| Stroke continues to represent a leading cause of morbidity in many countries. Among impairments following stroke, unilateral spatial neglect is recognized as a significant disabling deficit, clinically defined as a failure to report or orient to novel stimuli presented on the side opposite to a brain lesion. The neglect is characterized as vision, hearing, motor, limb, et al. So most clinicians recognize that unilateral spatial neglect is neglect syndrome, the presence of unilateral spatial neglect has been strongly associated with an increased risk for injury and with poor functional outcome. Consequently, it is not surprising that many different rehabilitation techniques or treatments have been put forward to alleviate, reduce or remediate unilateral spatial neglect, but most of them remain controversial. In our country, traditional occupational therapy is limited to basic daily tasks such as wearing, eating, transferring, lack for aiming at neglect. As traditional Chinese medical treatments, acupuncture is one of the most important techniques on stroke rehabilitation, but only a few reports involved neglect. In our study we used acupuncture combined with specific occupational therapy on the base of conventional rehabilitation therapy, observed the effects of two rehabilitation approaches on unilateral spatial neglect after stroke.ObjectiveTo explore the effects of motor, cognition, activities of daily living, mental state, living quality on unilateral spatial neglect after stroke. Subjects and methods1. Clinical materialsFrom Dec 2007 to Jul 2010, patients with left-sided spatial neglect following right hemisphere stroke were assessed with neuropsychological tests such as line bisection, cancelling, drawing clock, and copying drawing.69 right hemispheric stroke patients out of them identified with USN, randomly assigned to three groups. 20 patients as a control group received conventional rehabilitation therapy,22 patients as an observational group received type-specific occupational therapy while received conventional rehabilitation therapy, the remain patients as an experimental group received acupuncture on both of conventional and occupational therapies. These patients were suffered from stroke for the first time, the duration of attack is no longer 180 days, and their age is from 40 to 80 years. During the treatment, there are 2 patients lost and 1 patient died in the control group,1 patient lost in the observational group, excluding patients with dementia, severe cognitive dysfunction, dysphasia, not willing to obey the rules.1.1 Experimental groupThe subjects consisted of 23 patients,18 male and 5 female, aged from 46 to 80 years(average age 62.35±10.14 years), duration from 30 to 150 days(average duration 70.96±37.06 days),19 infarct and 4 hemorrhage,3 smaller than primary school,5 junior middle school,15 senior middle school. 1.2 Observational groupThe subjects consisted of 22 patients,16 male and 6 female, aged from 51 to 76 years(average age 64.00±8.88 years), duration from 20 to 160 days(average duration 76.41±36.71 days),18 infarct and 4 hemorrhage,1 smaller than primary school,7 junior middle school,10 senior middle school,4 university.1.3 Control groupThe subjects consisted of 20 patients,11 male and 9 female, aged from 45 to 80 years(average age 66.25±11.46 years), duration from 21 to 160 days(average duration 74.40±41.70 days),16 infarct and 4 hemorrhage,5 smaller than primary school,4 junior middle school,7 senior middle school,4 university.2. Experiment MethodsThe patients in three groups all received conventional rehabilitation therapy: physical therapists give patients "Bobath" program, occupational therapists guide patients how to sit on the edge of bed, transfer from bed to wheelchair, eat with tableware, and so on. Speech therapists train how to speak. These trainings were 3-4 hours per days, five days per week for eight weeks. In addition to these conventional rehabilitation therapies, the patients in the observational group were given the specific occupational therapy. We designed specific occupational tasks according to age, sight, energy, and clinical symptom. A therapist can only guide one patient,10-15 minutes per day,5 days per week for eight weeks. The tasks are from easy to difficult gradually. Meanwhile, the patients took part in the collective program,20-30 minutes per time,2-3 times per week for eight weeks. The patients in the experimental group received acupuncture on both of conventional and specific therapy. The acupuncture therapy is 30 minutes per day,5 days per week for eight weeks. All the patients in three groups were evaluated by motor function, cognition, activities of daily living, mental state, living quality.3. MeasurementsWe use Fugl-Meyer motor assessment (FMA) to assess motor function, use Functional Independent Measurement (FIM) and Modified Barthel Index (MBI) to assess activities of daily living, use Mini Mental Status Examination (MMSE) to assess cognitive function, use Hamilton depression scale (HAMD) to assess mental state, use life satisfaction index A (LSIA) to assess living quality.4. Statistical analysisThe outcome was performed using the Statistical Package of Social Sciences (SPSS 13.0). Chi-Square Test is used to analyze the sex, and stroke nature, education of the patients. Kruskal-Wallis Test is used to analyze FMA,FIM,MMSE,MBI,HAMD,LSI A before and after treatment. P-value less than 0.05 on two sides were considered significant. Compared the increased scores between experimental and control group, experimental and observational group, control and observational group, P-value less than 0.01 on two sides were considered significant.ResultsThe scores with FMA,FIM,MMSE,MBI in three groups have no statistically differences before treatment. The scores with FMA,FIM,MMSE,MBI in the observational and experimental group post treatment have statistically significant higher than pretreatment, there are no statistically difference between pretreatment and post treatment in the control group. The mean increased scores with FMA,FIM,MMSE,MBI,HAMD,LSIA were not equal in three groups. The mean increased scores with FMA,FIM,MBI,MMSE in the experimental group were significantly higher than in the control and observational group. The mean increased scores with FMA,FIM,MBI,MMSE in the observational group were significantly higher than in the control group.The scores with HAMD in three groups have no statistically differences before treatment. The scores with HAMD in the observational and experimental group post treatment have statistically significant lower than pretreatment; there is no statistically difference between pretreatment and post treatment in the control group. The mean decreased scores with HAMD were not equal in three groups. The mean decreased scores with HAMD in the experimental and observational group were significantly greater than in the control group, there is no statistically difference between experimental and observational group.The scores with LSIA in three groups have no statistically differences before treatment. The scores with LSIA in the observational and experimental group post treatment have statistically significant higher than pretreatment; there is no statistically difference between pretreatment and post treatment in the control group. The mean increased scores with LSIA were not equal in three groups. The mean increased scores with LSIA in the experimental and observational group were significantly higher than in the control group, there is no statistically difference between experimental and observational group.Conclusions1. It is not enough for post stroke unilateral spatial neglect to be given conventional rehabilitation therapy. This creates a serious problem in regards to motor function, cognition and daily living activities. In our study, neglect is considered to have serious effects on functional recovery, mental state and living quality.2. Unilateral spatial neglect is a multi-model neglect syndrome. We designed to specific occupational technique, used several methods to correct neglect, and organized the collective programs and recreational activities. In our study, the specific occupational therapy showed greater effects on functional rehabilitation and abilities of daily living than the conventional therapy.3. The specific occupational therapy can help patients understand their diseases, actively take part in the treatment. In result, the neglect patients can be improved on depression and living quality.4. Acupuncture can help patients improve the motor function, cognition and activities of daily living but have no effect on mental state and life satisfaction. |
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