Functional outcome after stroke in patients with aphasia and neglect: assessment by the motor and cognitive functional independence measure instrument

Abstract

Background: The role of neuropsychological deficits in predicting functional outcome in patients with aphasia and neglect at the end of rehabilitation after stroke has been poorly investigated. This was the aim of this prospective study evaluated using a Functional Independence Measure (FIM) instrument.

Methods: Patients with a primary diagnosis of cerebrovascular accident [125 patients with aphasia, 45 with neglect and 131 without either aphasia or neglect (WAN)] were enrolled. Backward multiple linear regression analysis was used to predict motor and cognitive FIM, discharge destination, and length of stay. The independent variables were age, gender, aphasia, stroke type, stroke lesion size, comorbidity, bladder catheter, stroke severity, trunk control test, initial motor FIM, and committed caregiver identified on admission to rehabilitation.

Results: At the end of rehabilitation, patients with neglect had significantly lower final motor FIM scores and lower daily efficiency improvement in motor FIM scores compared with those with aphasia (both p < 0.001) and WAN (both p < 0.001). Patients with aphasia showed lower final cognitive FIM scores compared with those with neglect (p < 0.001) and those without deficits (p < 0.001). Neglect was a predictor of final motor FIM (β = -0.24) and efficiency in motor FIM (β = -0.29), while aphasia was a predictor of final cognitive FIM (β = -0.54). Neglect and aphasia did not differ and were not predictors of discharge destination and length of stay.

Conclusions: Patients with neglect have lower motor FIM scores if compared with those with aphasia, while patients with aphasia have lower cognitive FIM scores. Neglect is a predictor of motor FIM, while aphasia is a predictor of cognitive FIM scores.