Anosognosia for Hemiplegia in Stroke Rehabilitation

Abstract

Objective: The purpose of this study was to investigate anosognosia for hemiple gia (AHP) in the rehabilitation phase after onset of stroke. Methods: Forty-six hemi plegic stroke patients, 29 with right hemisphere damage (RHD) and 17 with left hemi sphere damage (LHD) were evaluated ∼1 month after onset of stroke. Anosognosia was evaluated with an implicit measure designed to assess anosognosic behaviors (choosing between unimanual and bimanual tasks), in addition to a traditional ex plicit verbal measure. Results: AHP was found m 28% of the RHD and 24% of the LHD group. The majority of patients with AHP in the RHD group had large lesions involving the frontal, parietal, or temporal lobes and had coexisting sensory deficits and unilateral spatial neglect, whereas the LHD patients with AHP had predominantly small subcortical lesions and no sensory or attentional deficits. The functional out comes of AHP patients in both hemisphere groups revealed their inability to retain safety measures at discharge from rehabilitation (p < 0.036) and their need for assis tance in basic and instrumental activities of daily living at follow-up. Conclusions: AHP presents a significant risk for negative functional outcome in stroke rehabilita tion. The underlying mechanisms of AHP may be different for left and right hemi sphere patients, therefore requiring different intervention approaches. Key Words: Anosognosia—Cerebrovascular accident—Rehabilitation outcome.