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Background Visuospatial neglect (VSN) is a cognitive disorder after stroke in which patients fail to consciously process and interact with contralesional stimuli. Visual Scanning Training (VST) is the recommended treatment in clinical guidelines. At the moment, several mixed reality versions of Visual Scanning Training (VST) are being developed. The aim of this study was to explore the opinions of end-users (i.e., therapists) on the use of Virtual Reality (VR) and Augmented Reality (AR) in VSN treatment. Methods Therapists played one VR and two AR Serious Games, and subsequently filled out a questionnaire on User Experience, Usability, and Implementation. Results Sixteen therapists (psychologists, occupational, speech, and physiotherapists) played the games, thirteen of them evaluated the games. Therapists saw great potential in all three games, yet there was room for improvement on the level of usability, especially for tailoring the games to the patient’s needs. Therapists’ opinions were comparable between VR and AR Serious Games. For implementation, therapists stressed the urgency of clear guidelines and instructions. Discussion Even though VR/AR technology is promising for VSN treatment, there is no one-size-fits-all applicability. It may thus be crucial to move towards a plethora of training environments rather than a single standardized mixed reality neglect treatment. Conclusion As therapists see the potential value of mixed reality, it remains important to investigate the efficacy of AR and VR training tools.

In the first part of my thesis no hand lateralization effect was found, neither did it matter whether the illusion was applied to the left or the right hand. I believe that feelings of body ownership may not be as lateralized as current literature indicates and that hand representations in the brain might be equal for the left and right hand during the rubber hand illusion. Next, results indicated that actual touch to induce ownership over a fake hand was not necessary. I therefore suggest that our brain uses bottom–up multisensory information, as well as top-down predictions about anticipated sensory input to represent our hand. I furthermore showed that synchronous multisensory stimulation as opposed to asynchronous stimulation is able to shift the perceived action space towards the fake hand. Critically, the subjective experience of the illusion did not correlate with this shift in space, however proprioceptive drift did. Thus, it seems likely that multisensory integration of bodily information drives this shift in PPS and not feelings of ownership per se. Lastly, results showed that we perceive our hands as highly distorted; an overestimation of width and an underestimation of length. The overall shape of the hand was perceived wider than it is long. What was surprising is that this shape was robust to most sensory modulations. However, when the finger moved, perceived distortions became slightly more apparent. Overall, I conclude that implicit representation of our hand relies on a stored body-model, which seems unaffected by the modulation of sensory input. In the second part I found that patients with somatosensory deficits perceive their hand as (normally) distorted as healthy individuals do; wide short hands. A few patients perceived their affected hand as disproportionally large, which I believe is linked to diminished body awareness, and sensorimotor deficits. As expected, most patients had a veridical percept of their conscious hand as assessed with the

Previous research suggests that attention is drawn by self-related information. Three online experiments were conducted to investigate whether self-related stimuli alter visuospatial perceptual judgments. In a matching task, associations were learned between labels ('Yourself'/friend/stranger's name) paired with cues. Cues were coloured outlines (Experiment 1, N = 135), geometric shapes (Experiment 2, N = 102), or coloured gradients (Experiment 3, N = 110). Visuospatial perception bias was measured with a greyscales task. Cues were presented prior to, and/or alongside greyscales. We hypothesized there would be a bias towards the self-related cue. In all experiments, we found a self-related bias in the matching task. Furthermore, there was an overall leftward visuospatial perceptual bias (pseudoneglect). However, we found anecdotal to moderate evidence for the absence of an effect of self-related cues on visuospatial perception judgments. Although self-related stimuli influence how our attention is oriented to stimuli, attention mechanisms that influence perceptual judgements are seemingly not affected by a self-bias.

