Influencing factors for the disappearance of hemispatial neglect in patients during acute stroke

摘要

BACKGROUND: Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect (HSN) during acute stroke, whether HSN disappearance is related to those trainings or not should be further studied. OBJECTIVE: To analyze the correlation between HSN disappearance and related intervention of patients during acute stroke. DESIGN: Case analysis. SETTING: Department of Neurology, First Affiliated Hospital of Guangxi Medical University. PARTICIPANTS: A total of 21 patients with stroke were selected from the Department of Neurology, the First Affiliated Hospital of Guangxi Medical University from May 2005 to March 2006. Diagnosis criteria: ① Stroke was diagnosed by CT and MRI; ② Diagnosis was coincidence with HSN evaluation criteria; ③ All cases were consent. Exclusion criteria: Patients who had poly-focus, conscious disturbance, severe amentia and hard communication combined with aphasia were excluded. A total of 12 males and 9 females were included, and the mean age was (68±10) years. Among them, 14 patients had cerebral infarction and 7 had cerebral hemorrhage. METHODS: Disappearance and existence of HSN were analyzed with HSN evaluation criteria: body agnosia, left and right agnosia, maintenance of supine position, place of things, sitting up straight, center of line measured by eyes, and cutting 30 lines with paring method. Items mentioned below belonged to HSN disappearance: ① without body agnosia; ② without left and right agnosia; ③ be able to maintain supine position; ④ knowing place of things; ⑤ sitting up straight by one’s own; ⑥ be able to measure the center of line by eyes; ⑦ be able to cut 30 lines with paring method. However, only one item belonged to HSN remnant; but only one item belonged to HSN remnant. Numbers of patients who were of body agnosia, left and right agnosia and difficult maintenance of supine position were observed during acute period (within 1 week) and recovery period (at 2 weeks after onset). Related factors with HSN disappearance contained time of physiotherapy, duration of sitting training (sitting in bed and near bedside: heels fallen to ground, feet loaded heavies, center of gravity located at middle line, head raised towards frontage) and hospitalized time. However, control group was not set up.Measurement data were expressed as Mean±SD and compared with t test; enumeration data were compared with Chi-square test and Mann-Whitney U test. P < 0.05 was regarded as significant difference. MAIN OUTCOME MEASURES: ① HSN disappearance; ② Numbers of body agnosia, left and right agnosia and difficult maintenance of supine position; ③ Correlation among therapeutic time, sitting-training time and hospitalized time. RESULTS: All 21 patients were involved in the final analysis. ① HSN disappearance: Among 21 cases, 2 patients had right HSN disappearance, 19 left HSN disappearance, 8 (38%, 8/21) HSN disappearance, and 13 (62%, 13/21) HSN remnant. Among 8 patients of HSN disappearance, symptoms of 4 cases lasted for 7 days and that of another 4 lasted for 8-12 days. ② Evaluation of HSN disappearance at various phases: Within 1 week, 19% (4/21) HSN patients had body agnosia, left and right agnosia; during recovery period, body agnosia of 20 cases was disappeared and that of 1 case was still survived. Within 1 week, cases with difficult maintenance of supine position were 67% (13/21), but 43% (17/21) during recovery period. ③ Analysis of effective factors on HSN disappearance and related intervention: At acute phase, HSN disappearance through sitting training lasted for (2.5±1.3) days, and remaining HSN symptoms were relieved for (5.0±3.7) days. There was significant difference between them (χ2 = 3.96, P = 0.039). The hospitalized time of patients with HSN disappearance and HSN remnant was (17.6±10.4), (16.2±4.9) days, but there was no significant difference between them (χ2 = 1.41, P = 0.679). Physiotherapy time of patients with HSN disappearance and HSN remnant was (11.1±7.5), (11.4±4.1) days, but there was no significant difference between them (χ2 = 1.05?熏 P = 0.894?雪. CONCLUSION: Early sitting training may play a possible role in HSN symptom disappearance of patients with stroke.