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Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen's Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone. ispartof: NEUROREHABILITATION AND NEURAL REPAIR vol:35 issue:9 pages:823-835 ispartof: location:United States status: published

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 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 should be systematically and carefully assessed during rehabilitation. 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. Systematic review Registration No. PROSPERPO Registration No. CRD42018087483.

International audience; Visuospatial neglect is a frequent and disabling consequence of injuries to the right hemisphere. Patients with neglect show signs of impaired attention for left-sided events, which depends on dysfunction of fronto-parietal networks. After unilateral injury, such as stroke, these networks and their contralateral homologs can reorganize following multiple potential trajectories, which can be either adaptive or maladaptive. This article presents possible factors influencing the profile of evolution of neglect towards recovery or chronicity, and highlights potential mechanisms that may constrain these processes in time and space. The integrity of white matter pathways within and between the hemisphere appears to pose crucial connectivity constraints for compensatory brain plasticity from remote brain regions. Specifically, the availability of a sufficient degree of inter-hemispheric connectivity might be critical to shift the role of the undamaged left hemisphere in spatial neglect, from exerting maladaptive effects, to promoting compensatory activity.

The 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.

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 instrumented assessment of balance and gait performance, preferably longitudinally to investigate the associations over time.

Visuospatial neglect constitutes a supramodal cognitive deficit characterized by reduction or loss of spatial awareness for the contralesional space. It occurs in over 40% of right- and 20% of left-brain-lesioned stroke patients with lesions located mostly in parietal, frontal and subcortical brain areas. Visuospatial neglect is a multifaceted syndrome - symptoms can be divided into sensory, motor and representational neglect - and therefore requires an individually adapted diagnostic and therapeutic approach. Several models try to explain the origins of visuospatial neglect, of which the “interhemispheric rivalry model” is strongly supported by animal and human research. This model proposes that allocation of spatial attention is balanced by transcallosal inhibition and both hemispheres compete to direct attention to the contralateral hemi-space. Accordingly, a brain lesion causes an interhemispheric imbalance, which may be re-installed by activation of lesioned, or deactivation of unlesioned (over-activated) brain areas through noninvasive brain stimulation. Research in larger patient samples is needed to confirm whether noninvasive brain stimulation can improve long-term outcomes and whether these also affect activities of daily living and discharge destination.

Visuospatial neglect (VN) frequently occurs in Posterior Cortical Atrophy (PCA) and requires specific rehabilitation. In this single-case study, we investigated the efficacy of a computer-assisted cognitive training (CCT) alone or coupled with multiple sessions of anodal transcranial direct-current stimulation (A-tDCS) over the right posterior parietal cortex in improving left VN symptoms in a patient with PCA. The digital ReMoVES platform was used for both VN assessment and training. We found a significant improvement after CCT combined with A-tDCS within the limits of a single-case, our results suggest, for the first time, the usefulness of this combined approach in a neurodegenerative disorder.

Word-centred neglect dyslexia is generally thought to be caused by a visuospatial neglect-like attentional deficit which impacts orientation-canonical representations of visual stimuli. However, the relationship between word-centred neglect dyslexia and more general attentional processes is not well described. Here, we investigated the impact of attentional load manipulations within a case of word-centred neglect dyslexia. This study presents data from a single case, Patient CD, who exhibited ipsilesional word-centred neglect dyslexia in conjunction with severe, contralesional allocentric neglect. CD demonstrated an intact ability to name all letters in visually presented words, but committed neglect dyslexia errors when subsequently asked to read the same word as a whole. The severity of patient CD's neglect dyslexia was not found to be impacted by attentional manipulations. We found no effect of exposure time or visual crowding on the frequency of neglect dyslexia errors. This absence of an apparent, right-lateralised perceptual deficit, comorbid left-lateralised object-centred neglect, and insensitivity to attentional load manipulations suggests that the deficit underlying word-centred neglect dyslexia is not related to broad visuo-spatial attention. These findings suggest that neglect dyslexia and domain-general visuospatial neglect may not be as related as previously asserted.

Neglect is a disabling neuropsychological syndrome that is frequently observed following right-hemispheric stroke. Affected individuals often present with multiple attentional deficits, ranging from reduced orienting towards contralesional space to a generalized impairment in maintaining attention over time. Although a degree of spontaneous recovery occurs in most patients, in some individuals this condition can be treatment-resistant with prominent ongoing non-spatial deficits. Further, there is a large inter-individual variability in response to different therapeutic approaches. Given its potential to alter neuronal excitability and affect neuroplasticity, non-invasive brain stimulation is a promising tool that could potentially be utilized to facilitate recovery. However, there are many outstanding questions regarding its implementation in this heterogeneous patient group. Here we provide a critical overview of the available evidence on the use of non-invasive electrical brain stimulation, focussing on transcranial direct current stimulation (tDCS), to improve neglect and associated attentional deficits after right-hemispheric stroke. At present, there is insufficient robust evidence supporting the clinical use of tDCS to alleviate symptoms of neglect. Future research would benefit from careful study design, enhanced precision of electrical montages, multi-modal approaches exploring predictors of response, tailored dose-control applications and increased efforts to evaluate standalone tDCS versus its incorporation into combination therapy.

