Spatial Neglect Is Common Among Patients With TBI

PHILADELPHIA—Approximately 27% of patients with traumatic brain injury (TBI) have spatial neglect, according to a study presented at the 66th Annual Meeting of the American Academy of Neurology. The condition also may be a predictor of poor rehabilitation outcome.

Spatial neglect is a disorder of spatial cognition. It affects attentional control, spatial perception and representation, and motor action planning. Spatial neglect occurs in 30% to 50% of stroke survivors with unilateral brain damage. Besides stroke, TBI is another common cause of brain damage leading to spatial neglect. “We need to raise awareness of spatial neglect in the TBI population,” said Peii Chen, PhD, Research Scientist at the Kessler Foundation in West Orange, New Jersey.

Dr. Chen and colleagues conducted a retrospective analysis to estimate the prevalence of spatial neglect following TBI and to examine the condition’s effect on rehabilitation outcomes. They examined data for patients admitted between February 2012 and April 2013 to an acute inpatient rehabilitation program following TBI. Eligible patients were admitted to the program at fewer than 100 days after their injury and did not have severe disorder of consciousness. Participants were assessed for spatial neglect with the Catherine Bergego Scale (CBS) or the Star Cancellation test.

The researchers identified 359 admissions during the study period but excluded 187 admissions who failed to meet inclusion criteria. A total of 172 patients (78 women) were included in the analysis. Participants’ ages ranged between 17 and 95. Mean age was approximately 65.

Of 172 patients, 47 (27.3%) showed spatial neglect. The CBS was more sensitive at detecting spatial neglect than the Star Cancellation test. Thirty-four of 118 patients (28.8%) demonstrated symptoms of spatial neglect measured on the CBS, compared with 19 of 150 patients (12.7%) who took the Star Cancellation test.

The researchers used a regression model to examine whether spatial neglect affected clinical outcomes. After controlling for age and days after injury at admission, Dr. Chen and colleagues found that spatial neglect prolonged patients’ length of stay in the rehabilitation program. In addition, spatial neglect decreased functional independence measure (FIM) cognitive score at discharge and FIM total score at discharge.

Spatial neglect also reduced FIM motor score change per day and FIM total score change per day. Similar to previous findings of stroke patients, spatial neglect adversely affected rehabilitation outcome in the TBI population.

“Now that we have identified the prevalence and consequences of spatial neglect following TBI, it is important to explore effective treatment, using treatments that have been developed extensively with stroke survivors,” said Dr. Chen.

“Further prospective studies are required to understand the neural mechanisms underlying symptoms of spatial neglect following diffuse brain damage or TBI, which may differ from those following focal brain damage or stroke.”

—Erik Greb

PHILADELPHIA—Approximately 27% of patients with traumatic brain injury (TBI) have spatial neglect, according to a study presented at the 66th Annual Meeting of the American Academy of Neurology. The condition also may be a predictor of poor rehabilitation outcome.

Spatial neglect is a disorder of spatial cognition. It affects attentional control, spatial perception and representation, and motor action planning. Spatial neglect occurs in 30% to 50% of stroke survivors with unilateral brain damage. Besides stroke, TBI is another common cause of brain damage leading to spatial neglect. “We need to raise awareness of spatial neglect in the TBI population,” said Peii Chen, PhD, Research Scientist at the Kessler Foundation in West Orange, New Jersey.

Dr. Chen and colleagues conducted a retrospective analysis to estimate the prevalence of spatial neglect following TBI and to examine the condition’s effect on rehabilitation outcomes. They examined data for patients admitted between February 2012 and April 2013 to an acute inpatient rehabilitation program following TBI. Eligible patients were admitted to the program at fewer than 100 days after their injury and did not have severe disorder of consciousness. Participants were assessed for spatial neglect with the Catherine Bergego Scale (CBS) or the Star Cancellation test.

