Search

This review aimed to assess the effect of repetitive transcranial magnetic stimulation (rTMS) in improving post-stroke unilateral spatial neglect (USN) using a meta-analysis. Further, we aimed to identify any association between rTMS parameters, patient demographics, and treatment effect sizes using subgroup analyses and meta-regression. A literature search was conducted through four databases from inception to March 6, 2024, to retrieve all relevant controlled trials investigating the effects of rTMS on symptoms of USN in post-stroke patients. Overall, rTMS significantly improved post-stroke USN, as measured by the line bisection test (Hedges' g = – 1.301, p < 0.0001), the cancelation test (Hedge's g = – 1.512, p < 0.0001), and the Catherine Bergego Scale (Hedges'g = – 0.770, p < 0.0001), compared to sham stimulation. Subgroup analysis found that generally larger effect sizes following excitatory rTMS across several outcome measures, indicating that excitatory rTMS on the ipsilesional hemisphere may be more effective than inhibitory rTMS on the contralesional hemisphere in ameliorating neglect symptoms. Meta-regression analysis of the line bisection test showed a significant difference in the chronicity of stroke patients, suggesting that rTMS may be more effective for USN in patients at the acute stage (within 3 months since stroke) than in those at the post-acute stage (p = 0.035). In conclusion, rTMS appears to be effective in promoting recovery from post-stroke USN. Excitatory protocols and early intervention may enhance recovery outcomes for neglect behaviors in post-stroke survivors. [ABSTRACT FROM AUTHOR]

Patients with unilateral spatial neglect (USN) commonly experiences stimulus-driven attention deficit characterized by unexpected stimuli detection. We investigated whether virtual reality (VR) balloon search training with the screen background shifted to left space could improve stimulus-driven attention in patients with USN. The participants were divided into two groups: immediate VR group (n = 14) and delayed VR group (n = 14). The immediate VR group first received VR balloon search training, followed by control training, for two weeks each. Delayed VR group received the same training in reverse order. Outcomes were changes in scores on Catherine Bergego Scale (CBS) and reaction time on the modified Posner task (MPT). There was significant improvement in CBS score change after VR balloon retrieval training (all F > 2.71; P < 0.002). In the invalid condition of MPT, significant improvements were shown after VR balloon search training in left-sided reaction time (improvement of stimulation-driven attention). This study shows that VR balloon search training can improve neglect symptoms by using an intensive intervention lasting 2 weeks. [ABSTRACT FROM AUTHOR]

The assessment of unilateral spatial neglect (USN) primarily relies on paper-and-pencil tests, which do not fully represent daily life difficulties. To address this limitation, ecological tests, like the Baking Tray Test (BTT), have been developed. However, the original BTT identifies the presence of USN without providing information on its severity. In this aim, a new severity measure, the Centre of Mass (CoM), has been proposed, but its calculation in real environments poses challenges. Immersive virtual reality (VR) offers a promising solution for implementing a BTT in which measures are automatically calculated. This study aimed to assess the feasibility and relevance of an immersive VR BTT. Nineteen right brain-damaged patients with and without USN and 25 healthy participants were included. Group analyses showed an equivalence between the two BTT versions. Individual analyses revealed that all USN patients, except one, had pathological results in both versions. They also underlined pathological scores in patients without USN signs on paper-and-pencil tests. Finally, the CoM strongly correlated with paper-and-pencil tests and appeared to be a good indicator of USN severity. These findings support the relevance of implementing the BTT in an immersive VR version, suggesting its potential to enhance USN assessment. [ABSTRACT FROM AUTHOR]

This study is crucial for improving unilateral spatial neglect (USN) treatments, focusing on comparing the effectiveness of computer-assisted cognitive rehabilitation (CACR) against conventional rehabilitation (CR) methods. It aimed to address a significant research gap and improve patient outcomes by evaluating the impact of CACR versus CR on visuospatial perception, visual field and attention, and visual memory in patients with USN. This study was a randomized controlled trial. Forty-five consecutive patients with USN from a university rehabilitation center were divided into two groups: 22 patients received CACR with Rehacom software, focusing on saccadic eye movement, visual field, and visual-motor coordination, while 23 underwent CR that combined hemispheric activation approach, mental imagery training, and vibration therapy. Assessments included the Motor-Free Visual Perception Test (MVPT), Line Bisection Test (LBT), Visual Span Test (VST), and Visual Recognition Test (VRT). The study employed ANCOVA and effect size calculations to evaluate the effectiveness of CACR compared to CR in treating patients with USN. Results indicated that CACR significantly outperformed CR in improving visuospatial perception, visual field, attention, and memory, showcasing its effectiveness in treating USN. These findings demonstrate the superiority of CACR over CR, particularly in enhancing visual memory and attention, as evidenced by the large effect size in VRT and moderate effects in LBT and VST. This suggests CACR's potential as a more effective approach for rehabilitation in patients with USN due to brain injuries. [ABSTRACT FROM AUTHOR]