Objective: To review the current evidence on the efficacy of transcranial magnetic stimulation as a therapeutic strategy in visuospatial neglect in post-stroke patients. Methods: Between January and February 2021, a systematic search was carried out in different databases, obtaining a total of 161 articles, of which only 11 studies were included. Results: The sum of these results generated a sample of 298 participants with right stroke. In all studies, stimulation was applied to the posterior parietal cortex; however, the stimulation pattern varied between transcranial magnetic stimulation and Theta-burst stimulation. As for the tests selected to confirm the presence or absence of neglect, the researchers mainly chose the line bisection test and the star cancellation test. Conclusions: The results suggest that the use of transcranial magnetic stimulation is effective in reducing the severity of neglect after stroke. However, the limitations found make it impossible to ensure its efficacy and further research is needed., Objetivos: revisar le evidencia actual sobre la eficacia de la estimulación magnética transcraneal, como estrategia terapéutica en la negligencia visuoespacial en pacientes post-ictus. Métodos: entre enero y febrero del 2021 se realizó una búsqueda sistemática en diferentes bases de datos obteniendo un total de 161 artículos, de los cuales, únicamente 11 estudios son incluidos. Resultados: la suma de estos generó una muestra de 298 participantes con ictus derecho. En todos los estudios la estimulación se aplicó en la corteza parietal posterior, sin embargo, el patrón de estimulación fue variante entre la estimulación magnética transcraneal y la de tipo Theta-burst. En cuanto a las pruebas seleccionadas para ratificar la presencia o no de negligencia, las investigaciones se decantaron principalmente por el test de bisección de líneas y el test de cancelación de estrellas. Conclusiones: los resultados sugieren que el uso de la estimulación magnética transcraneal es eficaz para reducir la gravedad de la negligencia después de un ictus. Sin embargo, las limitaciones encontradas imposibilitan asegurar su eficacia y se requieren más investigaciones.

BACKGROUND: Although previous narrative reviews have highlighted a potential association between visuospatial neglect (VSN) and balance disorders, to what extent different areas of balance and mobility could be affected is still unclear.OBJECTIVES: This systematic review updates previous literature findings and systematically reviews sitting balance, standing balance and mobility outcomes.METHODS: PubMed, Web of Science, ScienceDirect, Naric-Rehabdata, PEDro and the Cochrane Trials Library were systematically searched. Methodological quality was assessed by the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The association between VSN and sitting balance, standing balance and mobility (walking, stair climbing/descending and transfers) was investigated.RESULTS: In total, 48 studies were included (4595 stroke survivors): at least 1319 (29%) showed symptoms of VSN. VSN was associated with less independence during sitting, with an asymmetric posture toward the affected body side. For standing balance, we revealed a significant negative association between VSN and mediolateral stability and weight shifting, whereas only activities of daily living-related VSN was associated with weight-bearing asymmetry during static stance. While walking, patients with VSN laterally deviated from their path. Results were inconclusive regarding other aspects of mobility. The association between VSN and balance/mobility seemed to decrease over time.CONCLUSIONS: Despite great heterogeneity in results, this study suggests that stroke survivors with VSN show specific deviations in posture and movement in the mediolateral direction. Although the association between VSN and balance/mobility has been extensively investigated, explanatory studies evaluating underlying mechanisms of the frequently present association are lacking. Future studies should address this by combining clinical and instr