Consistently lateralized reading errors are commonly understood as side-effects of visuospatial neglect impairment. There is however a qualitative difference between systematically omitting full words presented on one side of passages (egocentric neglect dyslexia) and lateralized errors when reading single words (allocentric neglect dyslexia). This study aims to investigate the relationship between egocentric and allocentric neglect dyslexia and visuospatial neglect. 1209 stroke survivors completed standardized reading and cancellation tests. Stringent criteria identified unambiguous cases of allocentric neglect dyslexia (N = 17) and egocentric neglect dyslexia (N = 35). These conditions were found to be doubly dissociated with all cases of egocentric and allocentric neglect dyslexia occurring independently. Allocentric neglect dyslexia was dissociated from both egocentric and allocentric visuospatial neglect. Additionally, two cases of allocentric neglect dyslexia which co-occurred with oppositely lateralized domain-general visuospatial neglect were identified. Conversely, all cases of egocentric neglect dyslexia were found in the presence of domain-general visuospatial neglect. These findings suggest that allocentric neglect dyslexia cannot be fully understood as a consequence of visuospatial neglect. In contrast, we found no evidence for a dissociation between egocentric neglect dyslexia and visuospatial neglect. These findings highlight the need for new, neglect dyslexia specific rehabilitation strategies to be designed and tested. ispartof: Journal Of Clinical And Experimental Neuropsychology vol:42 issue:4 pages:1-11 ispartof: location:England status: Published online

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.

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.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.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.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.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.

Rehabilitation of patients with chronic visuospatial neglect is underexplored, and little is known about neural mechanisms that can be exploited to promote recovery. In this study, we present data on resting-state functional connectivity within the dorsal attention network (DAN) in chronic neglect patients as they underwent training in a virtual reality (VR) environment that improved left-side awareness.The study included 13 patients with visuospatial neglect persisting more than six months after a right-sided stroke. The patients underwent resting-state functional magnetic resonance imaging (fMRI). Scans were collected at baseline and after five weeks of intense training. We specifically examined resting-state functional connectivity within the DAN. In addition, using spatial concordance correlation, we compared changes in the spatial topology of the DAN with that of other networks.We found a longitudinal increase in interhemispheric functional connectivity between the right frontal eye field and the left intraparietal sulcus following training (before: 0.33 ± 0.17 [mean ± SD]; after: 0.45 ± 0.13; P = 0.004). The spatial concordance analyses indicated that training influenced the DAN connectivity more than any of the other networks.Intense VR training that improved left-sided awareness in chronic stroke patients also increased sporadic interhemispheric functional connectivity within the DAN. Specifically, a region responsible for saccadic eye movement to the left became more integrated with the left posterior parietal cortex. These results highlight a mechanism that should be exploited in the training of patients with chronic visuospatial neglect.

Background Visuospatial neglect (VSN) impairs the control of locomotor heading in post-stroke individuals, which may affect their ability to safely avoid moving objects while walking. Objective We aimed to compare VSN+ and VSN− stroke individuals in terms of changes in heading and head orientation in space while avoiding obstacles approaching from different directions and reorienting toward the final target. Methods Stroke participants with VSN (VSN + ) and without VSN (VSN−) walked in a virtual environment avoiding obstacles that approached contralesionally, head-on or ipsilesionally. Measures of obstacle avoidance (onset-of-heading change, maximum mediolateral deviation) and target alignment (heading and head-rotation errors with respect to target) were compared across groups and obstacle directions. Results In total, 26 participants with right-hemisphere stroke participated (13 VSN+ and 13 VSN−; 24 males; mean age 60.3 years, range 48 to 72 years). A larger proportion of VSN+ (75%) than VSN− (38%) participants collided with contralesional and head-on obstacles. For VSN− participants, deviating to the same side as the obstacle was a safe strategy to avoid diagonal obstacles and deviating to the opposite-side led to occasional collisions. VSN+ participants deviated ipsilesionally, displaying same-side and opposite-side strategies for ipsilesional and contralesional obstacles, respectively. Overall, VSN+ participants showed greater distances at onset-of-heading change, smaller maximum mediolateral deviation and larger errors in target alignment as compared with VSN− participants. Conclusion The ipsilesional bias arising from VSN influences the modulation of heading in response to obstacles and, along with the adoption of the “riskier” strategies, contribute to the higher number colliders and poor goal-directed walking abilities in stroke survivors with VSN. Future research should focus on developing assessment and training tools for complex locomotor tasks such as obstacle avoidance in this population.