Unilateral Spatial Neglect is a disabling neuropsychological deficit. Patients with spatial neglect fail to detect and report events, and to perform actions in the side of space contralateral to a hemispheric cerebral lesion. Neglect is assessed by evaluating the patients' abilities in daily life activities and by psychometric tests. Computer-based, portable and Virtual Reality technologies may provide more and precise data, and be more sensitive and informative, compared to current paper-and-pencil procedures. Studies since 2010, in which such technologies have been used, are reviewed. Forty-two articles meeting inclusion criteria are categorized according to their technological approaches (computer-, graphics tablet or tablet-, virtual reality-based assessment, and other). The results are promising. However, a definite golden standard, technologically based procedure cannot be still established. Developing technologically based tests is a laborious process, which requires technical and user experience improvements as well as normative data, to increase the evidence of efficacy for clinical evaluation of at least some of the tests considered in this review. [ABSTRACT FROM AUTHOR]

Abstract Background Unilateral spatial neglect (USN) is a leading cause of disability and handicap in stroke survivors affecting functional recovery. Therapists’ knowledge and practice in post-stroke unilateral spatial neglect are key to the success of rehabilitation. Aim This study aimed to evaluate physiotherapists’ knowledge of USN and the current practice of USN management. Method A cross-sectional study was undertaken among Nigerian physiotherapists (N = 240). An online structured questionnaire that assessed respondents’ knowledge, current practice, barriers, and enablers to post-stroke USN rehabilitation was administered. Results The total knowledge score was 12.6 ± 4.75 on a scale of 25. Few physiotherapists (7.92%) demonstrated good knowledge of USN. Postgraduate certification (p = 0.001), clinical practice setting (p = 0.008), and working full time in neurorehabilitation (p = 0.033) were significantly associated with the therapist’s knowledge of USN. There was a nonsignificant positive correlation between the duration of practice in the neurorehabilitation setting (r = 0.02; p = 0.854) and USN knowledge. A nonsignificant minimal negative correlation between practice as a physiotherapist (r = − 0.02; p = 0.772) and USN knowledge was also noted. The age of physiotherapists showed no linear relationship with the therapist’s knowledge of USN (r = − 0.00; p = 0.992). Constraint-induced movement therapy (86.47%) was the most commonly used USN treatment, while Albert’s test (49.37%) was the most utilized screening tool for USN. Conclusions Very few physiotherapists had good knowledge of USN. Participants’ knowledge increased as they attained higher education levels relating to neurological physiotherapy. These findings emphasize the need for specialist rehabilitation training for physiotherapy practice.

This short review examines recent advancements in neurotechnologies within the context of managing unilateral spatial neglect (USN), a common condition following stroke. Despite the success of brain-computer interfaces (BCIs) in restoring motor function, there is a notable absence of effective BCI devices for treating cerebral visual impairments, a prevalent consequence of brain lesions that significantly hinders rehabilitation. This review analyzes current noninvasive BCIs and technological solutions dedicated to cognitive rehabilitation, with a focus on visuo-attentional disorders. We emphasize the need for further research into the use of BCIs for managing cognitive impairments and propose a new potential solution for USN rehabilitation, by combining the clinical subtleties of this syndrome with the technological advancements made in the field of neurotechnologies. [ABSTRACT FROM AUTHOR]

Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these diseases, and is one of the causes of long-term disability. The opportunity to treat these patients is via rehabilitation. A promising new technology that can enhance rehabilitation is virtual reality (VR). However, this technology is not widely used by elderly patients, and, moreover, the elderly often do not use modern technology at all. It therefore becomes a legitimate question whether elderly people will be able to use virtual reality in rehabilitation. This article presents a rehabilitation application dedicated to patients with upper limb paresis and unilateral spatial neglect (USN). The application was tested on a group of 60 individuals including 30 post-stroke patients with an average age of 72.83 years. The results of the conducted study include a self-assessment by the patients, the physiotherapist's evaluation, as well as the patients' performance of the exercise in VR. The study showed that elderly post-stroke patients are able to use virtual reality applications, but the ability to correctly and fully perform an exercise in VR depends on several factors. One of them is the ability to make logical contact (p = 0.0001 < 0.05). However, the study presented here shows that the ability to use VR applications does not depend on age but on mental and physical condition, which gives hope that virtual reality applications can be used in post-stroke rehabilitation among patients of all ages. [ABSTRACT FROM AUTHOR]

Unilateral visual neglect is a condition that negatively impacts the lives of many stroke survivors. Studies have investigated different forms of vestibular stimulation as a potential therapy, but evidence is yet to be systematically reviewed. We therefore reviewed the effects of vestibular stimulation on outcomes of neglect and activities of daily living (ADL) for people with visual neglect. We searched relevant databases up until September 2022. Eligible articles included any form of vestibular stimulation, study design, or control condition. Included participants were 18 years or older, presenting with neglect following a haemorrhagic or ischaemic stroke. Relevant outcomes were clinically validated measures of neglect and ADL. Cochrane risk of bias tools were used to assess study quality. Meta-analyses and narrative methods were used to synthesize the data. Our search returned 17 relevant studies comprising 180 participants. Meta-analyses showed no difference between galvanic vestibular stimulation and sham conditions on outcomes, whereas caloric vestibular stimulation led to improvement compared to pre-stimulation scores. Narrative syntheses showed mixed results. Clinical and methodological heterogeneity was found both within and between studies. Overall, results were inconsistent regarding the effects of vestibular stimulation as a treatment for neglect. Further trials are warranted but require more careful methodological planning. [ABSTRACT FROM AUTHOR]

In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient's rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications. [ABSTRACT FROM AUTHOR]

Background: Unilateral Spatial Neglect (USN) is one of the most pejorative pro - gnostic factor of functional outcome after stroke. Modern Visual Art Therapy (VAT) is an innovative approach introducing art into a care process. The purpose of our study was to assess the feasibility and benefits of VAT by a trained art-therapist in addition to standard reha - bilitation in cognitive functions and quality of life in post stroke patients. Material/Methods: We selected 67 consecutive patients and we finally included 23 patients (13 women, 10 men), mean age of70.43 (±12.15) into three groups: 7 in AAT group, 8 in CAT group and SR group respectively. Patients were included into three groups: 7 patients received Active Art Therapy (AAT) sessions; 8 Contemplative Art Therapy (CAT) sessions; 8 Standard Rehabilitation (SR) alone. Results: We notice a trend to improve USN and Mini-Mental Status-Exami - nation (MMSE) in all groups of patients and this persisted at long-term follow-up (V3). This improvement of cognitive performances was more marked in the VAT groups. All patients showed also a global improvement of their quality of life (QoL) at the long-term followup, particularly in the CAT group. Depression score remained high in SR group comparing to VAT group. Conclusions: Modern visual art-therapy (VAT) delivered by a trained art-therapist seems to be a positive and feasible additional method of reha - bilitation of neglect in sub-acute post-stroke patients. We re commend VAT also to improve depression and quality of life during rehabilitation period. This is the first study to evaluate the impact of VAT delivered by a trained art-therapist in rehabilitation of neglect post-stroke patients. Our findings should be confirmed by others studies with larger sample patients including brain imaging. [ABSTRACT FROM AUTHOR]

Background: Unilateral spatial neglect (USN) is a leading cause of disability and handicap in stroke survivors affecting functional recovery. Therapists' knowledge and practice in post-stroke unilateral spatial neglect are key to the success of rehabilitation. Aim: This study aimed to evaluate physiotherapists' knowledge of USN and the current practice of USN management. Method: A cross-sectional study was undertaken among Nigerian physiotherapists (N = 240). An online structured questionnaire that assessed respondents' knowledge, current practice, barriers, and enablers to post-stroke USN rehabilitation was administered. Results: The total knowledge score was 12.6 ± 4.75 on a scale of 25. Few physiotherapists (7.92%) demonstrated good knowledge of USN. Postgraduate certification (p = 0.001), clinical practice setting (p = 0.008), and working full time in neurorehabilitation (p = 0.033) were significantly associated with the therapist's knowledge of USN. There was a nonsignificant positive correlation between the duration of practice in the neurorehabilitation setting (r = 0.02; p = 0.854) and USN knowledge. A nonsignificant minimal negative correlation between practice as a physiotherapist (r = − 0.02; p = 0.772) and USN knowledge was also noted. The age of physiotherapists showed no linear relationship with the therapist's knowledge of USN (r = − 0.00; p = 0.992). Constraint-induced movement therapy (86.47%) was the most commonly used USN treatment, while Albert's test (49.37%) was the most utilized screening tool for USN. Conclusions: Very few physiotherapists had good knowledge of USN. Participants' knowledge increased as they attained higher education levels relating to neurological physiotherapy. These findings emphasize the need for specialist rehabilitation training for physiotherapy practice. [ABSTRACT FROM AUTHOR]

