Comparing Consequences of Right and Left Unilateral Neglect in a Stroke Rehabilitation Population

Objective: This article details right and left unilateral neglect (UN) in a stroke rehabilitation population. Design: This prospective observational cohort study documented hemipersonal neglect and hemispatial neglect in 309 of 325 stroke rehabilitation patients consecutively admitted over a 28-month period. Shoulder-hand complications, safety concerns, length of stay, discharge function, and discharge destination were documented. Results: Of the 85 with right UN and 1 13 with left UN, 17.7% had expressive aphasia, and 17.7% had mixed or receptive aphasia. Hemispatial neglect was associated with hemianopsia (29.2% and 31.8% for right and left, respectively). Having both hemipersonal neglect and hemispatial neglect was related to greater safety risk (46.9% vs. 24.3%), greater incidence of shoulder-hand complications (28.3% vs. 9.9%), lower FIM scores (> 10 points lower), longer length of stay (8 days), and less likelihood of discharge to home (67.3% vs. 87.4%) than subjects without UN. Results were similar for those with right and left UN. Conclusions: Right and left UN occur after stroke, can be detected even in the presence of aphasia, and are associated with shoulder-hand problems, lower discharge function, and lower likelihood of discharge home. Having both hemispatial neglect and hemipersonal neglect impacts people more than having either type of UN alone.