[Resumen] INTRODUCCIÓN: Los ACV son considerados la causa más importante de discapacidad a largo plazo en el adulto. Entre sus alteraciones neurológicas más comunes, se encuentra la negligencia visuoespacial (NVE) con una incidencia acumulada de más del 40%. Esta revisión, se centra en las técnicas de estimulación cerebral no invasiva, concretamente en la estimulación magnética transcraneal (EMT), como estrategia terapéutica en la NVE en pacientes post-ictus. OBJETIVOS: El objetivo de este trabajo es revisar la evidencia actual sobre la efectividad de la EMT en el tratamiento de la NVE tras un ictus. METODOLOGÍA: entre enero y febrero del 2021 se realizó una búsqueda sistemática de estudios que utilizaban la EMT en pacientes que, tras un ictus, presentaban NVE. Para hacer efectiva la búsqueda, se revisaron las bases de datos PubMed, WOS, Scopus, CINHAL, Tripdatebase y Embase, y se hizo uso de la técnica “bola de nieve”. RESULTADOS: se obtienen 161 artículos, de los cuales, tras el proceso de cribado son incluidos 11 estudios. La suma de estos genera una muestra de 298 participantes con ACV derecho. La totalidad de la estimulación se aplicó en la corteza parietal posterior, sin embargo, el patrón de estimulación varió entre los estudios, 4 se decantaron por EMTr y los 6 restantes por TBS. La mayoría de los investigadores se inclinaron para ratificar la presencia de negligencia por: test de bisección de líneas y test de cancelación de estrellas. CONCLUSIONES: los resultados de esta revisión sistemática sugieren que el uso de la EMT es eficaz para reducir la gravedad de la NVE después de un ictus. Sin embargo, varias limitaciones hacen imposible asegurar su eficacia y se requieren más investigaciones que recojan más información y garanticen la fiabilidad del tratamiento., [Resumo] INTRODUCIÓN: os ACV son considerados a causa máis importante de discapacidade a longo prazo no adulto. Entre as súas alteracións neurolóxicas máis comúns, atópase a neglixencia visuoespacial (NVE) cunha incidencia acumulada de máis do 40%. Esta revisión, céntrase nas técnicas de estimulación cerebral non invasiva, concretamente na estimulación magnética transcraneal (EMT), como estratexia terapéutica na NVE en pacientes postictus. OBXECTIVOS: o obxectivo deste traballo é revisar a evidencia actual sobre a efectividade da EMT no tratamento da NVE tras un ictus. METODOLOXÍA: entre xaneiro e febreiro do 2021 realizouse unha procura sistemática de estudos que utilizaban a EMT en pacientes que, tras un ictus, presentaban NVE. Para facer efectiva a procura, revisáronse as bases de datos PubMed, WOS, Scopus, CINHAL, Tripdatebase e Embase, e fíxose uso da técnica “bóla de neve”. RESULTADOS: obtéñense 161 artigos, dos cales, tras o proceso de cribado son incluidos 11 estudos. A suma destes xera unha mostra de 298 participantes con ACV dereito. A totalidade da estimulación aplicouse na cortiza parietal posterior, con todo, o patrón de estimulación variou entre os estudos, 4 decantáronse por EMTr e os 6 restantes por TBS. A maioría dos investigadores inclinándose para ratificar a presenza de neglixencia por: test de bisección de liñas e test de cancelación de estrelas. CONLCUSIÓNS: os resultados desta revisión sistemática suxiren que, o uso da EMT é eficaz para reducir a gravidade da NVE despois dun ictus. Con todo, varias limitacións fan imposible asegurar a súa eficacia, e requírense máis investigacións que recollan máis información e garantan a fiabilidade do tratamento., [Abstract] INTRODUCTION: stroke is considered the most important cause of longterm disability in adults. Among it’s most common neurological disorders is visuospatial neglect (VSN) with acumulative incidence of more than 40%. This review focuses on non-invasive brain stimulation techniques, specifically transcranial magnetic stimulation (TMS), as a therapeutic strategy for VNS in postictus patients. OBJECTIVES: the aim of this study is to review the current evidence on the effectiveness of TMS in the treatment of post-stroke VNS. METHODOLOGY: A systematic search for studies using TMS in post-stroke patients with VNS was conducted between January and February 2021. In order to carry out the search, PubMed, WOS, Scopus, CINHAL, Tripdatebase and Embase databases were reviewed and the "snowballing” technique was used. RESULTS: 161 articles were obtained, of which 11 studies were included after the screening process. The sum of these results in a sample of 298 participants with right stroke. All stimulation was applied to the posterior parietal cortex, however, the pattern of stimulation varied between studies, 4 opted for rTMS and the remaining 6 for TBS. Most of the researchers opted for: line bisection test and star cancellation test to confirm the presence of neglect. CONCLUSIONS: the results of this systematic review suggest that the use of TBS is effective in reducing the severity of EVN after stroke. However, several limitations make it impossible to ensure it’s efficacy and further research is needed to gather more information and ensure the reliability of the treatment.