Background Position sense is commonly impaired after stroke. Traditional rehabilitation methods instruct patients to visualize their limbs to compensate for impaired position sense. Objective Our goal was to evaluate how the use of vision influences impaired position sense. Methods We examined 177 stroke survivors, an average of 12.7 days (+/− 10 days (SD)) post-stroke, and 133 neurologically-intact controls with a robotic assessment of position sense. The robot positioned one limb (affected) and subjects attempted to mirror-match the position using the opposite limb (unaffected). Subjects completed the test without, then with vision of their limbs. We examined three measures of position sense: variability (Var), contraction/expansion (C/E) and systematic shift (Shift). We classified stroke survivors as having full compensation if they performed the robotic task abnormally without vision but corrected performance within the range of normal with vision. Stroke survivors were deemed to have partial compensation if they performed the task outside the range of normal without and with vision, but improved significantly with vision. Those with absent compensation performed the task abnormally in both conditions and did not improve with vision. Results Many stroke survivors demonstrated impaired position sense with vision occluded [Var: 116 (66%), C/E: 91 (51%), Shift: 52 (29%)]. Of those stroke survivors with impaired position sense, some exhibited full compensation with vision [Var: 23 (20%), C/E: 42 (46%), Shift: 32 (62%)], others showed partial compensation [Var: 37 (32%), C/E: 8 (9%), Shift: 3 (6%)] and many displayed absent compensation (Var: 56 (48%), C/E: 41 (45%), Shift: 17 (33%)]. Stroke survivors with an affected left arm, visuospatial neglect and/or visual field defects were less likely to compensate for impaired position sense using vision. Conclusions Our results indicate that vision does not help many stroke survivors compensate for impaired position sense, at least within the current paradigm. This contrasts with historical reports that vision helps compensate for proprioceptive loss following neurologic injuries.

This paper presents the immersive virtual reality (VR) application iVRoad for the detection of unilateral visuospatial neglect in right hemisphere poststroke patients. With our immersive VR tool, it is possible to perform realistic road crossing in a safe environment using a head-mounted display (HMD). We present and discuss the virtual environment (VE) for an upcoming study with neglect patients, a broad range of neurological patients and a healthy control group. Our aim is to determine whether extrapersonal neglect can be reliably diagnosed in the chronic phase using VR with the help of various measured values (task completion time, errors, head rotations, eye tracking).

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.

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.

Background: The clinical gender-dependent characteristics of visuospatial neglect between men and women have not been elucidated in Korean patients with cognitive impairment. The goal of this study was to observe the asymmetric lateralization in patients using a novel e-pen based cognitive assessment system. Methods: A total of 31 patients, 16 men and 15 women, with early stage hemispheric cerebral dysfunction were recruited for the assessment of unilateral neglect suing a novice paper-and-pencil based electronic evaluation system from a rehabilitation center of Inha University hospital in 2016. Results were assessed for degrees of deviations, and numbers of neglected lines. Degree of deviation was assessed using the positions and distances from the horizontal line centers. Effect sizes were calculated to assess proximities between the assessed results. Results: Comparatively greater left and rightward biasness for the right-sided and left-sided horizontal lines were observed for the male patients, respectively. Moreover, greater degree of left to rightward biasness was observed as the horizontal lines shortened in both groups. However, the magnitude of biasness in female patients showed comparatively less directional bias, indicating greater prevalence for the center of mass effect in male patients. Conclusion: Gender difference in visuospatial neglect seems to exist with less accuracy in recognition for the bisecting center for the female and asymmetrical lateralization and magnitude of deviation for the male patients.

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 − 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.

