Is visuospatial hemineglect really a determinant of postural control following stroke? An acute-phase study.

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.

The Come Back Programme: a rehabilitation programme for patients with brain injury with psychosocial problems despite previous rehabilitation.

In 1994 the Come Back Programme (CBP) started in the rehabilitation centre, Groot Klimmendaal, in Arnhem, The Netherlands. The CBP is a rehabilitation programme for (young) adults with brain injury (BI) having problems with their psychosocial functioning despite having undergone a rehabilitation programme previously. The main goal of the CBP is to regain maximal independence in psychosocial functioning. The objectives of the study were to assess problems experienced after BI, despite having undergone a rehabilitation programme previously, and whether the CBP can improve psychosocial functioning. The study was retrospective, through investigating medical records and via a structured questionnaire sent to patients who participated in the CBP between 1994 and 1998 (n = 25). Follow-up was at least 1 year after the CBP. There was an 80% response (n = 20). The mean age at BI was 22 years. The patients had severe BI (mean duration of coma 4.7 weeks) and 17 had traumatic BI. Prior to the CBP negative consequences were seen on independence of living, employability, relationships and contact with friends. No or little effect was seen on contact with family and leisure activities. After the CBP, positive effects were found on employability and independence of living but not on premorbid levels. The effect on the other aspects were absent or not clear. Most patients wanted support at follow-up. The authors concluded that the CBP had a positive effect on independence of living and employability. A 'second' rehabilitation programme can be useful if psychosocial problems are present. Long-lasting support and structural control seem necessary and are recommended.