Visuospatial neglect (VSN) is characterized by a lateralized attentional deficit in the visual domain. In addition, patients with VSN might have an impairment in the temporary storage of spatial information in working memory (spatial working memory; SWM) that, like VSN, could impair systematic searching behavior. Several studies have demonstrated either SWM impairments or impaired searching behavior in VSN patients. Here, we related SWM performance to search behavior in patients with and without VSN. We assessed SWM using a novel task in a group of 182 stroke patients (24 with VSN, 158 without) and 65 healthy controls. We related SWM performance to available stroke-related and cognitive data. Patients with VSN exhibited lower SWM performance than patients without VSN and healthy controls. Additional control analyses indicated that differences in SWM performance are specific to visuospatial processing, instead of e.g. verbal working memory or the general level of physical disability. Last, we related SWM performance to visual search performance on cancellation tasks, one where their cancellation markings remained visible and another one where their prior cancellations markings were invisible to the patient and therefore patients had to remember which targets they had canceled. SWM performance correlated with search organization. Together, these results from a large sample of stroke patients corroborate the findings of earlier studies, while excluding several alternative explanations: SWM impairment is a part of the neglect syndrome, and SWM impairments are related to search behavior.

Objectives Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age < 65 versus ≥ 65 years. Methods PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. Results Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age ≥ 65), and 2 on caregiver burden (1 study with mean age ≥ 65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences. Conclusions and implications VSN has a negative impact not only on patients’ independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN during rehabilitation should be systematically and carefully assessed. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice.

Spatial neglect is a debilitating disorder frequently observed after damage to the right cerebral hemisphere. Previous investigations have revealed that prism adaptation (PA) therapy can lead to improvements in neglect-related symptoms. In the typical PA protocol patients repeatedly point toward a visual target while wearing prism goggles. A few years ago, a novel PA procedure, involving a variety of more “ecological” visuo-motor activities during adaptation, less repetitive than a sequence of pointings, was introduced by our research group, and shown to be able to improve neglect-related symptoms to the same extent as the standard pointing task. The ecological procedure was easy to administer and pleasant for the patients. In all previous studies, patients were treated by specialized personnel during hospitalization. In the current study, we investigated the effectiveness of the ecological PA method when performed in a home-based setting, with the help of caregivers and family members. Seven right-brain-damaged patients with chronic left spatial neglect underwent a two-week ecological PA treatment, extended, for two extra weeks, in 6 patients, who were available for this additional rehabilitation session. As a control treatment, patients performed the same activities while wearing neutral goggles, before the PA procedure. Two weeks of ecological PA training proved to be able to significantly improve performance in neuropsychological tests (BIT, Cancellation tasks), a neurological scale (NIH), and functional abilities (CBS), when compared to both the baseline and the neutral control treatment, with improvements being maintained over 6 months. The ecological home-based PA training is effective in alleviating signs of spatial neglect. Importantly, this training is affordable, pleasant, and feasible to be performed in the comfort of the patient's home. Easily extendable to larger patient populations and prolonged periods, this method has a real potential to benefit the

Patients with visuospatial neglect (VSN) suffer from an imbalance in visual attention between their left and right (egocentric or allocentric) hemispace. The view of VSN as an attentional imbalance between two hemispaces ignores the fact that—in our daily life—we are presented with varying levels of stimulus density, within but also across hemispaces. Therefore, we developed a novel experimental paradigm in which stroke patients (n = 207) were presented with a different number of simple objects in the left and right (egocentric) hemispaces and were asked to indicate whether there were more objects in the left or the right hemispace. We systematically varied the density of visual stimuli to investigate whether a high level of stimulus density impairs task performance of patients with VSN to a larger degree than it does for patients without VSN. Error rate increased when more objects were presented in the display, but this effect was most pronounced in patients with VSN, especially when more objects were presented in their contralesional than in their ipsilesional hemispace. Our findings reveal that deficits in early visual processing in patients with VSN become especially apparent when overall stimulus density is high. The degree of stimulus density should therefore be taken into account when considering the impact of attentional deficits on activities in daily life.

