Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

The relationship between fractional amplitude of low-frequency fluctuations (fALFF) and the severity of neglect in patients with unilateral spatial neglect (USN) after stroke: A functional near-infrared spectroscopy study

Objective

Unilateral spatial neglect (USN) following right hemisphere stroke is more pronounced, severe, and persistent than in the left hemisphere. However, the pathophysiological mechanisms underlying USN remain largely unknown. This study aims to investigate the relationship between the fractional amplitude of low-frequency fluctuations (fALFF) in the right hemisphere of patients with post-stroke USN and the severity of neglect using resting-state functional near-infrared spectroscopy (fNIRS) technology. This could provide new theoretical insights into the subtle changes in the pathophysiology of spontaneous neural activity in brain regions of patients with USN.

Methods

Seventeen patients with post-stroke USN (USN group) and twenty-four control subjects (control group) were selected. A 22-channel fNIRS system was used to test the hemodynamic signals of the right hemisphere at rest for all subjects. Data preprocessing and analysis were performed using the NIRS-KIT toolbox. Patients in the USN group were assessed using the Behavioral Inattention Test-Conventional (BIT-C) and the Catherine Bergego Scale (CBS). Differences in fALFF values across channels between the two groups were compared, and the fALFF values from channels showing significant differences in the USN group were correlated with scores on scales evaluating the severity of USN.

Results

(1) Significant differences in fALFF values were observed between the USN and control groups in specific channels, with channels CH6 and CH11 showing significantly lower fALFF values in the USN group compared to the control group (p < 0.05), while channels CH12, CH16, and CH21 exhibited significantly higher fALFF values in the USN group (p < 0.05). (2) In patients with USN, fALFF values in CH12 were significantly negatively correlated with BIT-C scores (r = -0.4966, p = 0.0443), and fALFF values in CH21 were also significantly negatively correlated with BIT-C scores (r = -0.5270, p = 0.0318). (3) Only the fALFF values in CH21 were significantly positively correlated with CBS scores in patients with USN (r = 0.5512, p = 0.0236).

Conclusions

The severity of symptoms of neglect towards the left side in patients with USN may be related to compensatory neural functional activity in the right dorsolateral prefrontal cortex area.

A scoping review on the body awareness rehabilitation after stroke: are we aware of what we are unaware?

Body awareness (BA) is a complex multi-dimensional construct that refers to the subject's ability to consciously perceive and integrate sensory and proprioceptive information related to the position, movement, and balance of one's own body and body parts. Since it involves multiple brain regions and include different functional networks, it is very often affected by cerebrovascular damage such as stroke. Deficits in the ability to monitor our actions and predict their consequences or recognize our body parts and distinguish them from those of others may emerge after stroke. In this study, we decided to explore whether specific treatments targeting BA are discussed in current literature, and whether BA is considered as an outcome in neurorehabilitation processes for stroke patients. To achieve our goal, a scoping review on this often-underreported problem was performed. After analyzing the existing literature, emerged BA in stroke patients is rarely assessed or rehabilitated through specific stimulation or rehabilitation protocol. Additionally, treatment outcomes related to BA are often considered only from a "physical" perspective such as improvements in walking, balance, or the movement of specific body parts, rather than from a proprioceptive standpoint. Further research is needed to facilitate developing early and effective intervention strategies for the recovery of BA after stroke.

Domain-specific cognitive impairments, mood and quality of life 6 months after stroke

PURPOSE

To identify which acute and 6-month domain-specific cognitive impairments impact mood, participation, and stroke-related quality of life 6 months post-stroke.

MATERIALS AND METHODS

A prospective cohort of 430 stroke survivors completed the Oxford Cognitive Screen (OCS) acutely and 6 months post-stroke. Participants completed the Stroke Impact Scale (SIS) and Hospital Depression and Anxiety Scale (HADS) at 6 months. Multivariable regression analyses assessed whether severity of, and domain-specific, cognitive impairment acutely and at 6 months was associated with composite 6-month SIS scores, each SIS subscale, and HADS scores.

