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From Moss Rehabilitation Research Institute (Drs. Buxbaum, Ferraro, Whyte, and Coslett, and T. Veramonti), Philadelphia; Thomas Jefferson University (Drs. Buxbaum and Whyte), Philadelphia; Centro di Neuroscienze Cognitive (Drs. Farne, Ladavas, and Frassinetti), Dipartimento di Psicologia dell’Universita di Bologna, Italy; and University of Pennsylvania (Dr. Coslett), Philadelphia. T. Veramonti is currently affiliated with the University of Houston, TX.
Address correspondence and reprint requests to Dr. Laurel Buxbaum, Moss Rehabilitation Research Institute, Korman 213, 1200 W. Tabor Rd., Philadelphia, PA 19141; e-mail: Lbuxbaum{at}einstein.edu
Objective: To assess the relative frequency of occurrence of motor, perceptual, peripersonal, and personal neglect subtypes, the association of neglect and other related deficits (e.g., deficient nonlateralized attention, anosognosia), and the neuroanatomic substrates of neglect in patients with right hemisphere stroke in rehabilitation settings.
Methods: The authors assessed 166 rehabilitation inpatients and outpatients with right hemisphere stroke with measures of neglect and neglect subtypes, attention, motor and sensory function, functional disability, and family burden. Detailed lesion analyses were also performed.
Results: Neglect was present in 48% of right hemisphere stroke patients. Patients with neglect had more motor impairment, sensory dysfunction, visual extinction, basic (nonlateralized) attention deficit, and anosognosia than did patients without neglect. Personal neglect occurred in 1% and peripersonal neglect in 27%, motor neglect in 17%, and perceptual neglect in 21%. Neglect severity predicted scores on the Functional Independence Measure and Family Burden Questionnaire more accurately than did number of lesioned regions.
Conclusions: The neglect syndrome per se, rather than overall stroke severity, predicts poor outcome in right hemisphere stroke. Dissociations between tasks assessing neglect subtypes support the existence of these subtypes. Finally, neglect results from lesions at various loci within a distributed system mediating several aspects of attention and spatiomotor performance.
Received July 12, 2002. Accepted in final form November 13, 2003.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 9 issue to find the title link for this article.
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