INTRODUCTION: Impairments in visual search are a common symptom in visuospatial neglect (VSN). The severity of the lateralized attention bias in visual search tasks can vary depending on the number of distractors: the more distractors, the more targets are missed. However, little is known about how the number of targets affect search performance in VSN. The aim of the current study was to examine the effect of the number of targets on hit rate in VSN. METHODS: We included 23 stroke patients with right-brain damage and VSN, 55 with right-brain damage without VSN, and 49 with left-brain damage without VSN, all admitted for inpatient rehabilitation. In a visual search task, patients had to find and tap targets, presented along with non-targets. The location and number of targets varied from trial to trial, allowing the evaluation of the effects of number and location of targets on hit rate. RESULTS: VSN patients detected a lower percentage of targets when more targets were present. For patients with right-brain damage without VSN, adding targets only reduced the hit rate of the most contralesional target. No effect of number of targets on hit rate was seen in patients with left-brain damage. Additionally, VSN patients found less contralesional targets than ipsilesional targets, made more delayed revisits, and had an initial rightward bias when compared to the other groups. There were no differences in search time, search consistency, or immediate revisits between groups. There was a moderate positive relation between the hit rate asymmetry score in our search task and conventional paper-and-pencil VSN tasks, and neglect behavior in daily life. CONCLUSIONS: In VSN patients, a higher number of targets reduces the hit rate. The reduced hit rate in visual search evoked by additional targets should be taken into account when assessing visual search in VSN.

Unilateral visuospatial neglect and neglect dyslexia are neuropsychological syndromes in which patients exhibit consistently lateralised perceptual deficits. However, there is little agreement surrounding whether neglect dyslexia is best understood as a consequence of a domain-general visuospatial neglect impairment or as an independent, content-specific cognitive deficit. Previous case studies have revealed that neglect dyslexia is an exceptionally heterogeneous condition and have strongly suggested that not all neglect dyslexia patient error patterns can be fully explained as a consequence of domain-general visuospatial neglect impairment. Additionally, theoretical models which attempt to explain neglect dyslexia as a consequence of domain-general unilateral visuospatial neglect fail to account for neglect dyslexia errors which occur when reading vertically presented words, lack of neglect errors when reading number strings, and neglect dyslexia which co-occurs with oppositely lateralised domain-general visuospatial neglect. Cumulatively, these shortcomings reveal that neglect dyslexia cannot always be accurately characterised as a side-effect of domain-general visuospatial unilateral neglect deficits. These findings strongly imply that neglect dyslexia may be better understood as a content-specific impairment.

Neglect Dyslexia is a neuropsychological syndrome in which patients commit consistently lateralised letter omission, addition, and substitution errors when reading individual words. Although neglect dyslexia frequently co-occurs with domain-general visuospatial neglect, some cases of neglect dyslexia may be best characterised as a dissociable impairment within a word-centred reference frame. This investigation employs data from a single case study of a patient who demonstrated word-centred neglect dyslexia to clarify neglect dyslexia's relationship with visuospatial neglect. AB completed the Oxford Cognitive Screen and an original reading assessment in which she read 302 words, pseudo-words, and numbers presented in normal, vertical, and mirror-reflected orientations. AB was found to commit consistently lateralised right neglect dyslexia errors (e.g., SHOWN misread as "show" or RELATED misread as "relate"). By contrast, AB did not exhibit object-centred or viewer-centred neglect. AB was also found to commit lateralised reading errors affecting the terminal portions of words when lateralised spatial bias was eliminated by presenting words vertically. Additionally, AB consistently misread terminal letters (originally right-lateralised) even when words were mirror-reflected so that these letters were presented in the left side of space. AB committed no neglect dyslexia errors when reading normally, vertically, or mirror-reflected numbers, and demonstrated a qualitatively different error pattern when reading pseudo-words. The results of this case study imply that neglect dyslexia can involve a content-specific, word-centred cognitive deficit and can be dissociated from egocentric and allocentric visuospatial neglect.

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 quality of life of brain-damaged patients with left spatial neglect.

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 conjunction with neuropsychological assessment.

Visuospatial neglect is a disorder that can often result from stroke and is characterized by an inability to attend to contralesional stimuli. Two common subtypes include allocentric (object-centered) neglect and egocentric (viewer-centered) neglect. In allocentric neglect, spatial inattention is localized to the contralesional side of an object regardless of its relative position to the observer. In egocentric neglect, spatial inattention is localized to the contralesional side of the individual's midline. The neuroanatomical correlates of each subtype are unknown. However, recent work has suggested that damage to temporal, inferior parietal, and occipital areas may result in allocentric neglect and that damage to frontoparietal areas may result in egocentric neglect. We used voxel-based lesion-symptom mapping (VLSM) to compare lesion location to behavioral performance on the conventional six subtests of the Behavioral Inattention Test (BIT) in 62 subjects with acute right hemisphere ischemic stroke. Results identified an anatomical dissociation in lesion location between subjects with neglect based on poor performance on allocentric tests (line bisection, copying, and drawing tasks) and on egocentric tests (star, letter, and line cancellation). VLSM analyses revealed that poor performance on the allocentric tests was associated with lesions to the superior and inferior parietal cortices, and the superior and middle temporal gyri. In contrast, poor performance on the egocentric tests was associated with lesions in the precentral gyrus, middle frontal gyrus, insula, and putamen. Interestingly, the letter cancellation test and average performance on egocentric tests were associated with frontal and parietal lesions. Some of these parietal lesion locations overlapped with lesion locations associated with allocentric neglect. These findings are consistent with suggestions that damage to temporal and parietal areas is more associated with allocentric neglect and damage to frontal lobe areas is more associated with egocentric neglect.