RESULTS

Increased severity of acute and 6-month cognitive impairment was associated with lower 6-month SIS composite scores independent of age, sex, education years, and stroke severity (both p < 0.001). Domain-specific impairments in memory (p < 0.001) and attention (p = 0.002) acutely, and language (p < 0.001), memory (p = 0.001) and number processing (p = 0.006) at 6 months showed the strongest associations with worse SIS composite scores. Severity of acute and 6-month cognitive impairment was associated with poorer functioning in each SIS subscale, and greater levels of depression (acute p = 0.021, 6-months p < 0.001), but not anxiety (p = 0.174, p = 0.129).

CONCLUSIONS

Both acute and 6-month domain-specific cognitive impairments, particularly in memory, were found to negatively impact overall functional and mood outcomes 6 months post-stroke.

The importance of recovering body awareness in post-stroke rehabilitation: insights from clinical case reports

Introduction

Body awareness (BA) is the process of gaining sensory awareness based on the physiological states and actions of the body. It is influenced by an individual's attitudes, perceptions, beliefs, and experiences within the social and cultural contexts. Following a stroke, impairments in BA are thought to be widespread and could have a significant impact on recovery results. Regaining body awareness, however, is often neglected in the neurorehabilitation field. This study aimed to assess body image perception in two stroke patients and the potential effect of motor and cognitive rehabilitative treatments on possible improvement of BA.

Methods

Patients were evaluated through a multidimensional neuropsychological assessment before and after a 3-month motor and cognitive rehabilitative training. Sessions were scheduled 6 times per week with a total duration of 3 h per session.

Results

After the neurorehabilitative treatment, both patients showed an improvement in BA, cognition, mood, and motor skills. Differences emerged related to the progression and improvement of their respective performances.

Discussion

The causes of these differences could include the following: different brain areas affected, the ischemic or hemorrhagic nature of the stroke, age, and sex. Further research is needed to better understand the differences and similarities in the correlations between deficit and lesional sites. Structured and early multidisciplinary intervention can certainly guarantee a better functional recovery for patients after a stroke. However, in this study we show how complementary assessment methods (such as human figure drawing) may be highly informative in choosing treatment modalities and verifying rehabilitation outcomes.

Post-stroke fatigue severity is associated with executive dysfunction in chronic stroke

Following stroke, fatigue is highly prevalent and managing fatigue is consistently rated a key unmet need by stroke survivors and professionals. Domain-specific cognitive impairments have been associated with greater fatigue severity in earlier stages of stroke recovery, but it is unclear whether these associations hold in chronic (>2 years) stroke. The present cross-sectional observational study evaluates the relationship between domain-specific cognitive functioning and the severity of self-reported fatigue among chronic stroke survivors. Participants (N = 105; mean age = 72.92, 41.90% female; mean years post-stroke = 4.57) were assessed in domains of attention (Hearts Cancellation test), language (Boston Naming Test), episodic memory (Logical Memory Test), working memory (Digit Span Backwards task), and executive functioning (set-shifting: Trail Making Test, Part B), as part of the OX-CHRONIC study, a longitudinal stroke cohort. Fatigue was assessed using the Fatigue Severity Scale. In a multiple linear regression analysis inclusive of above cognitive domains, only poorer executive functioning was associated with increased fatigue severity. This provides insight into the cognitive impairment profile of post-stroke fatigue long-term after stroke, with executive functioning deficits as the key hallmark.

Recovery of Visuospatial Neglect With Standard Treatment: A Systematic Review and Meta-Analysis

BACKGROUND

Visuospatial neglect is a common consequence of stroke and is characterized by impaired attention to contralesional space. Currently, the extent and time course of recovery from neglect are not clearly established. This systematic review and meta-analysis aimed to determine the recovery trajectory of poststroke neglect with standard treatment.

METHODS

PsycInfo, Embase, and MEDLINE were searched for articles reporting recovery rates of neglect after stroke. Time since stroke was categorized into early (0-3 months), mid (3-6 months), and late (>6 months) recovery phases. Random-effects models for pooled prevalence were generated for each phase, and potential sources of heterogeneity were explored with metaregressions. Methodological quality of each study was assessed using the Joanna Briggs Institute checklist, with low-quality studies excluded in sensitivity analyses.

