Hemispatial Neglect and Rehabilitation in Acute Stroke

Objectives: To compare 2 methods for determining neglect in patients within 2 days of stroke, and to investigate whether early neglect was related to rehabilitation practice, and whether this relationship was affected by an early, intensive mobilization intervention. Design: Data were collected from patients participating in a phase II randomized controlled trial of early rehabilitation after stroke. Setting: Acute hospital stroke unit. Participants: Stroke patients (N=71). Intervention: The 2 arms of the trial were very early mobilization (VEM) and standard care (SC). Main Outcome Measures: Neglect was assessed using the Star Cancellation Test and the National Institutes of Health Stroke Scale (NIHSS) inattention item within 48 hours of stroke onset, and therapy details were recorded during the hospital stay. Results: Assessing neglect so acutely after stroke was difficult: 29 of the 71 patients were unable to complete the Star Cancellation Test, and agreement between this test and the NIHSS measure was only .42. Presence of neglect did not preclude early mobilization. SC group patients with neglect had longer hospital stays (median, 11d) than those without neglect (median, 4d); there was no difference in length of stay between patients with and without neglect in the VEM group (median, 6d in both). Conclusion: Early mobilization of patients with neglect was feasible and may contribute to a shorter acute hospital stay.