Objectives: The purpose of this pilot study was to investigate the feasibility and effects of computer-based cognitive rehabilitation (CBCR) in patients with symptoms of visuospatial neglect or homonymous hemianopia in the subacute phase following stroke. Method: A randomized, controlled, unblinded cross-over design was completed with early versus late CBCR including 7 patients in the early intervention group (EI) and 7 patients in the late intervention group (LI). EI received CBCR training immediately after inclusion (m = 19 days after stroke onset) for 3 weeks and LI waited for 3 weeks after inclusion before receiving CBCR training for 3 weeks (m = 44 days after stroke onset). Results: CBCR improved visuospatial symptoms after stroke significantly when administered early in the subacute phase after stroke. The same significant effect was not found when CBCR was administered later in the rehabilitation. The difference in the development of the EI and LI groups during the first 3 weeks was not significant, which could be due to a lack of statistical power. CBCR did not impact mental well-being negatively in any of the groups. In the LI group, the anticipation of CBCR seemed to have a positive impact of mental well-being. Conclusion: CBCR is feasible and has a positive effect on symptoms in patients with visuospatial symptoms in the subacute phase after stroke. The study was small and confirmation in larger samples with blinded outcome assessors is needed.

Objectives: To identify studies concerning the effects of computer based cognitive rehabilitation (CBCR) on visuospatial neglect (VN) after stroke to summarize the current state of knowledge in this research field and make recommendations for future research. Methods: Four electronic databases were systematically searched. Authors of relevant studies were contacted to detect unpublished data or articles not found by searching databases. Data was extracted from included studies using predefined coding schemes and characteristics and results of individual studies were summarized qualitatively. Selection criteria: Studies were included if at least 50% of the included patients had a stroke, if the studies explored the effects of CBCR as a primary intervention for rehabilitation of VN and if they included neuropsychological outcome measures for the presence of VN. Results: Seven studies were included. Six of the seven studies suggested positive effects of CBCR on VN after stroke. However, the study that did not find these effects was also the study with the strongest methodological quality. All included studies consisted of small samples, varied greatly in design and had various methodological limitations. Conclusion: Because the existing literature is very sparse and studies have various methodological limitations, it is currently not possible to either support or reject the effects of CBCR on VN after stroke. Future studies should aim to compare CBCR with active and passive control conditions and include larger samples in randomized and blinded designs.

Visuospatial neglect is not a unitary phenomenon, but can be better considered a syndrome, consisting of a multitude of different spatial and non-spatial components. In this study, we used a temporal order judgement (TOJ) test in a large sample of stroke patients (n = 73) to scrutinize the contribution of a spatial bias to the performance on shape cancellation and line bisection tests. In the TOJ test, patients were presented with two elements, one in each visual field, after which the one needed to indicate which of the two elements was presented earlier. For each visual field, the presentation of the stimuli was determined by a staircase procedure where the interval between the two stimuli was determined by the performance of the patient. Results indicated that the strength of the spatial bias was strongly correlated with an object cancellation test, but not with a line bisection test. We argue that these findings are explained by differences in the extent to which a spatial bias determines performance on both tasks: In contrast to shape cancellation tests, successful performance on line bisection tests depends primarily on an object-based, allocentric representation of space, unrelated to any spatial bias in the detection of elements in the contralesional visual field.