Patients with unilateral spatial neglect (USN) are unable to explore or to report stimuli presented in the left personal and extra‐personal space. USN is usually caused by lesion of the right parietal lobe: nowadays, it is also clear the key role of structural connections (the second and the third branch of the right Superior Longitudinal Fasciculus, respectively, SLF II and III) and functional networks (Dorsal and Ventral Attention Network, respectively, DAN and VAN) in USN. In this multimodal case report, we have merged those structural and functional information derived from a patient with a right parietal lobe tumour and USN before surgery. Functional, structural and neuropsychological data were also collected 6 months after surgery, when the USN was spontaneously recovered. Diffusion metrics and Functional Connectivity (FC) of the right SLF and DAN, before and after surgery, were compared with the same data of a patient with a tumour in a similar location, but without USN, and with a control sample. Results indicate an impairment in the right SLF III and a reduction of FC of the right DAN in patients with USN before surgery compared to controls; after surgery, when USN was recovered, patient's diffusion metrics and FC showed no differences compared to the controls. This single case and its multimodal approach reinforce the crucial role of the right SLF III and DAN in the development and recovery of egocentric and allocentric extra‐personal USN, highlighting the need to preserve these structural and functional areas during brain surgery. [ABSTRACT FROM AUTHOR]

Conventionally, the adaptive body area for prism adaptation (PA) has been limited to the visible area of prism glasses, especially the unilateral upper limbs. In this study, we developed a virtual reality system that extends PA's adaptive body area. This system sets the visible area of the target and introduces a symbolic representation of the body position to realize a head position adaptation task. As a result, the develped system generates PA not to individual body parts but to a collection of multiple motor units. Furthermore, experimental results in healthy subjects showed that the head position adaptation task could generate PA in the upper trunk system (The upper trunk system is defined as a system consisting of the upper trunk, head, and upper extremities) and displace it to the left anteriorly. Therefore, the head position adaptation task is expected to be effective for the postural correction of USN patients with upper trunk system tilt to the right posteriorly. Moreover, the developed system has potential applications in a wide range of fields, such as detecting cerebellar disorders. [ABSTRACT FROM AUTHOR]

Patients with right hemisphere damage (RHD) may exhibit mild unilateral spatial neglect (USN), which is difficult to detect in general assessments performed during driving rehabilitation. We compared driving simulator performance, practical driving performance, and neuropsychological test results between patients with RHD who were able and unable to return to driving to predict driving fitness based on driving simulator performance. This unmatched case-control study included 29 patients with RHD who were able (return-to-driving group, n = 16) and unable (non-return-to-driving group, n = 13) to return to driving. Patient demographics, motor function, attention, driving simulator performance (participants' reaction time and rate to green lamps appearing in any of the three displays and average lane position), and practical driving performance were compared between the groups. Receiver operating characteristic (ROC) analysis was performed to examine the predictive performance of driving fitness in reaction rate and paper-and-pencil tests. The non-return-to-driving group had a significantly lower reaction rate than the return-to-driving group (p = 0.027; 95% confidence interval [CI], 0–7; r = 0.407). No significant difference in reaction time or lane position in either the left or right lane during driving simulation was observed. ROC analysis of the reaction rate in the driving simulator task showed sensitivity of 0.692, specificity of 0.812, and area under the curve of 0.738 [95% CI, 0.541–0.935]. Decreases in reaction rates during simulated driving assessments are associated with an inability to resume driving in patients with RHD. Such assessments may aid in predicting fitness for driving in these patients. [ABSTRACT FROM AUTHOR]