Background In previous studies, rTMS has been successfully employed to interfere with the right posterior parietal cortex (rPPC) inducing neglect-like behavior in healthy subjects. Several studies have shown that the use of tools can modulate the boundaries between near and far space: indeed when far space is reached by the stick, far space can be remapped as near. Objective The aim of the present study was to investigate whether once that rTMS on the rPPC has selectively induced neglect-like bias in the near space (but not in the far space), neglect can appears also in the far space when the subjects used a tool to perform the task. Methods Fifteen right-handed healthy subjects executed a line length judgment task in two different spatial positions (60 cm: near space and 120 cm: far space), with or without rPPC on-line rTMS. In the far space condition, subjects performed the perceptual task while holding or not a tool. Results During rTMS, visuospatial performance significantly shifted toward right when the task was performed in the near space and in the far space when the tool was used. No significant effect was found when rTMS was delivered in the far space condition without tool use. Conclusions Our results demonstrate that the application of rTMS on rPPC, specifically affect the representation of near space because it caused neglect both when the subjects acted in the near space and when they acted in a far space that was remapped as near by the use of a tool.

Persons with post-stroke visuospatial neglect (VSN) often collide with moving obstacles while walking. It is not well understood whether the collisions occur as a result of attentional-perceptual deficits caused by VSN or due to post-stroke locomotor deficits. We assessed individuals with VSN on a seated, joystick-driven obstacle avoidance task, thus eliminating the influence of locomotion. Twelve participants with VSN were tested on obstacle detection and obstacle avoidance tasks in a virtual environment that included three obstacles approaching head-on or 30 $^{\circ}$ contralesionally/ipsilesionally. Our results indicate that in the detection task, the contralesional and head-on obstacles were detected at closer proximities compared to the ipsilesional obstacle. For the avoidance task collisions were observed only for the contralesional and head-on obstacle approaches. For the contralesional obstacle approach, participants initiated their avoidance strategies at smaller distances from the obstacle and maintained smaller minimum distances from the obstacles. The distance at detection showed a negative association with the distance at the onset of avoidance strategy for all three obstacle approaches. We conclusion the observation of collisions with contralesional and head-on obstacles, in the absence of locomotor burden, provides evidence that attentional-perceptual deficits due to VSN, independent of post-stroke locomotor deficits, alter obstacle avoidance abilities.

Objective To investigate whether the efficacy of continuous theta-burst stimulation (cTBS) for improving visuospatial neglect can be enhanced by providing more days of stimulation and more stimulation trains per day. Methods In a prospective study, right-handed patients with right hemisphere stroke and visuospatial neglect were randomized to cTBS or sham cTBS treatment for 2 weeks and were followed up for 4 weeks. The cTBS group received active cTBS over the posterior parietal cortex of the unaffected hemisphere, combined with conventional rehabilitation therapy. Changes in scores for two paper–pencil tests for visuospatial neglect (star cancellation and line bisection) were evaluated. Results In each group, 10 patients completed follow up. Compared with the sham group, star cancellation test scores in the cTBS group were improved by 37.03% at the end of treatment and by 47.21% after 4 weeks’ follow up, and the line bisection score improved by 21.37% at the end of treatment and by 35.99% after 4 weeks’ follow up. Conclusions These results suggest that the efficacy of cTBS in visuospatial neglect can be enhanced and prolonged by increasing the days of stimulation and the number of stimulation trains per day over the left posterior parietal cortex.

