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(Stroke. 2005;36:2687.)
© 2005 American Heart Association, Inc.

Original Contributions

Functional Recovery After Hemiplegia in Patients With Neglect

The Rehabilitative Role of Anosognosia

From the Rehabilitation Department (B.G., V.M., R.S.) and the Psychology Service (S.R.) of "Salvatore Maugeri" Foundation, Istituto di ricovero e cura a carattere scientifico–Scientific Institute of Gussago/Lumezzane (BS), Italy.

Correspondence to Bernardo Gialanella, MD, Rehabilitation Department, "Salvatore Maugeri" Foundation, Istituto di ricovero e cura a carattere scientifico–Scientific Institute of Gussago/Lumezzane (BS), via Pinidolo 23, 25064 Gussago (BS), Italy. E-mail bgialanella{at}fsm.it

Background and Purpose— The aim of this study was to verify whether the presence of anosognosia (A) affects the rehabilitative prognosis of hemiplegic subjects with neglect (N).

Methods— This study was carried out on 30 patients with left hemiplegia: 15 patients had neglect (group N) and 15 had neglect and anosognosia (group N+A). Mean age was 68.2±6.3 in group N (9 men and 6 women) and 72.1±6.4 in group N+A (7 men and 8 women). The average interval from onset of stroke to admission for rehabilitation was 23 and 23.6 days, respectively, in group N and in group N+A. Patients were assessed through the Mesulam test, Bisiach test, Wechsler Adult Intelligence Scale, Fugl-Meyer scale, Functional Independence Measure (FIM), and Rankin scale.

Results— Before rehabilitation, cognitive FIM scores of patients of group N were significantly higher than those of group N+A (P=0.001), whereas motor FIM scores and total FIM scores did not differ between the 2 groups. After rehabilitation, cognitive FIM scores (P=0.000) and even motor (P=0.009) and total FIM scores (P=0.000) were statistically higher in group N than in group N+A. Effectiveness (P=0.005) and efficiency (P=0.012) in the motor FIM scores of group N were significantly greater than those of group N+A. Disability was lower in group N (P=0.040).

Conclusions— Our study shows that the presence of anosognosia worsens the rehabilitation prognosis in hemiplegic subjects who also have neglect.

Key Words: cerebrovascular disorders • neglect • stroke • rehabilitation

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