RESULTS

The search captured 4130 articles including duplicates, and 111 full-text reviews were undertaken. A total of 27 studies reporting data from 839 stroke survivors with neglect were included for review. Meta-analyses indicated a recovery rate of 42% in the early phase, which increased to 53% in the mid-recovery phase. Additional recovery in the late phase was minimal, with an estimated 56% recovery rate. Heterogeneity of studies was high (I2>75%) in all 3 phases of recovery. Estimates were robust to sensitivity analyses. Metaregressions showed significantly greater recovery in studies that included patients with left-hemisphere lesions (β=0.275, P<0.05, I2=84%).

CONCLUSIONS

Most recovery from neglect occurs in the first 3 months, although additional gains can be expected up to 6 months poststroke. While a large proportion of patients recover from neglect, over 40% show persistent symptoms. Further research is needed on effective rehabilitation interventions, particularly focusing on patients most at risk of chronic visuospatial neglect.

REGISTRATION

URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023388763.

The influence of clinical characteristics on prism adaptation training in visuospatial neglect: A post-hoc analysis of a randomized controlled trial

Previous studies indicate that the effect of prism adaptation training (PAT) on unilateral neglect may depend on clinical characteristics. In this explorative work, we re-analyzed data from a previously conducted randomized controlled trial (N = 23) to investigate whether age, etiology, severity of motor impairments, and visual field deficits affect the efficacy of PAT. Additionally, we reviewed PAT studies that reported lesion maps and distinguished responders from non-responders. We transferred these maps into a common standard brain and added data from 12 patients from our study. We found patients suffering from subarachnoid bleeding appeared to show stronger functional recovery than those with intracranial hemorrhage or cortical infarction. Furthermore, patients with visual field deficits and those with more severe contralateral motor impairments had larger after-effect sizes but did not differ in treatment effects. In addition, patients with parietal lesions showed reduced recovery, whereas patients with lesions in the basal ganglia recovered better. We conclude that PAT (in its current form) is effective when fronto-subcortical areas are involved but it may not be the best choice when parietal regions are affected. Overall, the present work adds to the understanding on the effects of clinical characteristics on PAT.

Comparing the Oxford Digital Multiple Errands Test (OxMET) to a real-life version: Convergence, feasibility, and acceptability

We aimed to assess the convergence, feasibility, and acceptability of the Oxford Digital Multiple Errands Test (OxMET) and the in-person Multiple Errands Test-Home version (MET-Home). Participants completed OxMET, MET-Home, Montreal Cognitive Assessment (MoCA), and questionnaires on activities of daily living, depression, technology usage, mobility, and disability. Forty-eight stroke survivors (mean age 69.61, 41.67% female, and average 16.5 months post-stroke) and 50 controls (mean age 71.46, 56.00% female) took part. No performance differences were found for healthy and stroke participants for MET-Home, and only found below p = .05 for OxMET but not below the corrected p = .006. Convergent validity was found between MET-Home and OxMET metrics (most r ≥ .30, p < .006). MET-Home accuracy was related to age (B = -.04, p = .03), sex (B = -.98, p = .03), disability (B = -0.63, p = .04), and MoCA (B = .26, p < .001), whereas OxMET accuracy was predicted by MoCA score (B = .40, p < .001). Feedback indicated that the OxMET was easy and fun and more acceptable than the MET-Home. The MET-Home was more stressful and interesting. The MET tasks demonstrated good convergent validity, with the OxMET digital administration providing a more feasible, inclusive, and acceptable assessment, especially to people with mobility restrictions and more severe stroke.

Unilateral Spatial Neglect May Not Be Detected by Performance-Based Functional Neglect Assessment

IMPORTANCE

Unilateral spatial neglect (neglect) poststroke is disabling. It is critical that people with neglect are identified so that treatment can be provided to maximize independence. However, there is some evidence to suggest that existing assessments may not adequately measure neglect. It is unclear whether assessments also fail to identify people with neglect entirely.