BACKGROUND Persons with perceptual-attentional deficits due to visuospatial neglect (VSN) after a stroke are at a risk of collisions while walking in the presence of moving obstacles. The attentional burden of performing a dual-task may further compromise their obstacle avoidance performance, putting them at a greater risk of collisions. OBJECTIVE The objective of this study was to compare the ability of persons with (VSN+) and without VSN (VSN-) to dual task while negotiating moving obstacles. METHODS Twenty-six stroke survivors (13 VSN+, 13 VSN-) were assessed on their ability to (a) negotiate moving obstacles while walking (locomotor single task); (b) perform a pitch-discrimination task (cognitive single task) and (c) simultaneously perform the walking and cognitive tasks (dual task). We compared the groups on locomotor (collision rates, minimum distance from obstacle and onset of strategies) and cognitive (error rates) outcomes. RESULTS For both single and dual task walking, VSN+ individuals showed higher collision rates compared to VSN- individuals. Dual tasking caused deterioration of locomotor (more collisions, delayed onset and smaller minimum distances) and cognitive performances (higher error rate) in VSN+ individuals. Contrastingly, VSN- individuals maintained collision rates, increased minimum distance, but showed more cognitive errors, prioritizing their locomotor performance. CONCLUSION Individuals with VSN demonstrate cognitive-locomotor interference under dual task conditions, which could severely compromise safety when ambulating in community environments and may explain the poor recovery of independent community ambulation in these individuals.

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.

It is widely known that visuospatial neglect and hemianopia maybe superimposed. We considered the differences in implicit information processing which is effective in patients with neglect but not with hemianopia. We then hypothesize that a prime-word in the neglected field should determine a semantic activation effect but not in a blind hemifield. Moreover eye movements could provide further details. In this work we considered a patient with a bilateral with the presence of either a left visual neglect and a right homonymous hemianopia. Our results supported implicit information processing in the space affected by neglect but not by hemianopia.

Most studies on sensory extinction have focused on selected patients with subacute and chronic right hemisphere lesions. In studies conducted on acute stroke patients, risk factors and time course were not evaluated. Our aim was to determine the prevalence, risk factors, and time course of sensory extinction in the acute stroke setting. Consecutive patients with acute stroke were tested for tactile, visual, auditory, and auditory-tactile cross-modal extinction, as well as for peripersonal visuospatial neglect (PVN). Tests were repeated at 2, 7, 15, 30, and 90 days after initial examination. A multivariable logistic regression analysis was performed to test the association between sensory extinction and demographic and clinical risk factors. Seventy-three patients (38.4% women) were recruited: 64 with ischemic stroke and nine with haemorrhagic stroke. Mean age was 62.3 years (95% CI 58.8–65.7), mean NIHSS score was 1.6 (95% CI 1.2–2.1), and mean time to first examination was 4.1 days (95% CI 3.5–4.8). The overall prevalence of all subtypes of sensory extinction was 13.7% (95% CI 6.8–23.8). Tactile extinction was the most frequent subtype with a prevalence of 8.2% (95% CI 3.1–17.0). No extinction was found beyond 15 days after the first examination. After adjustment for age, sex, lesion side, type of stroke, time to first examination and stroke severity, a lesion volume ≥2 mL (adjusted OR = 38.88, p = 0.04), and presence of PVN (adjusted OR = 24.27, p = 0.04) were independent predictors of sensory extinction. The insula, the putamen, and the pallidum were the brain regions most frequently involved in patients with sensory extinction. Extinction is a rare and transient phenomenon in patients with minor stroke. The presence of PVN and lesion volume ≥2 mL are independent predictors of sensory extinction in acute stroke. Electronic supplementary material The online version of this article (doi:10.1007/s00702-016-1663-x) contains supplementary material, which is available to authorized users.

BACKGROUND: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames-games based on therapeutic principles-aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. OBJECTIVES: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. METHODS: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. RESULTS: The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%). CONCLUSIONS: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations-for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample., JMIR Serious Games, 5 (3), ISSN:2291-9279

Background. After stroke, visuospatial and kinesthetic (sense of limb motion) deficits are common, occurring in approximately 30% and 60% of individuals, respectively. Although both types of deficits affect aspects of spatial processing necessary for daily function, few studies have investigated the relationship between these 2 deficits after stroke. Objective. We aimed to characterize the relationship between visuospatial and kinesthetic deficits after stroke using the Behavioral Inattention Test (BIT) and a robotic measure of kinesthetic function. Methods. Visuospatial attention (using the BIT) and kinesthesia (using robotics) were measured in 158 individuals an average of 18 days after stroke. In the kinesthetic matching task, the robot moved the participant’s stroke-affected arm at a preset direction, speed, and magnitude. Participants mirror-matched the robotic movement with the less/unaffected arm as soon as they felt movement in their stroke affected arm. Results. We found that participants with visuospatial inattention (neglect) had impaired kinesthesia 100% of the time, whereas only 59% of participants without neglect were impaired. For those without neglect, we observed that a higher percentage of participants with lower but passing BIT scores displayed impaired kinesthetic behavior (78%) compared with those participants who scored perfect or nearly perfect on the BIT (49%). Conclusions. The presence of visuospatial neglect after stroke is highly predictive of the presence of kinesthetic deficits. However, the presence of kinesthetic deficits does not necessarily always indicate the presence of visuospatial neglect. Our findings highlight the importance of assessment and treatment of kinesthetic deficits after stroke, especially in patients with visuospatial neglect.

