The effectiveness of compensatory strategies in the rehabilitation of patients with visuospatial neglect during the post-acute period of stroke rehabilitation

Анотація

Despite significant advances in the rehabilitation of patients with acute stroke, there is no convincing evidence on the effectiveness of individual interventions to improve function in the presence of visuospatial neglect (VSN). The aim of this study was to evaluate the impact of compensatory strategies on fine motor skills, gross motor functions of the upper limb, cognitive functions and disability in patients with acute stroke and visuospatial neglect during the post-acute rehabilitation period. In the study 86 patients were included, the mean age was 61.9±13.5 years. All patients were assessed for cognitive function, motor and sensory impairments, activity limitations, visual impairments, and visuospatial perception at the beginning and the end of rehabilitation. Patients were divided into two groups: the main group (n=18) with signs of VSN and the control group (n=68) without signs of VSN. All patients received 3 hours of rehabilitation interventions per day for 14 days. The occupational therapy program consists of compensatory techniques for patients in the main group. The use of the rehabilitation program improved the cognitive level of patients with acute stroke by an average of 3.2±3.0 points according to the Montreal Cognitive Test (p<0.05). At the same time it wasn’t established statistically significant difference between the groups at the end of the rehabilitation program (p>0.05). During the course of therapy an improvement in the gross motor functions of the upper limb on the opposite side to the area of damage to the cerebral hemisphere was determined according to the results of the “Box and Blocks” test (p<0.05). However, in the presence of VSN the dynamics was 4.2 times worse than in patients in the control group (p<0.05). When studying fine motor skills of the upper limb, the average time to complete the “9 pegs” test in the group with VSN was 14.5 seconds longer at the beginning of the study and 21.3 seconds longer at the end of the study (p<0.05). The effect of the standard therapy program led to significantly lower dynamics in the level of the Barthel Index in the group with VSN, which resulted in a lower level of the Barthel Index in this group at the end of the study (p<0.05). Thus, the use of approaches focused mainly on compensatory strategies is insufficient to restore fine motor and gross motor functions of the upper limb, which is an important base for a negative impact on the ability of patients to perform basic activities of daily living. Therefore, there is an urgent need to continue research to find therapeutic interventions aimed at restoring the functions of the affected limbs, starting from the earliest stages of rehabilitation.