OBJECTIVE

To determine whether there are stroke survivors who self-report neglect symptoms that are not detected by therapist-rated assessments and to compare self-report and therapist-ratings.

DESIGN

Cross-sectional study.

SETTING

U.S. university research center.

PARTICIPANTS

Unilateral stroke survivors (N = 133).

INTERVENTION

Not applicable.

OUTCOMES AND MEASURES

The Catherine Bergego Scale (CBS) was administered to participants and scored by a trained occupational therapist. The parallel self-evaluation anosognosia form was also administered to participants to self-report and rate neglect symptoms.

RESULTS

Forty-eight participants (36.1%) were classified as without neglect on the basis of therapist-rated total CBS scores, yet 30 (62.5%) of these 48 participants reported symptoms of neglect on the CBS self-evaluation anosognosia form. There was a significant difference (p < .001) between therapist-rated and self-rated total CBS scores.

CONCLUSIONS AND RELEVANCE

Our results indicate that many stroke survivors report some level of disability associated with neglect yet do not meet the criteria to be classified as having neglect according to a commonly used therapist-rated performance-based measure. Plain-Language Summary: The findings of this study contribute to the evidence that existing assessments used by occupational therapists to measure performance-based neglect may not always detect neglect symptoms comprehensively in people poststroke. The finding also suggest that we may be missing neglect symptoms entirely. Occupational therapists should consider using various methods to assess for neglect, including patient self-report and comprehensive occupational profiles. Clinicians should also thoroughly screen all clients with stroke for neglect, regardless of lesion location.

Domain-specific cognitive impairment 6 months after stroke: The value of early cognitive screening

BACKGROUND

Cognitive screening following stroke is widely recommended, yet few studies have considered the prognostic value of acute domain-specific function for longer-term cognitive outcome. Identifying which post-stroke cognitive impairments more commonly occur, recover, and persist, and which impairments hold prognostic value, could inform care planning, and resource allocation.

AIMS

This study aimed to determine the prevalence of domain-specific impairment acutely and at 6 months, assess the proportion of change in cognitive performance, and examine the prognostic value of acute domain-specific cognitive screening.

METHODS

A prospective stroke cohort completed the Oxford Cognitive Screen acutely (⩽2 weeks) and 6 months post-stroke. We determined the prevalence of acute and 6-month domain-specific impairment and proportion of change in performance from acute to 6 months. Hierarchical multivariable regression was used to predict global and domain-specific cognitive impairment at 6 months adjusted for demographic/vascular factors, stroke severity, and lesion volume.

RESULTS

A total of 430 stroke survivors (mean/SD age 73.9/12.5 years, 46.5% female, median/interquartile range (IQR) National Institute of Health Stroke Scale (NIHSS) 5/2-10) completed 6-month follow-up. Acutely, domain-specific impairments were highly prevalent ranging from 26.7% (n = 112) in praxis to 46.8% (n = 183) in attention. At 6 months, the proportion of domain-specific recovery was highest in praxis (n = 73, 71%) and lowest in language (n = 89, 46%) and memory (n = 82, 48%). Severity of 6-month cognitive impairment was best predicted by the addition of acute cognitive impairment (adj R2 = 0.298, p < 0.0001) over demographic and clinical factors alone (adj R2 = 0.105, p < 0.0001). Acute cognitive function was the strongest predictor of 6-month cognitive performance (p < 0.0001). Acute domain-specific impairments in memory (p < 0.0001), language (p < 0.0001), and praxis (p < 0.0001) significantly predicted overall severity of cognitive impairment at 6 months.

CONCLUSION

Post-stroke cognitive impairment is highly prevalent across all domains acutely, while impairments in language, memory, and attention predominate at 6 months. Early domain-specific screening can provide valuable prognostic information for longer-term cognitive outcomes.

