Case Report

Return to Driving In a Patient with Chronic Stroke and Unilateral Neglect Syndrome

Author: Laura Zajac-Cox

Background and Purpose: Unilateral neglect syndrome is a common issue following stroke correlated with poor prognosis for recovery of independent functioning including driving. The purpose of this case report is to describe an episode of physical therapy in which a multi-modal treatment approach was utilized resulting in return to driving for an individual who experienced a right hemispheric ischemic stroke with associated left unilateral neglect syndrome. An overview of the clinical assessments, plan of care, patient and family centered goal setting, intervention strategies, and use of the International Classification of Functioning, Disability and Health to guide patient management, are provided. Case Description: The patient was a 67-year-old male post ischemic stroke. Although this patient was physically high functioning following the stroke, the presence of unilateral neglect syndrome required him to have assistance with instrumental activities of daily living and precluded him from driving. Driving was the primary goal identified by the patient and his care partners, therefore the physical therapy plan of care was structured around skills required for this task such as motor control, visual attention, sensory awareness, and spatial perception. Outcomes: The patient demonstrated improvement in visuospatial awareness, reaction time and accuracy, attention, sensory awareness and coordination. Upon re-evaluation, the patient was deemed to be safe to drive with limitations. Discussion: In a patient with chronic stroke, a multi-modal approach to treating unilateral neglect syndrome achieved the outcome of safe return to driving. Appropriate early identification and documentation of neglect, specialized multidisciplinary assessment and patient and family centered