Introduction: Visual neglect is a frequent disorder following stroke and is often diagnosed by neuropsychological assessment. However, paper-and-pencil tasks have low predictive value as they lack sensitivity to capture neglect in complex, dynamic situations, such as activities of daily living. Aims of the current study were to assess the feasibility of the Mobility Assessment Course (MAC), a visual search multitask, to assess neglect, and its relation with existing neglect tasks. Method: Stroke patients admitted for inpatient rehabilitation and healthy controls were tested with the MAC in different corridors. Participants had to move through a corridor, finding and reporting 24 targets attached to the walls. In addition, the shape cancellation, line bisection, and Catherine Bergego Scale (CBS) were used in order to compare the MAC with existing diagnostic tools for neglect. Results: Administering the MAC was feasible, as 112 of 113 patients completed the MAC with a median duration of 4.09 min. Depending on the corridor where the assessment took place, in 88.5–93.3% of assessments all targets were visible. The number of omissions (total and contralesional) and the asymmetry score (contralesional–ipsilesional omissions) on the MAC as well as collisions and corrections, were higher for patients with neglect than for those without neglect. Depending on the neglect task used, 4.0–18.6% of patients without neglect on neuropsychological tasks or the CBS showed neglect on the MAC. Vice versa, 17.2–29.3% of patients who showed neglect at neuropsychological assessment or the CBS did not do so on the MAC. Finally, a moderate to strong positive relation was seen between neglect at neuropsychological assessment, the CBS, and the MAC. Conclusions: The MAC is an ecological task in which both quantitative and qualitative data on neglect can be collected. In order to assess the presence of neglect and neglect severity in a dynamic way, the MAC could be administered in conjunctio

Objectives The aims of the current review were (1) to give an overview of human studies investigating pharmacotherapy to ameliorate visuospatial neglect and (2) to evaluate the quality of those studies. Methods A systematic literature search using PubMed, Scopus, and ResearchGate was conducted in regard to studies that evaluated pharmacological interventions aiming to ameliorate poststroke visuospatial neglect. The search was limited in the following features: species (human), adults (≥18 years of age), language (English), and type of neglect (visuospatial). Two independent authors extracted data on study content and effectiveness and evaluated the quality of studies and methods. Results A total of 11 studies were identified. Three studies were considered to be of moderate quality, the others of low quality. Seven studies represented dopaminergic treatment; 3 studies represented cholinergic treatment; and 1 study represented noradrenergic treatment. Three dopaminergic studies showed primarily positive effects of dopaminergic stimulation on visuospatial neglect, whereas three others showed adverse effects. All 3 cholinergic studies found positive effects in some outcome measures concerning visuospatial neglect. Noradrenergic stimulation improved maintenance of attention when exploring space. Conclusions Currently, cholinergic therapy might be the best option for future research. However, we must emphasize the explorative nature and the limited quality of the reviewed studies.

Background and objective. Proportional recovery of upper-extremity motor function and aphasia after stroke may suggest common mechanisms for spontaneous neurobiological recovery. This study aimed to investigate if the proportional recovery rule also applies to visuospatial neglect (VSN) in right-hemispheric first-ever ischemic stroke patients and explored the possible common underlying mechanisms. Methods. Patients with upper-limb paresis and VSN were included. Recovery defined as the change in Letter Cancellation Test (LCT) score at ∼8 days and 6 months poststroke. Potential recovery defined as LCTmax-LCTinitial = 20 â' LCTinitial. Hierarchical clustering separated fitters and nonfitters of the prediction rule. A cutoff value on LCTmax-LCTinitial was determined. The change in LCT and Fugl-Meyer Assessment Upper Extremity was expressed as a percentage of the total possible score to investigate the communality of proportional recovery. Results. Out of 90 patients, 80 displayed proportional recovery of VSN (ie, "fitters," 0.97; 95% CI = 0.82-1.12). All patients who did not follow the prediction rule for VSN (ie, "nonfitters") had ≥15 missing O's at baseline and failed to show proportional recovery of the upper limb. Conclusions. This study shows that the proportional recovery rule also applies to patients with VSN poststroke. Patients who fail to show proportional recovery of VSN are the same patients who fail to show proportional recovery of the upper limb. These findings support the idea of common intrahemispheric mechanisms underlying spontaneous neurobiological recovery in the first months poststroke. Future studies should investigate the prognostic clinical and neurobiological markers of these subgroups.