Comprehensive voxel-wise, tract-based, and network lesion mapping reveals unique architectures of right and left visuospatial neglect

Visuospatial neglect is a common, post-stroke cognitive impairment which is widely considered to be a disconnection syndrome. However, the patterns of disconnectivity associated with visuospatial neglect remain unclear. Here, we had 480 acute stroke survivors [age = 72.8 (SD = 13.3), 44.3% female, 7.5 days post-stroke (SD = 11.3)] undertake routine clinical imaging and standardised visuospatial neglect testing. The data were used to conduct voxel-wise, tract-level, and network-level lesion-mapping analyses aimed at localising the neural correlates of left and right egocentric (body-centred) and allocentric (object-centred) visuospatial neglect. Only minimal anatomical homogeneity was present between the correlates of right and left egocentric neglect across all analysis types. This finding challenges previous work suggesting that right and left visuospatial neglect are anatomically homologous, and instead suggests that egocentric neglect may involve damage to a shared, but hemispherically asymmetric attention network. By contrast, egocentric and allocentric neglect was associated with disconnectivity in a distinct but overlapping set of network edges, with both deficits related to damage across the dorsal and ventral attention networks. Critically, this finding suggests that the distinction between egocentric and allocentric neglect is unlikely to reflect a simple dichotomy between dorsal versus ventral networks dysfunction, as is commonly asserted. Taken together, the current findings provide a fresh perspective on the neural circuitry involved in regulating visuospatial attention, and provide important clues to understanding the cognitive and perceptual processes involved in this common and debilitating neuropsychological syndrome.

Immersive virtual reality gameplay detects visuospatial atypicality, including unilateral spatial neglect, following brain injury: a pilot study

BACKGROUND

In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries.

METHODS

In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds.

RESULTS

The study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients-those with and without neglect.

CONCLUSION

Our research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect.

Recombination of the right cerebral cortex in patients with left side USN after stroke: fNIRS evidence from resting state

Objective

Unilateral spatial neglect (USN) is an impaired contralesional stimulus detection, response, or action, causing functional disability. After a stroke, the right hemisphere experiences USN more noticeably, severely, and persistently than the left. However, few studies using fNIRS have been reported in cases of USN. This study aimed to confirm weaker RSFC in USN and investigate the potential inherent features in hemodynamic fluctuations that may be associated with USN. Furthermore, these features were combined into a mathematical model for more accurate classification.

Methods

A total of 33 stroke patients with right-sided brain damage were chosen, of whom 12 had non-USN after stroke, and 21 had USN after stroke (the USN group). Graph theory was used to evaluate the hemodynamic signals of the brain's right cerebral cortex during rest. Furthermore, a support vector machine model was built to categorize the subjects into two groups based on the chosen network properties.

Results

First, mean functional connectivity was lower in the USN group (0.745 ± 0.239) than in the non-USN group (0.843 ± 0.254) (t = -4.300, p < 0.001). Second, compared with the non-USN group, USN patients had a larger clustering coefficient (C) (t = 3.145, p < 0.001), local efficiency (LE) (t = 3.189, p < 0.001), and smaller global efficiency (GE) (t = 3.047, p < 0.001). Notably, there were differences in characteristic path length (L) and small worldness (σ) values between the two groups at certain thresholds, mainly as higher L (t = 3.074, p < 0.001) and lower small worldness (σ) values (t = 2.998, p < 0.001) in USN patients compared with non-USN patients. Finally, the classification accuracy of the SVM model based on AUC aC (t = -2.259, p = 0.031) and AUC aLE (t = -2.063, p = 0.048) was 85%, the sensitivity was 75%, and the specificity was 89%.

Conclusion

The functional network architecture of the right cerebral cortex exhibits significant topological alterations in individuals with USN following stroke, and the sensitivity index based on the small-world property AUC may be utilized to identify these patients accurately.

