Stroke: spatiomotor cueing speeded rehabilitation in patients with visual neglect.

Clinical bottom line (level 1b-)

  1. Patients with partial anterior circulation infarction and visual neglect who were given spatiomotor cueing as part of rehabilitation therapy, had no clear difference in mortality or proportion discharged home, than those given conventional rehabilitation.
  2. Patients with visual neglect after stroke who were given spatiomotor cueing had a shorter mean stay in hospital.
Kalra et al: Stroke 1997; 28: 1386-1391
Expires December 2002

The study

Single-blinded ?concealed randomised trial with intention-to-treat
Setting: stroke unit, UK

150 patients (aged mean 78 years, 62% female) Stroke with partial anterior circulation infarction determined according to clinical and radiological criteria, and a score of 3 to 6 on a validated scale (concerning impairments in power, balance, proprioception and cognition) at weeks 1 to 2 after stroke, and with visual neglect (identified with multidisciplinary assessments, including visual and sensory confrontation tests, line bisection test and observation of patients during activities using structured observational test for function).

Excluded if
  • TIA or reversible neurological deficits
  • hemianopsia or severe dysphasia


    • Note:
  • Some patients with severe visual neglect could have been misdiagnosed as having hemianopsia and excluded unintentionally.


    • Control Group: (n = 25, 23 analysed): conventional therapy concentrating on restoration of normal tone, movement patterns, and motor activity before addressing skilled functional activity
    Experimental Group: (n = 25, 24 analysed): modified approach to rehabilitation involving spatiomotor cueing based on the 'attentional-motor integration' model and early emphasis on restoration of function

    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    mortality unknown 2
    (8.00%)    		 1
    (4.00%)    		 50.0%
    (-417% to 95.0%)    		 4.00%
    (-9.12% to 17.1%)    		 25
    (NNT = 6 to infinity;
    NNH = 11 to infinity)
    discharged home unknown 14
    (56.0%)    		 16
    (64.0%)    		 18%
    (-62% to 59%)    		 8.00%
    (-19.07% to 35.07%)    		 13
    (NNT = 5 to infinity;
    NNH = 3 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    median Barthel Activities of Daily Living index score 12.5 (range 4 - 16)
    ()     		14 (range 9 - 18)
    ()     		1.5
    ( to )
    median hospital stay (days) 66 (range 22 - 81)
    ()     		42 (range 7 - 73)
    ()     		24
    ( to )

    Citation

    1. Kalra L, Perez I, Gupta S, et al: The influence of visual neglect on stroke rehabilitation. Stroke 1997; 28: 1386-1391
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient stroke with visual neglect
    Intervention or Exposure modified rehabilitation approach
    Comparison conventional rehabilitation
    Outcome rehabilitation