Objective The goal of this review consists of showing the different interventions that could be apply from the field of the Occupational Therapy for the rehabilitation of the neglect syndrome in people who have suffered a sudden stroke. Methods It was carried out a bibliographic review of the different existing interventions in the neglect syndrome through the following databases: PubMed, OTseeker, Dialnet, Medline, Elsevier y PEDro. Moreover, for the selection of the articles used in this project, it has been taken into account the inclusion criteria as well as the exclusion criteria. Results In all, 14 articles have been selected to make the bibliographic review. The results show different interventions which could be used in Occupational Therapy such as, eye patching, optokinetic stimulation, virtual reality, constraint induced movement therapy, mirror therapy, sensory cueing, limb activation and physical integrity. Others interventions are combined with Occupational Therapy´s treatment, for example: prism adaptation, repetitive transcranial magnetic stimulation and the mirror neuron therapy. Conclusion It is not exist a clear and general agreement about what is the most appropriate treatment to apply from Occupational Therapy to the neglect syndrome. It is important to increase the knowledge of this diagnostic and the different neurorehabilitation interventions, which can be used from the field of Occupational Therapy., Objetivo Conocer las diferentes intervenciones que se pueden aplicar desde Terapia Ocupacional para la rehabilitación del síndrome de negligencia en personas que hayan sufrido un ictus. Métodos Se ha llevado a cabo una revisión bibliográfica de las diferentes intervenciones existentes en el síndrome de negligencia a través de las bases de datos PubMed, OTseeker, Dialnet, Medline, Elsevier y PEDro. Para la selección de los artículos utilizados en este trabajo, se han tenido en cuenta los criterios de inclusión y exclusión. Resultados En total han sido seleccionados 14 artículos para realizar la realización de la revisión de la literatura. Los resultados muestran diferentes intervenciones que se pueden realizar en terapia ocupacional: parches en los ojos, estimulación optocinética, realidad virtual, terapia restrictiva de movimiento, terapia de espejo, la activación del brazo y la activación de pre-escucha y la integridad física. Otras intervenciones se combinan con el tratamiento de terapia ocupacional como son: prisma de adaptación, estimulación repetitiva magnética transcraneal y la terapia de neuronas espejo. Conclusión No existe un consenso claro de cuál es la intervención más adecuada para la negligencia. Es importante aumentar el conocimiento sobre esta clínica y las diferentes intervenciones de neurorehabilitación que se pueden utilizar desde la terapia ocupacional.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Hemispatial neglect is a common outcome of stroke that is characterized by the inability to orient toward, and attend to stimuli in contralesional space. It is established that hemispatial neglect has a perceptual component, however, the presence and severity of motor impairments is controversial. Establishing the nature of space use and spatial biases during visually guided actions amongst healthy individuals is critical to understanding the presence of visuomotor deficits in patients with neglect. Accordingly, three experiments were conducted to investigate the effect of object spatial location on patterns of grasping. Experiment 1 required right-handed participants to reach and grasp for blocks in order to construct 3D models.The blocks were scattered on a tabletop divided into equal size quadrants: left near, left far, right near, and right far. Identical sets of building blockswere available in each quadrant. Space use was dynamic, with participants initially grasping blocks from right near space and tending to “neglect” left far space until the final stages of the task. Experiment 2 repeated the protocol with left-handed participants. Remarkably, left-handed participants displayed a similar pattern of space use to right-handed participants. In Experiment 3 eye movements were examined to investigate whether “neglect” for grasping in left far reachable space had its origins in attentional biases. It was found that patterns of eye movements mirrored patterns of reach-to-grasp movements.We conclude that there are spatial biases during visually guided grasping, specifically, a tendency to neglect left far reachable space, and that this “neglect” is attentional in origin.The results raise the possibility that visuomotor impairments reported among patients with right hemisphere lesions when working in contralesional space may result in part from this inherent tendency to “neglect” left far space irrespective of the presence of unilateral visuospatial neglect.

