Implementing a care pathway for spatial neglect to improve stroke outcomes

 

  • Stroke researchers strive to close the implementation gap for spatial neglect care

 

East Hanover, NJ., USA (May 14, 2019) – Spatial neglect remains a hidden disability despite the availability of effective tools for the diagnosis and treatment for this common complication of stroke. Addressing this implementation gap is critical to reducing disability, improving outcomes and controlling costs of stroke care, according to an article in Current Neurology and Neuroscience Reports, “Update on the Clinical Approach to Spatial Neglect” (DOI:10.1007/s11910-019-0940-0) published online on April 4, 2019. The authors are A.M. Barrett, MD, of the Center for Stroke Rehabilitation Research at Kessler Foundation, and K.E. Houston, OD, MSc, of Harvard Medical School and Spaulding Rehabilitation Hospital.

The article offers review and recommendations on spatial neglect, a common cause of functional disability after stroke. More than half of survivors of stroke are affected, and 30 percent of individuals with traumatic brain injury.

Spatial neglect has implications for deficits in visual/perceptual and motor function, as well as cognitive function. Affected individuals are at risk for prolonged hospitalization, falls, poor motor recovery, and discharge to nursing care.

The authors recommend that best practices in stroke rehabilitation include spatial neglect care, which can improve stroke outcomes, including motor recovery. They state that facilities incorporating assessment and treatment options in their stroke programs will find these processes bring them closer to their goals of quality improvement, lower costs of care, and improve quality of life for stroke survivors.

Drs. Barrett and Houston suggest in this article that there is sufficient evidence to support implementation of a care pathway for spatial neglect care. This may raise the standard of care, by raising awareness of the importance of integrating spatial neglect assessment in stroke rehabilitation. Available guidelines (American Heart Association, Veterans Administration, National Institute for Care and Health Excellence) recommend routine assessment for spatial neglect but do not specify diagnostic tools. Currently, an expanding network of U.S. rehabilitation facilities called Practice-RRuN, based at Kessler Foundation, implements an assessment tool based on the Catherine Bergego Scale. This assessment tool is part of the standard of care in the 14-member network.

The authors cite prism adaptation treatment as a highly feasible available treatment option. This method has been shown to improve spatial neglect symptoms, as well as performance of daily activities such as self-care, walking, wheelchair navigation, reading, and writing. “We anticipate that prism treatment will be feasible for therapists to administer,” said Dr. Barrett, “and that their time and effort will have a positive impact on the costs of care and the health and safety of stroke survivors.

To achieve optimal outcomes after stroke rehabilitation, spatial neglect research needs to be conducted in larger and more diverse study populations. Further research is needed to explore the neurobiology of spatial neglect, including brain interactions between spatial and motor systems. Incorporating neuroimaging techniques may yield biomarkers that will help identify candidates for clinical trials and treatment protocols, and may provide a way to measure the clinical course of spatial neglect and the effects of interventions.

May is Stroke Awareness Month

 

About the Center for Stroke Rehabilitation Research at Kessler Foundation

Research studies span all domains of post-stroke dysfunction, including cognitive deficits and mobility impairment. Under the direction of A.M. Barrett, MD, stroke scientists also mentor students, resident physicians, and post-doctoral trainees in translational neuroscience of rehabilitation. Cognitive research emphasizes hidden disabilities after stroke, including disabilities of functional vision (spatial bias and spatial neglect), and reading deficits. Related research addresses the risk factors for delirium and medication compliance. Mobility research, in partnership with the Center for Mobility and Rehabilitation Engineering Research, centers on the application of new technologies for restoring upper and lower limb function. Stroke research receives funding from the National Institute on Disability Independent Living and Rehabilitation Research, Department of Defense; the National Institutes of Health/NICHD/NCMRR; New Jersey Commission on Brain Injury Research, Kessler Foundation; the Healthcare Foundation of New Jersey; the Mabel Flory Trust; the Serraino Foundation, and the Wallerstein Foundation for Geriatric Improvement. Scientists have faculty appointments at Rutgers New Jersey Medical School.

 

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility, and long-term outcomes–including employment — for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand employment opportunities for people with disabilities.

 


Kessler Foundation, 15.05.2019 (tB).

Schlagwörter: ,

MEDICAL NEWS

Inadequate sequencing of SARS-CoV-2 variants impedes global response to COVID-19
New meta-analysis finds cannabis may be linked to development of…
New guidance on how to diagnosis and manage osteoporosis in…
Starting the day off with chocolate could have unexpected benefits
Better mental health supports for nurses needed, study finds

SCHMERZ PAINCARE

Versorgung verbessern: Deutsche Gesellschaft für Schmerzmedizin fordert die Einführung des…
Pflegeexpertise im Fokus: Schmerzmanagement nach Operationen
Versorgung verbessern: Bundesweite Initiative der Deutschen Gesellschaft für Schmerzmedizin zu…
Jedes vierte Kind wünscht bessere Schmerzbehandlung
Lebensqualität von Patienten in der dauerhaften Schmerztherapie mit Opioiden verbessern

DIABETES

„Wissen was bei Diabetes zählt: Gesünder unter 7 PLUS“ gibt…
Toujeo® bei Typ-1-Diabetes: Weniger schwere Hypoglykämien und weniger Ketoazidosen 
Bundestag berät über DMP Adipositas: DDG begrüßt dies als Teil…
Mit der Smartwatch Insulinbildung steuern
Verbände fordern bessere Ausbildung und Honorierung von Pflegekräften für Menschen…

ERNÄHRUNG

Wie eine Diät die Darmflora beeinflusst: Krankenhauskeim spielt wichtige Rolle…
DGEM plädiert für Screening und frühzeitige Aufbautherapie: Stationäre COVID-19-Patienten oft…
Führt eine vegane Ernährungsweise zu einer geringeren Knochengesundheit?
Regelmässiger Koffeinkonsum verändert Hirnstrukturen
Corona-Erkrankung: Fehl- und Mangelernährung sind unterschätze Risikofaktoren

ONKOLOGIE

Anti-Myelom-Therapie mit zusätzlich Daratumumab noch effektiver
Positive Ergebnisse beim fortgeschrittenen Prostatakarzinom: Phase-III-Studie zur Radioligandentherapie mit 177Lu-PSMA-617
Lymphom-News vom EHA2021 Virtual. Alle Berichte sind nun online verfügbar!
Deutsch-dänisches Interreg-Projekt: Grenzübergreifende Fortbildungskurse in der onkologischen Pflege
Sotorasib: Neues Medikament macht Lungenkrebs-Patienten Hoffnung

MULTIPLE SKLEROSE

NMOSD-Erkrankungen: Zulassung von Satralizumab zur Behandlung von Jugendlichen und Erwachsenen
Verzögerte Verfügbarkeit von Ofatumumab (Kesimpta®)
Neuer Biomarker bei Multipler Sklerose ermöglicht frühe Risikoeinschätzung und gezielte…
Multiple Sklerose beginnt oft lange vor der Diagnose
Goldstandard für Versorgung bei Multipler Sklerose

PARKINSON

Meilenstein in der Parkinson-Frühdiagnose
Parkinson-Erkrankte besonders stark von Covid-19 betroffen
Gangstörungen durch Kleinhirnschädigung beim atypischen Parkinson-Syndrom
Parkinson-Agenda 2030: Die kommenden 10 Jahre sind für die therapeutische…
Gemeinsam gegen Parkinson: bessere Therapie durch multidisziplinäre Versorgung