revised cologne apraxia screening (KAS-R). Fortschritte Der Neurologie Psychiatrie, 84(10), 634–640. https://​doi.​org/​10.​1055/​s-0042-115843CrossRef
Metadata
Title
The impact of apraxia and neglect on early rehabilitation outcome after stroke
Authors
S. Latarnik
J. Stahl
S. Vossel
C. Grefkes
G. R. Fink
P. H. Weiss
Publication date
01-12-2022
Publisher
BioMed Central
Keywords
Stroke
Apraxia
Published in
Neurological Research and Practice / Issue 1/2022
Electronic ISSN: 2524-3489
DOI
https://doi.org/10.1186/s42466-022-00211-x

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