Objective: Adaptation to prisms displacing the visual scene rightward is a therapeutic tool for left unilateral spatial neglect (USN). We aimed at comparing the effects of the classic adaptation procedure (repeated pointing toward visual targets, control treatment, C), with those of a novel adaptation method, involving ecological visuomotor activities (experimental treatment, E). Method: In 10 right-brain-damaged USN patients, each treatment was given for 1 week, with a crossover design, for a total of 20 sessions, twice per day. USN was assessed by cancellation, reading, and drawing tasks, and by a standardized scale. Neurological severity was assessed by the National Institutes of Health (NIH) stroke scale (Brott et al., 1989), disability by the Functional Independence Measure (FIM) scale. Results: The 2-week treatments (EC, CE) were equally effective, improving both USN, confirming previous reports (Frassinetti, Angeli, Meneghello, Avanzi, & Làdavas, 2002) and, importantly, disability. The improvement was independent of baseline performance, duration of disease, and neurological severity. Recovery took place after the first week, continued in the second week, and was stable at the follow-up of 3 months. The improvement of USN, measured by cancellation performance, and, in part, that of disability, measured through the FIM scale, were mediated by the size of the leftward aftereffects, suggesting a causal relationship between prism exposure and recovery. The E protocol was better tolerated. Conclusions: Daily life visuomotor activities, associated with prism exposure, are a useful tool for rehabilitating USN patients. This new treatment may widen the compliance with prism exposure treatments and their feasibility within home-based programs.

Purpose: The syndrome of unawareness (anosognosia) for sensory and motor neurological deficits (hemiplegia, hemianaesthesia, and hemianopia), contralateral to the side of a hemispheric lesion, is reviewed. Content: Main topics include: basic historical facts; the types of patient's interview and specific questions used to reveal the deficits; the clinical patterns of presentation; the associations and dissociations of the different anosognosic manifestations, and their relationships with associated disorders of sensory, memory, and executive-intellectual functions; the hemispheric asymmetry of anosognosia, that, as the syndrome of unilateral spatial neglect, is more frequent and severe after damage to the right cerebral hemisphere; the relationships between spatial neglect and the anosognosias, and their neural correlates; the effects of lateralized sensory stimulations on defective awareness of neurological impairments. Conclusions: The argument is made that anosognosia for sensory and motor neurological deficits should be considered as a multi-component syndrome, including a number of specific disorders that are due to the impairment of discrete monitoring systems, specific for the different supervised functions. The putative causal role of associated deficits of other parts of the sensory-motor or cognitive (e.g., memory, general intelligence) system is critically discussed. These specific control processes may be physically implemented in brain areas anatomically (and functionally) close to those subserving the monitored function.

The effects of adaptation to prisms displacing rightwards the field of vision on omission errors, and on perseveration and other graphic productions in a line cancellation task, were assessed in nine right-brain-damaged patients with left unilateral spatial neglect. Prism adaptation improved both neglect, as indexed by omission errors, and perseveration behaviour, up to a delay of 60 min. No correlation was found between omission and perseveration errors in all assessments. The suggestion is made that perseveration and other complex graphic productions made by right brain-damaged-patients with left spatial unilateral neglect is due to a defective monitoring of complex motor behaviour, frequently associated to cerebral damage involving the right frontal lobe. Interpretations of perseveration behaviour in terms of allochiria and directional hypokinesia are considered, and their limits discussed.

Objective: To quantitate a size distortion involving the side of space contralateral to the lesion (contralesional) in two right-brain-damaged patients. Methods: We studied two right-brain-damaged patients with lesions sparing the occipital lobe and a mild left neglect on target cancellation or line bisection. The lesions involved the temporoparietal region ( Patient 1) and the basal ganglia and the insula (Patients 1 and 2). Patients were given drawing tasks and tasks requiring perceptual and visuomotor judgments of horizontal extent. Results: In drawing objects such as a daisy both from memory and by copying, patients exhibited a disproportionate enlargement of the left-hand side of objects and added more left-sided petals to the drawn daisy. This pathologic behavior persisted when the patients were blindfolded and was likely to reflect a perceptual, rather than premotor, size distortion. In a task requiring the perceptual matching of two rectangles, patients underestimated the left-sided stimulus. In a visuomotor task requiring the reproduction of the horizontal extent of a segment, patients exhibited a hyperextension, when a leftward movement was required. Conclusions: We showed a disordered representation of extrapersonal space, possibly involving a contralesional relaxation of the spatial medium. The deficit does not arise at the level of retinotopic coordinate frames and is independent of unilateral spatial neglect.