Higher prefrontal activity based on short-term neurofeedback training can prevent working memory decline in acute stroke

This study aimed to clarify whether short-term neurofeedback training during the acute stroke phase led to prefrontal activity self-regulation, providing positive efficacy to working memory. A total of 30 patients with acute stroke performed functional near-infrared spectroscopy-based neurofeedback training for a day to increase their prefrontal activity. A randomized, Sham-controlled, double-blind study protocol was used comparing working memory ability before and after neurofeedback training. Working memory was evaluated using a target-searching task requiring spatial information retention. A decline in spatial working memory performance post-intervention was prevented in patients who displayed a higher task-related right prefrontal activity during neurofeedback training compared with the baseline. Neurofeedback training efficacy was not associated with the patient's clinical background such as Fugl-Meyer Assessment score and time since stroke. These findings demonstrated that even short-term neurofeedback training can strengthen prefrontal activity and help maintain cognitive ability in acute stroke patients, at least immediately after training. However, further studies investigating the influence of individual patient clinical background, especially cognitive impairment, on neurofeedback training is needed. Current findings provide an encouraging option for clinicians to design neurorehabilitation programs, including neurofeedback protocols, for acute stroke patients.

The neuroanatomy of visuospatial neglect: A systematic review and analysis of lesion-mapping methodology

While visuospatial neglect is commonly associated with damage to the right posterior parietal cortex, neglect is an anatomically heterogenous syndrome. This project presents a systematic review of 34 lesion-mapping studies reporting on the anatomical correlates of neglect. Specifically, the reported correlates of egocentric versus allocentric, acute versus chronic, personal versus extra-personal, and left versus right hemisphere neglect are summarised. The quality of each included lesion-mapping analysis was then evaluated to identify methodological factors which may help account for the reported variance in correlates of neglect. Overall, the existing literature strongly suggests that egocentric and allocentric neglect represent anatomically dissociable conditions and that the anatomy of these conditions may not be entirely homologous across hemispheres. Studies which have compared the anatomy of acute versus chronic neglect have found that these conditions are associated with distinct lesion loci, while studies comparing the correlates of peripersonal/extrapersonal neglect are split as to whether these neglect subtypes are anatomically dissociable. The included studies employed a wide range of lesion-mapping analysis techniques, each producing results of varying quality and generalisability. This review concludes that the reported underlying anatomical correlates of heterogeneous visuospatial neglect vary considerably. Future, high quality studies are needed to investigate patterns of disconnection associated with clearly defined forms of visuospatial neglect in large and representative samples.

Unilateral Spatial Neglect Recovery Poststroke

Unilateral spatial neglect (USN) is a common and disabling cognitive consequence of stroke wherein individuals demonstrate decreased response to contralesional information. Here, we provide an updated narrative review of studies that shed light on the neural mechanisms and predictors of recovery of USN. Additionally, we report a rapid review of randomized controlled trials focusing on USN intervention, both nonpharmacological and pharmacological, published in the last 5 years. Randomized controlled trials are reviewed within the context of systematic reviews and meta-analyses of USN interventions published within the same time frame. The quality of randomized controlled trials of treatment is higher compared to quality reported in previous reviews and meta-analyses. However, remaining weaknesses in participant demographic reporting, as well as small, heterogenous samples, render generalizability and cross-study interpretation a challenge. Nevertheless, evidence regarding neural mechanisms underlying USN recovery and regarding the effectiveness of targeted USN interventions is accumulating and strengthening, setting the foundation for future investigations into patient-specific factors that may influence treatment response. We identify gaps and provide suggestions for future USN intervention research.

Aligning formal and functional assessments of Visuospatial Neglect: A mixed-methods study

ABSTRACTThe occurrence of visuospatial neglect acts as a key predictor of recovery outcome following stroke. However, the specific behavioural profiles associated with various neglect subtypes are not well understood. This study aims to identify real-world functional impairments associated with neglect, to determine whether functional impairment profiles differ across patients with egocentric and allocentric neglect, and to investigate how neglect severity predicts functional impairments.Notes from 290 stroke patients' occupational therapy functional assessments were qualitatively and quantitatively analysed in the context of neglect type and severity as reported by the OCS Cancellation Task. Overall, neglect patients had more references to having difficulty initiating tasks, finding items, exhibiting spatial inattention, and having difficulty using both arms than patients without neglect. The proportion of theme references did not differ significantly across patients with egocentric and allocentric neglect. The quantitative severity of egocentric neglect was acted as a significant predictor of reference occurrence over and above stroke severity within difficulty finding items, spatial inattention, body inattention, and upper limb use.This study expands on previous findings by identifying real-world functional impairments differentiating patients with and without neglect. This data provides novel insight into the impact of neglect on functional abilities.