The reported rate of the occurrence of unilateral spatial neglect (USN) is highly variable likely due to the lack of validity and low sensitivity of classical tools used to assess it. Virtual reality (VR) assessments try to overcome these limitations by proposing immersive and complex environments. Nevertheless, existing VR‐based tasks are mostly focused only on near space and lack analysis of psychometric properties and/or clinical validation. The present study evaluates the clinical validity and sensitivity of a new immersive VR‐based task to assess USN in the extra‐personal space and examines the neuronal correlates of deficits of far space exploration. The task was administrated to two groups of patients with right (N = 28) or left (N = 11) hemispheric brain lesions, also undergoing classical paper‐and‐pencil assessment, as well as a group of healthy participants. Our VR‐based task detected 44% of neglect cases compared to 31% by paper‐and‐pencil tests in the total sample. Importantly, 30% of the patients (with right or left brain lesions) with no clear sign of USN on the paper‐and‐pencil tests performed outside the normal range in the VR‐based task. Voxel lesion‐symptom mapping revealed that deficits detected in VR were associated with lesions in insular and temporal cortex, part of the neural network involved in spatial processing. These results show that our immersive VR‐based task is efficient and sensitive in detecting mild to strong manifestations of USN affecting the extra‐personal space, which may be undetected using standard tools. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of disability among adults in Europe. Complications following stroke include limb paresis and unilateral spatial neglect (USN) syndrome. These complications significantly reduce the patient's ability to function normally both in the short and long term. The chance to regain function is rehabilitation. One of the techniques in USN's rehabilitation is repetitive visual scanning training, and the effects of rehabilitation can be enhanced by limb activation, such as moving objects from one side to the other. However, rehabilitation carried out in this way is monotonous, and the assistance of a physiotherapist is necessary. This paper proposes an alternative method of rehabilitation, using virtual reality. The created application contains the most important element that occurs during rehabilitation, which is a movement pattern. At the same time, it diversifies the rehabilitation process and allows rehabilitation without constant contact with a physiotherapist. This paper presents the most important strategies to minimize the occurrence of cybersickness, which were applied in the developed application. The created application was approved by a physician and tested with the participation of five post-stroke patients. The first results were positive. Increased motivation was observed among patients using VR in therapy. Patients noticed an improvement in motor function, as well as a reduction in reaction times. In addition, physiotherapists observed an improvement in the range of motion during virtual reality therapy compared to traditional therapy. This gives hope that the app can be used in clinical practice. However, in order for the app to be incorporated into clinical practice, it is necessary to conduct studies with a larger group of patients. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Unilateral Spatial Neglect (USN) affects the rehabilitation process and leads to poor outcomes after stroke. Factors that influence USN recovery following prism adaptation therapy have not been investigated. This study investigated predictors of USN recovery after prism therapy at the sub-acute phase of recovery. METHODS: This study was a randomized controlled trial. USN was assessed with the Behavioural Inattention Test and Catherine Bergego scale. Seventy-four patients with USN were divided into control and intervention group (prism). The prism group used 20 dioptre prism lenses for repeated aiming for 12 sessions while the control group used neutral lenses for aiming training. Regression analysis was conducted to establish clinical and sociodemographic factors that influence USN recovery. RESULTS: Gender, age, years of education, race, employment status, handedness, type of stroke, time since stroke and site of stroke (p > 0.005) showed no significant influence on USN recovery following PA treatment. Higher Cognitive function (OR = 1.52, CI = 1.08–2.14, p = 0.016) and group allocationng (being in the prism group) (OR = 63.10, CI = 9.70–410.59, P < 0.001) were found to significantly influence USN recovery following PA treatment session. CONCLUSIONS: A significant modulating effect on general cognitive ability was found in this study. This suggests that prism adaptation therapy's effect on neural activity and spatial neglect depends on the cognitive function of stroke survivors. Trial registration: Pan African Clinical Trial Registry identifier: PACTR201903732473573. [ABSTRACT FROM AUTHOR]

This short review examines recent advancements in neurotechnologies within the context of managing unilateral spatial neglect (USN), a common condition following stroke. Despite the success of brain-computer interfaces (BCIs) in restoring motor function, there is a notable absence of effective BCI devices for treating cerebral visual impairments, a prevalent consequence of brain lesions that significantly hinders rehabilitation. This review analyzes current non-invasive BCIs and technological solutions dedicated to cognitive rehabilitation, with a focus on visuo-attentional disorders. We emphasize the need for further research into the use of BCIs for managing cognitive impairments and propose a new potential solution for USN rehabilitation, by combining the clinical subtleties of this syndrome with the technological advancements made in the field of neurotechnologies.