[Purpose] This study aimed to investigate the effects of body awareness training (BAT) on mild visuospatial neglect in patients following acute stroke. [Subjects] The subjects were 12 stroke patients randomly assigned to either the experimental group (n1=6) or control group (n2=6). [Methods] The experimental group underwent BAT for 15 minutes and then task-oriented training for 30 minutes a day, five times a week for three weeks. The control group underwent task-oriented training for 30 minutes a day, five times a week for three weeks. Assessments were made using the Motor-free Visual Perception Test (MVPT), Line Bisection Test (LBT), and modified Barthel index (MBI). [Results] Following the interventions, the experimental group showed a significant change in MVPT, LBT, and MBI scores. [Conclusion] The results of this study suggest the feasibility and suitability of BAT with task-oriented training for mild visuospatial neglect in patients with acute stroke.

This practice analysis introduces the Birmingham Cognitive Screen (BCoS), a comprehensive screening tool for stroke survivors including individuals with aphasia and visuospatial neglect. A case study is used to demonstrate how the cognitive profiles created by the multiple-domain assessment at different time points can reduce the need to use multiple standardised assessments to check relative deficits and residual abilities, as well as to guide the rehabilitation process, educate the stroke survivor and family, monitor improvement in impairment and help the therapist to evaluate his or her treatment.

Since the pioneering experimental work of Bisiach et al. (1984) on deficits in sound localisation associated with unilateral brain lesions and visual neglect, a number of systematic investigations have examined auditory processing in visuospatial neglect patients. Evidence from a variety of experimental paradigms has revealed some auditory deficits in detection and identification tasks, during bilateral stimulation; plus localisation deficits for single sounds. These deficits emerge predominantly for contra-lesional sounds, although some auditory disturbances applying to both contra- and ipsilesional sounds have also been documented. Here we review evidence suggesting that some of these auditory deficits arise in relatively high-level stages of spatial processing. In addition, we present new analyses showing that auditory deficits in identification and localisation tasks often correlate with clinical measures of visual neglect, across a variety of different studies and tasks. This empirical relation suggests that a disturbance of multisensory spatial processing may often account for the joint auditory and visual spatial deficits in neglect patients, although rarer dissociations between the modalities should also be considered.

Studies that have investigated prism adaptation (PA) effects on symptoms of visuospatial neglect have primarily used neuropsychological tests as outcome measures. An important question that remains to be answered is whether PA effects translate into improvements in patients' daily life activities. In the present review, we examined systematically the evidence for the effect of PA treatment on daily life activities in patients with neglect. Two authors independently assessed the methodological quality of 25 intervention and 1 follow-up studies using validated scales. PA effects were evaluated for reading/writing, activities of daily living (ADL) direct tests, ADL questionnaires, and navigation tests. Studies were evaluated as being of excellent (n = 1), good (n = 12), fair (n = 10), or poor (n = 3) quality. Among the 26 articles, a total of 32 measurements showed significant PA effects (one measurement from a study of excellent quality, 17 from studies of good quality, 10 from studies of fair quality, four from studies of poor quality), whereas non-significant effects were found in 15 measurements (two from a study of excellent quality, three from studies of good quality, eight from studies of fair quality, two from studies of poor quality). There is some evidence suggesting that PA can improve daily functioning, particularly as measured by reading/writing and ADL direct tests. The impact of several variables on PA effects should be investigated further including sample heterogeneity and time since injury.

Introduction: Unilateral brain damage can heterogeneously alter spatial processing. Very often brain-lesioned patients fail to report (neglect) items appearing within the contralesional space. Much less often patients mislocalize items' spatial position. We investigated whether a top-down attentional load manipulation (dual-tasking), known to result in contralesional omissions even in apparently unimpaired cases, might also induce spatial mislocalizations. Method: Nine right-hemisphere-damaged patients performed three computer-based tasks encompassing different levels of attentional load. The side of appearance of visual targets had to be reported either in isolation or while processing additional information (visual or auditory dual task). Spatial mislocalizations (from the contralesional hemispace towards the ipsilesional unaffected one) were then contrasted with omissions both within and across tasks, at individual as well as at group level. Results: The representation of ipsilesional targets was accurate and not affected by dual-tasking requirements. Contralesional targets were instead often omitted and, under dual-task conditions, also mislocalized by four patients. Three cases reported a significant number of left targets as appearing on the right (alloesthesia). Two of these patients perceived more targets (albeit to a wrong spatial location) under dual- than under single-task load. In a fourth patient, increased visual load resulted in synchiria, the (mis)perception of single, contralesional targets as being two (one on each side). Conclusions: When the neural circuitry subtending spatial processing is damaged, an increase in task load can lead to either a disregard or a bias in the processing of contralesional hemispace. The spatial bias subtending mislocalizations seems to index a more severe deficit than neglect, as if contralesional space would be completely erased rather than merely ignored.