Validation of the UK English Oxford cognitive screen-plus in sub-acute and chronic stroke survivors

Introduction

Stroke survivors are routinely screened for cognitive impairment with tools that often fail to detect subtle impairments. The Oxford Cognitive Screen-Plus (OCS-Plus) is a brief tablet-based screen designed to detect subtle post-stroke cognitive impairments. We examined its psychometric properties in two UK English-speaking stroke cohorts (subacute: <3 months post-stroke, chronic: >6 months post-stroke) cross-sectionally.

Patients and methods

This study included 347 stroke survivors (mean age = 73 years; mean education = 13 years; 43.06% female; 74.42% ischaemic stroke). The OCS-Plus was completed by 181 sub-acute stroke survivors and 166 chronic stroke survivors. All participants also completed the Oxford Cognitive Screen (OCS) and a subset completed the Montreal Cognitive Assessment (MoCA) and further neuropsychological tests.

Results

First, convergent construct validity of OCS-Plus tasks to task-matched standardized neuropsychological tests was confirmed (r > 0.30). Second, we evaluated divergent construct validity of all OCS-Plus subtasks (r < 0.19). Third, we report the sensitivity and specificity of each OCS-Plus subtask compared to neuropsychological test performance. Fourth, we found that OCS-Plus detected cognitive impairments in a large proportion of those classed as unimpaired on MoCA (100%) and OCS (98.50%).

Discussion and conclusion

The OCS-Plus provides a valid screening tool for sensitive detection of subtle cognitive impairment in stroke patients. Indeed, the OCS-Plus detected subtle cognitive impairment at a similar level to validated neuropsychological assessments and exceeded detection of cognitive impairment compared to standard clinical screening tools.

Research hotspots and frontiers about role of visual perception in stroke: A bibliometric study

Background

Visual perception is a dynamic process of perceiving the environment through sensory input and transforming sensory input into meaningful concepts related to environmental visual knowledge. Many studies focusing on the role of visual perception after stroke have been published in various journals. However, a bibliometric analysis in the domain of visual perception after stroke is still lacking. This study aimed to deliver a visual analysis to analyze the global trends in research on the role of visual perception after stroke in the last 10 years.

Methods

The literature was derived from the Web of Science core collection database from 2012 to 2021. The collected material was limited to English articles and reviews. CiteSpace and Microsoft Excel were used for bibliographic analysis.

Results

A total of 298 articles were included in the analysis. The annual number of publications increased from 23 to 42 in the last decade. Rehabilitation was the main research hotspot (n = 85). Journal of Physical Therapy Science published the largest number of papers (n = 14). The most influential author, institution, and country were Rowe FJ (n = 17), League of European Research Universities (n = 45), and England (n = 54), respectively. The keywords with the longest burst period are field defect, hemineglect, disorder, and quality of life.

Conclusion

This study analyzes the papers on the role of visual perception after stroke in the past 10 years and provides a new perspective for research in this field. At present, the number of articles in this field is not large and the cooperation network is not close enough. In the future, it is necessary to strengthen the cooperation among various countries, institutions, and authors. In addition, large samples and randomized controlled trials are needed to identify the potential treatments and pathophysiology for visual perceptual impairment after stroke.

Assessment tools for differential diagnosis of neglect: Focusing on egocentric neglect and allocentric neglect

BACKGROUND

There are very few studies on the differential diagnosis between egocentric neglect (EN) and allocentric neglect (AN).

AIM

To investigate the overall trend of the previously developed assessment tools by conducting a descriptive review of the studies on assessment tools that can perform a differential diagnosis of EN and AN.

