To investigate two approaches to treating patients with persistent dressing problems
and cognitive difficulties following stroke.
Pilot randomized controlled trial.
Inpatient stroke rehabilitation service.
Seventy consecutive stroke patients with persistent dressing problems and accompanying
cognitive difficulties at two weeks after their stroke.
Patients were randomly allocated to six weeks of either a systematic neuropsychological
approach, based on analysis of dressing problems and further cognitive testing, or to
the control group who received conventional (functional) dressing practice. Both groups
received treatment three times a week in accordance with two separately prepared
Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer
test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after
randomization by an independent assessor masked to group allocation.
Both neuropsychological and functional groups improved performance on the NSDA over the
treatment period (31% and 22%, respectively) but there was no significant difference
between groups at six weeks. However, the neuropsychological group showed a
significantly greater improvement on a line cancellation test of visual neglect
(t(62) = 2.1, P < 0.05) and a planned subanalysis
for those with right hemisphere damage showed a trend towards better dressing outcome
(P = 0.07, one-tailed).
Results demonstrate the potential benefits of a systematic neuropsychological approach
to dressing therapy, particularly for patients with right hemisphere damage. This study
suggests the need for a phase III study evaluating the efficacy of a systematic
neuropsychological approach in treating dressing difficulties, targeting patients with
right hemisphere stroke and visuospatial impairments.