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Is Visuospatial Hemineglect Really a Determinant of Postural Control Following Stroke? An Acute-Phase Study

Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands, Department of Rehabilitation Medicine, Sint Maartenskliniek, Nijmegen, The Netherlands, i.vannes{at}maartenskliniek.nl

Saskia van der Linden, MSc

Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

Henk T. Hendricks, MD, PhD

Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

Annette A. van Kuijk, MD, PhD

Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands, Rehabilitation Center Tolbrug and Jeroen Bosch Hospital,' s Hertogenbosch, The Netherlands

Marc Rulkens, MD

Department of Rehabilitation Medicine, Rijnstate Hospital, Arnhem, The Netherlands

Wim I. M. Verhagen, MD, PhD

Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands

Alexander C. H. Geurts, MD, PhD

Department of Rehabilitation, Radboud University Nijmegen, The Netherlands, Medical Center, Nijmegen Department of Rehabilitation Medicine, Sint Maartenskliniek, Nijmegen, The Netherlands

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. Conclusion. This study showed that hemineglect independently contributes to impaired postural control in the acute phase of stroke.

Key Words: Stroke • Posture • Balance • Visuospatial hemineglect

This version was published on July 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 6, 609-614 (2009)
DOI: 10.1177/1545968308328731


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