Impact of Neglect on the Relationship Between Upper Limb Motor Function and Upper Limb Performance in the (Hyper)acute Poststroke Phase

Visuospatial neglect (VSN) is a negative, strong, and independent predictor of poor outcome after stroke, and is associated with poorer upper limb (UL) motor recovery in terms of function or capacity (ie, in standardized, lab-based testing). Although the main aim of stroke rehabilitation is to re-establish optimal functioning in daily life, the impact of VSN on UL performance (ie, in unstructured, everyday environments) is largely unknown. In this proof of principle study, the impact of VSN on the strength of the association between UL motor function (Jamar Hand Dynamometer) and UL performance (Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale) was investigated in 65 (hyper)acute first-ever stroke patients. In a moderator analysis, the interaction term was negative and significant, showing that VSN suppresses the use of UL motor function in daily life (ie, performance). This finding suggests that, when considering UL performance in the (hyper)acute phase after stroke, interventions aimed to reduce deficits in both UL motor function and visuospatial function should already be started in the acute stroke unit setting.