RESUMEN
OBJECTIVE: To investigate whether rightward orienting bias, without neglect of left hemispace, increased accident risk. DESIGN: Case-control study. SETTING: Inpatient rehabilitation unit of department of government medical center. PATIENTS: Successive right-cerebrovascular accident (CVA) admissions were reviewed over a 2-year period. Only patients with left hemisphere damage, recent abusive drinking, dementia, or inpatient stays of less than 3 weeks were excluded. Fifty-five right-CVA subjects were divided into three groups, based on starting point and omissions in left hemispace on the Rey-Osterreith Complex Figure Drawing and Random Letter Cancellation test. Thirty-two patients were placed in the L-OMIT group (omitted stimuli in left hemispace), 11 patients were placed in the R-BIAS group (began tasks to the right without omissions), and 12 patients were placed in the Non-Neglect Stroke group (no evidence of unilateral neglect). Twenty male inpatients with no history of brain damage served as controls (Normal Control). MAIN OUTCOME MEASURES: Frequency of hospital falls and wheelchair obstacle course contacts. RESULTS: Both the L-OMIT and the R-BIAS groups had more inpatient falls than the other groups F(3,71) = 6.11, p < .001. On the wheelchair obstacle course, the L-OMIT group made more left-sided wheelchair collisions than any other group. However, the R-BIAS group also made more errors than the Non-Neglect Stroke and the Normal Control groups, F(3,55) = 5.72, p < .01). CONCLUSIONS: Results suggest that rightward orienting bias has clinical significance, even without more serious symptoms of unilateral neglect.
Asunto(s)
Accidentes por Caídas , Trastornos Cerebrovasculares/rehabilitación , Orientación , Silla de Ruedas , Estudios de Casos y Controles , Femenino , Humanos , MasculinoRESUMEN
The impact of hemispatial neglect on wheelchair navigation was investigated using a wheelchair obstacle course. The results replicated the findings of Webster et al. (1988): Right-CVA patients with hemispatial neglect (n = 25) struck more objects on their left and ran directly into obstacles placed in their path (p < .0001). Right-CVA patients who did not omit left-space targets on letter cancellation (n = 23) did not run directly into obstacles; however, they did sideswipe more obstacles and struck more left-sided obstacles than did left-CVA (n = 20) and nonpatient controls (n = 19; p < .0001). Both hemi-neglecting patients and right-CVA patients who committed left-space sideswipes (n = 12) evidenced attentional bias to right space, as measured by more rightward starting points on letter cancellation and the Rey-Osterreith Complex Figure copy (p < .0001).
Asunto(s)
Atención/fisiología , Dominancia Cerebral/fisiología , Hemianopsia/fisiopatología , Hemiplejía/fisiopatología , Infarto del Miocardio/fisiopatología , Orientación/fisiología , Desempeño Psicomotor/fisiología , Silla de Ruedas , Anciano , Daño Encefálico Crónico/diagnóstico , Daño Encefálico Crónico/fisiopatología , Daño Encefálico Crónico/psicología , Femenino , Hemianopsia/diagnóstico , Hemianopsia/psicología , Hemiplejía/diagnóstico , Hemiplejía/psicología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/psicología , Pruebas Neuropsicológicas , Lóbulo Parietal/fisiopatologíaRESUMEN
The purpose of the study was to examine neuropsychological and general medical risk factors for falls among a high-risk patient group in an inpatient rehabilitation setting. The sample consisted of 32 nonambulatory males who had sustained a right-hemisphere stroke (R-CVA). The Fall Assessment Questionnaire (FAQ) was introduced as a measure of known risk factors for falls in an inpatient setting. Neuropsychological assessment included measures of attention, perceptual deficits, hemispatial neglect, and impulsivity. A predictive model generated using multiple regression found that the FAQ combined with a measure of behavioral impulsivity successfully predicted fall status in 78% to 81% of cases, depending upon the cutting score used (p < .003). R-CVA patients who fell were more impulsive (p < .001) and received higher FAQ scores (p < .001). Perceptual deficit as measured by the Rey-Osterreith Complex Figure and general inattention as measured by Digit Span (reverse) were associated with falls (p < .04); however, they did not add to the model predicting which of the R-CVA patients would fall. It was suggested that impulsivity may act as an important mediating factor in determining individual risk for fall.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Trastornos Cerebrovasculares/rehabilitación , Centros de Rehabilitación/estadística & datos numéricos , Anciano , Análisis de Varianza , Trastornos Cerebrovasculares/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tiempo de Reacción , Análisis de Regresión , Factores de Riesgo , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
We developed a relationally processing-based scoring system (RPSS) for the Wechsler Memory Scale's (WMS) Logical Memory subtest. Information from the stories was classified as either essential to the plot (Essential proposition) or nonessential to the plot (Detail proposition). The subjects' responses were also scored for intrusion errors (Self-Generated propositions). The normal control group's performance was compared with the performance of a right cerebrovascular accident group (R-CVA), and a left cerebrovascular accident group (L-CVA), each consisting of 20 right-handed subjects. ANOVAs revealed that the R-CVA group recalled significantly fewer Detail propositions and produced significantly more Self-Generated propositions than did the Normal Control group. In contrast, these groups recalled approximately the same number of Essential propositions. The L-CVA group recalled fewer Essential propositions than did any other group, but also produced the fewest intrusion errors.