Abstract
Conflicting opinions have been expressed concerning optimal bed orientation for patients with stroke and homonymous hemianopsia (HHA) or visual neglect (VN). Some advocate that the bed be oriented so that the patient's impaired hemifield is directed toward the side of stimulation (door, bathroom, night table, telephone, visitor's chair) to force the patient to search into the affected field. Others advocate that the patient's bed be oriented so they can take maximum benefit from the stimuli directed toward the patient's unaffected visual field. We have been unable to find data to support either of these opinions. We therefore randomized 44 consecutive patients with unilateral hemispheric stroke having HHA or VN to beds oriented with the above-mentioned environmental stimuli either contralateral to the side of infarct (CS) or ipsilateral to the side of infarct (IS). Visual field deficits were assessed by confrontation testing. Patients were said to have HHA if they failed to detect unilateral finger movement 30° off midline. Patients were said to have VN if they detected unilateral stimuli but extinguished bilateral, simultaneously presented stimuli. There was no significant difference in any of the outcome measures for CS versus IS for the group as a whole, for the subgroup with HHA, or for those with VN: initial Barthel score, final Barthel score, change in Barthel score, home versus skilled nursing facility placement, number of falls, duration of rehabilitation hospital stay. We conclude that the bed orientation of patients with stroke and HHA or VN is not related to rehabilitation outcome during the subacute phase post-stroke.