Hartman-Maeir A, Soroker N, Oman S D, Katz N
School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Disabil Rehabil. 2003 Jan 7;25(1):35-44.
To investigate the frequency of unawareness of disabilities after stroke during the rehabilitation stage, the relationship of unawareness with neuroanatomical variables, and the impact of unawareness on functional outcomes.
Sixty consecutive patients (36 with right, 24 with left hemisphere damage) admitted to rehabilitation hospital with a first, single, unilateral stroke were evaluated at admission, discharge and at 1-year post onset of stroke. Unawareness of disabilities was operationally defined as the discrepancy between therapist and patient's rating on the motor scale of the functional independence measure (FIM). Functional outcomes included FIM, instrumental activities of daily living (IADL) scale, activity card sort (ACS) and safety rating scale.
Unawareness of disabilities was found in 44/60 patients at admission and 24/57 at discharge. There was no significant difference between the hemisphere groups in the frequency of unawareness at both times. Discharge unawareness in the right hemisphere group was significantly associated with lesions in the frontal and temporal lobes, and with lesion size. Unawareness in the left hemisphere damaged group was not associated with any neuroanatomical variables. A negative impact of unawareness at admission on functional outcomes was not found, but it was found that unawareness at discharge was a negative predictor of activity level (ACS score) at follow up, after controlling for the severity of initial disability level.
Unawareness of disabilities is a significant issue in stroke rehabilitation. Unawareness that persists to discharge from rehabilitation correlates with neuroanatomical variables in right hemisphere damaged patients, and is a negative predictor for some rehabilitation outcomes at follow-up.
调查中风康复阶段残疾失认的发生率、失认与神经解剖学变量的关系，以及失认对功能结局的影响。
连续纳入60例首次发生单侧中风并入住康复医院的患者（36例右侧半球损伤，24例左侧半球损伤），在入院时、出院时及中风发病后1年进行评估。残疾失认在操作上定义为治疗师与患者在功能独立性测量（FIM）运动量表上评分的差异。功能结局包括FIM、日常生活活动能力量表（IADL）、活动卡片分类（ACS）和安全评定量表。
入院时44/60例患者存在残疾失认，出院时24/57例存在残疾失认。两个半球组在这两个时间点的失认发生率无显著差异。右侧半球组出院时的失认与额叶和颞叶病变及病变大小显著相关。左侧半球损伤组的失认与任何神经解剖学变量均无关联。未发现入院时的失认对功能结局有负面影响，但发现在控制初始残疾严重程度后，出院时的失认是随访时活动水平（ACS评分）的负性预测因素。
残疾失认是中风康复中的一个重要问题。持续到康复出院时的失认与右侧半球损伤患者的神经解剖学变量相关，并且是随访时一些康复结局的负性预测因素。