METHODS

The data were collected by using databases such as Google Scholar, PubMed, and ScienceDirect. The most commonly used search terms were “neglect”, “stroke”, “egocentric neglect”, and “allocentric neglect”.

RESULTS

A total of seven studies that met the inclusion criteria were selected and analyzed. We were able to confirm the research process, test method, and differential diagnosis criteria of the seven presented assessment tools from four studies on paper-based tests and three studies on computerized tests. The majority of the tests were carried out via the cancellation method using stimuli such as everyday objects or numbers. EN distinguished the left from right based on the test paper, while AN distinguished the left from right based on stimuli. In order to perform differential diagnosis, the difference in the number of left and right responses or non-responses was used based on the EN and AN criteria.

CONCLUSION

It was confirmed that all the seven assessment tools can effectively perform differential diagnosis of EN and AN. This study may provide important data that can be used in clinical practice for differential diagnosis and future intervention planning for neglect patients.

Principal Component Analysis of Oxford Cognitive Screen in Patients With Stroke

Cognitive deficits occur in most patients with stroke and are the important predictors of adverse long-term outcome. Early identification is fundamental to plan the most appropriate care, including rehabilitation and discharge decisions. The Oxford Cognitive Screen (OCS) is a simple, valid, and reliable tool for the assessment of cognitive deficits in patients with stroke. It contains 10 subtests, providing 14 scores referring to 5 theoretically derived cognitive domains: attention, language, number, praxis, and memory. However, an empirical verification of the domain composition of the OCS subtests in stroke data is still lacking in the literature. A principal component analysis (PCA) was performed on 1,973 patients with stroke who were enrolled in OCS studies in the UK and in Italy. A number of six main components were identified relating to the domains of language and arithmetic, memory, visuomotor ability, orientation, spatial exploration, and executive functions. Bootstrapped split-half reliability analysis on patients and comparison between patients and 498 healthy participants, as that between patients with left and right hemisphere damage, confirmed the results obtained by the principal component analysis. A clarification about the contribution of each score to the theoretical original domains and to the components identified by the PCA is provided with the aim to foster the usability of OCS for both clinicians and researchers.

The TWIST Tool Predicts When Patients Will Recover Independent Walking After Stroke: An Observational Study

BACKGROUND

The likelihood of regaining independent walking after stroke influences rehabilitation and hospital discharge planning.

OBJECTIVE

This study aimed to develop and internally validate a tool to predict whether and when a patient will walk independently in the first 6 months post-stroke.

METHODS

Adults with stroke were recruited if they had new lower limb weakness and were unable to walk independently. Clinical assessments were completed one week post-stroke. The primary outcome was time post-stroke by which independent walking (Functional Ambulation Category score ≥ 4) was achieved. Cox hazard regression identified predictors for achieving independent walking by 4, 6, 9, 16, or 26 weeks post-stroke. The cut-off and weighting for each predictor was determined using β-coefficients. Predictors were assigned a score and summed for a final TWIST score. The probability of achieving independent walking at each time point for each TWIST score was calculated.

RESULTS

We included 93 participants (36 women, median age 71 years). Age < 80 years, knee extension strength Medical Research Council grade ≥ 3/5, and Berg Balance Test < 6, 6 to 15, or ≥ 16/56, predicted independent walking and were combined to form the TWIST prediction tool. The TWIST prediction tool was at least 83% accurate for all time points.

CONCLUSIONS

The TWIST tool combines routine bedside tests at one week post-stroke to accurately predict the probability of an individual patient achieving independent walking by 4, 6, 9, 16, or 26 weeks post-stroke. If externally validated, the TWIST prediction tool may benefit patients and clinicians by informing rehabilitation decisions and discharge planning.

Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations

Background and purpose

Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time‐limited clinical environments.

Methods

Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations.

Results

A total of 512 articles were screened, and 42 were included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copying, reading/writing, and behavioral. Cancellation tasks were most frequently used (97.6% of studies), followed by bisection, copying, behavioral, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying, and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, the literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible.

Conclusions

This study provides consensus recommendations for rapid bedside detection of neglect in real‐world, clinical environments.