Neglect patients are not aware of stimuli in the contralesional space. We aimed to simulate neglect-like behaviour in healthy participants, by asking them to orient their visuospatial attention in two conditions: non-hypnotic suggestion and post-hypnotic suggestion. Results showed that directing visuospatial attention to one side of space caused neglect of stimuli in the opposite side of space, but only when participants were under post-hypnotic suggestion. Furthermore, directing visuospatial attention to the right side of space caused more neglect of left-sided stimuli than directing visuospatial attention to the left side of space did for right-sided stimuli. We propose that post-hypnotic suggestion can be a useful tool for (de)activating neurocognitive mechanisms underlying visuospatial awareness, a function that is fundamental for our survival. The use of post-hypnotic suggestion could be applied to the study of many domains of cognitive neurosciences (e.g., neurocognitive rehabilitation).

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.

There is growing evidence that visuospatial neglect (VSN) is associated with lower functional performance in other modalities and is not restricted to the lesioned hemisphere alone, and may also affect the non-lesioned hemisphere in severe first-ever strokes. We aimed to investigate the longitudinal association between the severity of VSN, as reflected by the extent of ipsilesional and contralesional spatial attention deficit, and clinical severity of stroke.This is a secondary data analysis with merged data from two prospective cohort studies. Resulting in 90 patients and 8 longitudinal measurements at 1, 2, 3, 4, 5, 8, 12, and 26 weeks post-stroke onset. A letter cancellation test (LCT) was used as the primary outcome measure to demonstrate presence and severity of VSN. The clinical severity of stroke was classified using the Bamford Classification.No significant association between clinical severity and the number of ipsilesional, as well as contralesional, omissions on the LCT was observed. Recovery of VSN at the contralesional hemiplegic, as well as ipsilesional non-hemiplegic side, was only dependent on 'time' as a reflection of spontaneous neurobiological recovery post-stroke. The recovery of the ipsilesional extension of VSN was significantly slower for the total anterior circulation infarct (TACI) group compared to the non-TACI group.Larger strokes have a significant negative impact on recovery of visual attention at the non-hemiplegic side. No clinical determinants that regulate spontaneous time-dependent recovery of VSN were found. While early 'stroke severity' has been regarded as a strong predictor of functional outcome at a group level, other prognostic factors (demographic, stroke related) need to be determined.EXPLICIT-stroke Trial: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1424 Stroke Intensity Trial: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1665.

The contralesional line bisection error in hemianopia is a well-known clinical phenomenon. Its origin, however, is still unclear. We therefore investigated the causes of the hemianopic bisection error in 84 patients with unilateral homonymous hemianopia without visuospatial neglect. Our results suggest that the contralesional bisection error is neither a consequence of the visual field defect itself nor a manifestation of strategic adaptation of attention and eye movements into contralesional hemispace. Additional extrastriate brain injury, presumably to occipito-temporal areas including the occipital white matter, seems to be critical for the emergence of the contralesional bisection error that is frequently associated with but separable from homonymous hemianopia.

Aim: The study aims to describe the epidemiology and the neural correlates of peripersonal visuospatial neglect (PVN) in patients admitted to the Geneva Stroke Unit for an acute stroke or a transient ischemic attack (TIA). Methods: Eligible subjects were tested for PVN using both the Ota's discriminative cancellation task and a line bisection task. Brain lesions were identified on diffusion-weighted imaging. A multivariate analysis was performed to identify risk factors of PVN. Results: Ninety-eight consecutive patients (40.8% females) were recruited: 64 cases of ischemic stroke, 9 cases of hemorrhagic stroke and 25 cases of TIAs. The mean age was 61.9 ± 2.86 years. The incidence of PVN was 23.5% (95% CI 15.5-33.1) and was not significantly different between patients with right and left hemisphere stroke. There were 5 cases of ipsilesional neglect. There was no association between PVN and age, sex, stroke severity, handedness, lesion type, lesion volume and time to first examination. Lesions of temporal and parietal lobes were the most frequent in patients with PVN. Conclusion: PVN has a low incidence in the acute stroke settings and there is no particular predictor of its presence. It is most often associated with temporo-parietal lesions.