The researchers identified 359 admissions during the study period but excluded 187 admissions who failed to meet inclusion criteria. A total of 172 patients (78 women) were included in the analysis. Participants’ ages ranged between 17 and 95. Mean age was approximately 65.

Of 172 patients, 47 (27.3%) showed spatial neglect. The CBS was more sensitive at detecting spatial neglect than the Star Cancellation test. Thirty-four of 118 patients (28.8%) demonstrated symptoms of spatial neglect measured on the CBS, compared with 19 of 150 patients (12.7%) who took the Star Cancellation test.

The researchers used a regression model to examine whether spatial neglect affected clinical outcomes. After controlling for age and days after injury at admission, Dr. Chen and colleagues found that spatial neglect prolonged patients’ length of stay in the rehabilitation program. In addition, spatial neglect decreased functional independence measure (FIM) cognitive score at discharge and FIM total score at discharge.

Spatial neglect also reduced FIM motor score change per day and FIM total score change per day. Similar to previous findings of stroke patients, spatial neglect adversely affected rehabilitation outcome in the TBI population.

“Now that we have identified the prevalence and consequences of spatial neglect following TBI, it is important to explore effective treatment, using treatments that have been developed extensively with stroke survivors,” said Dr. Chen.

“Further prospective studies are required to understand the neural mechanisms underlying symptoms of spatial neglect following diffuse brain damage or TBI, which may differ from those following focal brain damage or stroke.”

—Erik Greb

PHILADELPHIA—Approximately 27% of patients with traumatic brain injury (TBI) have spatial neglect, according to a study presented at the 66th Annual Meeting of the American Academy of Neurology. The condition also may be a predictor of poor rehabilitation outcome.

Spatial neglect is a disorder of spatial cognition. It affects attentional control, spatial perception and representation, and motor action planning. Spatial neglect occurs in 30% to 50% of stroke survivors with unilateral brain damage. Besides stroke, TBI is another common cause of brain damage leading to spatial neglect. “We need to raise awareness of spatial neglect in the TBI population,” said Peii Chen, PhD, Research Scientist at the Kessler Foundation in West Orange, New Jersey.

Dr. Chen and colleagues conducted a retrospective analysis to estimate the prevalence of spatial neglect following TBI and to examine the condition’s effect on rehabilitation outcomes. They examined data for patients admitted between February 2012 and April 2013 to an acute inpatient rehabilitation program following TBI. Eligible patients were admitted to the program at fewer than 100 days after their injury and did not have severe disorder of consciousness. Participants were assessed for spatial neglect with the Catherine Bergego Scale (CBS) or the Star Cancellation test.

The researchers identified 359 admissions during the study period but excluded 187 admissions who failed to meet inclusion criteria. A total of 172 patients (78 women) were included in the analysis. Participants’ ages ranged between 17 and 95. Mean age was approximately 65.

Of 172 patients, 47 (27.3%) showed spatial neglect. The CBS was more sensitive at detecting spatial neglect than the Star Cancellation test. Thirty-four of 118 patients (28.8%) demonstrated symptoms of spatial neglect measured on the CBS, compared with 19 of 150 patients (12.7%) who took the Star Cancellation test.

The researchers used a regression model to examine whether spatial neglect affected clinical outcomes. After controlling for age and days after injury at admission, Dr. Chen and colleagues found that spatial neglect prolonged patients’ length of stay in the rehabilitation program. In addition, spatial neglect decreased functional independence measure (FIM) cognitive score at discharge and FIM total score at discharge.

Spatial neglect also reduced FIM motor score change per day and FIM total score change per day. Similar to previous findings of stroke patients, spatial neglect adversely affected rehabilitation outcome in the TBI population.

“Now that we have identified the prevalence and consequences of spatial neglect following TBI, it is important to explore effective treatment, using treatments that have been developed extensively with stroke survivors,” said Dr. Chen.

“Further prospective studies are required to understand the neural mechanisms underlying symptoms of spatial neglect following diffuse brain damage or TBI, which may differ from those following focal brain damage or stroke.”

—Erik Greb