Background Unilateral spatial neglect (USN) is a common post-stroke cognitive impairment that severely affects the functional recovery and quality of life of patients. Therefore, objective assessment of USN is essential to facilitate patients' functional recovery. Objective To investigate the feasibility of using adynamic eye-tracking task to assess USN in sub acute stroke patients. Methods Thirty inpatients in the sub acute phase after stroke in Department of Rehabilitation Medicine, Nanchong Central Hospital were recruited from September 2021 to July 2022. USN was assessed using the Behavioral Inattention Test-Conventional (BIT-C), Catherine Bergego Scale (CBS), and a two-minute dynamic eye-tracking task within one week of admission by two professional rehabilitation therapists, and adverse effects during the assessment were recorded. USN was diagnosed by a CBS score >0, a total BIT-C score

This study aimed to evaluate the effects of music-based interventions on unilateral spatial neglect. Five databases were retrieved prior to May 5, 2022. A range of study designs were considered, including randomized controlled trials, controlled clinical trials, cohorts, and case series/reports. Types of music-based interventions were not limited. Methodological quality of randomized trials were evaluated using the RoB 2 tool, and the RoBiNT scale was utilized to assess the quality of case studies. Two authors independently summarized main results for assessments. Search strategies identified 186 potentially relevant articles, and 10 articles were collected for in-depth analysis. Preliminary results showed that USN patients performed better in cancellation tests than bisection tests after music-based intervention. In summary, pleasant music listening may have a beneficial effect on the visual attention of USN patients, and it can be hypothesized that this is related to the positive mood and emotions of patients induced by music. Music with a dynamic auditory stimulus as a new music listening programme in USN rehabilitation is worthy of further investigation. Instrument playing intervention can be considered as a multisensory stimulation to ameliorate neglect performance via multiple mechanisms. However, current results only support the short-term positive effects of music-based interventions on USN. [ABSTRACT FROM AUTHOR]

Patients with left unilateral spatial neglect (USN) typically place the subjective midpoint to the right of the objective centre when bisecting a horizontal line. This pathological phenomenon may be explained as a result of greater dependence on the right endpoint in the external reference frame (Koyama et al., Brain Cogn, 35, 1997, 271; McIntosh et al., Cogn Brain Res, 25, 2005, 833). Ishiai et al. (Brain, 112, 1989, 1485) reported that once patients with USN fixated on a certain point on the right part of the presented line, they persisted with this point and marked the subjective midpoint there without leftward searches. Ishiai et al.'s interpretation was that the patients saw a totalised line representation that extended equidistantly to the right and left sides, based on the information of the attended rightward extent from the subjective midpoint. Accordingly, we used virtual reality goggles (VRG) and devised a mirror‐image viewing (MV) condition that showed a full‐field view based on the right visual field information to test whether healthy participants would thereby show neglect‐like bisection performance. The participants were 30 healthy adults (22–37 years old; 15 women and 15 men). In this condition, 96.7% (29/30) of participants were judged to exhibit USN‐like performance of line bisection, indicating the effectiveness of MV condition to simulate USN. The novelty of the present study lies in the use of a task‐specific intervention of neglect‐like visuospatial processing during line bisection without attempting to modify the direction of spatial attention. This approach may contribute to the understanding of the pathological visuospatial processing of USN. [ABSTRACT FROM AUTHOR]

Abstract Background Unilateral spatial neglect (USN) is a debilitating neuropsychological syndrome that often follows brain injury, in particular a stroke affecting the right hemisphere. In current clinical practice, the assessment of neglect is based on old-fashioned paper-and-pencil and behavioral tasks, and sometimes relies on the examiner’s subjective judgment. Therefore, there is a need for more exhaustive, objective and ecological assessments of USN. Methods In this paper, we present two tasks in immersive virtual reality to assess peripersonal and extrapersonal USN. The tasks are designed with several levels of difficulty to increase sensitivity of the assessment. We then validate the feasibility of both assessments in a group of healthy adult participants. Results We report data from a study with a group of neurologically unimpaired participants (N = 39). The results yield positive feedback on comfort, usability and design of the tasks. We propose new objective scores based on participant’s performance captured by head gaze and hand position information, including, for instance, time of exploration, moving time towards left/right and time-to-reach, which could be used for the evaluation of the attentional spatial bias with neurological patients. Together with the number of omissions, the new proposed parameters can result in lateralized index ratios as a measure of asymmetry in space exploration. Conclusions We presented two innovative assessments for USN based on immersive virtual reality, evaluating the far and the near space, using ecological tasks in multimodal, realistic environments. The proposed protocols and objective scores can help distinguish neurological patients with and without USN.

Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these diseases, and is one of the causes of long-term disability. The opportunity to treat these patients is via rehabilitation. A promising new technology that can enhance rehabilitation is virtual reality (VR). However, this technology is not widely used by elderly patients, and, moreover, the elderly often do not use modern technology at all. It therefore becomes a legitimate question whether elderly people will be able to use virtual reality in rehabilitation. This article presents a rehabilitation application dedicated to patients with upper limb paresis and unilateral spatial neglect (USN). The application was tested on a group of 60 individuals including 30 post-stroke patients with an average age of 72.83 years. The results of the conducted study include a self-assessment by the patients, the physiotherapist’s evaluation, as well as the patients’ performance of the exercise in VR. The study showed that elderly post-stroke patients are able to use virtual reality applications, but the ability to correctly and fully perform an exercise in VR depends on several factors. One of them is the ability to make logical contact (p = 0.0001 < 0.05). However, the study presented here shows that the ability to use VR applications does not depend on age but on mental and physical condition, which gives hope that virtual reality applications can be used in post-stroke rehabilitation among patients of all ages.

Stroke survivors with right-brain damage (RBD) often present with attentional deficits such as left unilateral spatial neglect. Some patients also present with contralesional visual hemi-field deficits. A late detection of visual hemi-field deficits (VHFD) contributes to hampering neurorehabilitation and functional outcome of patients with neglect. The Brentano Illusion Test (BRIT) may be used for an early detection of VHFD during the neuropsychological assessment. In the present study, we determined the sensitivity and specificity of the BRIT for screening VHFD in patients with neglect. Sixty-four consecutive RBD patients were examined. Forty-five presented with neglect. Of these, 23 presented with VHFD (hemianopia or quadrantanopia) as detected by the Humphrey automated static visual field testing (reference standard). Consecutive patients also included 19 participants without neglect, who did not have any VHFD. The sensitivity and specificity of the BRIT for neglect patients were 78.3% (95% CI: 61.4–95.1) and 90.9 (95% CI: 78.9–100.0), respectively. Positive predictive value (PPV) was 89.6% (95% CI: 76.4–100.0); negative predictive value (NPV) 80.7% (95% CI: 65.2–96.2). No false positives in the group without neglect were identified. We conclude that the BRIT is an effective tool for clinical neuropsychologists to screen for possible VHFD in neglect patients during the neuropsychological assessment, allowing the refinement of the clinical picture in the neuropsychological report. An early detection of VHFD also allows referring the patient to standard diagnostics for a formal visual field examination, right from the first neuropsychological assessment. [ABSTRACT FROM AUTHOR]

Unilateral spatial neglect (USN) causes difficulties in disengaging attention from the right side to unexpected targets on the left. However, the relationship between egocentric spatial position and attentional disengagement remains unclear. Therefore, this study aimed to clarify the relationship between trunk position and attentional disengagement. Thirty-eight patients with early stroke onset were classified as follows: USN (n = 18), right brain damage without USN (n = 10), and left brain damage (n = 10). The primary outcome was reaction time (RT) in the modified Posner task (MPT). The MPT comprised a condition in which the preceding cue and target direction were the same (valid condition) and a condition in which the directions were opposite (invalid condition). RT to the target was calculated. The MPT was performed in three different trunk positions (trunk midline, left, and right). In each group, the RT was compared on the basis of the stimulus conditions and trunk position. The RT was delayed in the valid and invalid left conditions, especially in the invalid left condition. The RT of the trunk right condition was significantly reduced compared with that of trunk midline and left conditions in the invalid left condition. Thus, trunk position influences attentional disengagement. This study contributes to the rehabilitation of patients with neglect symptoms.

Patients suffering from Unilateral Spatial Neglect (USN) fail to pay attention to, respond to, and report sensory events occurring in the contralesional side of space. The traditional neuropsychological assessment of USN is based on paper-and-pencil tests, whose data recording and scoring may be subjected to human error. The utilization of technological devices can be expected to improve the assessment of USN. Therefore, we built Neurit.Space, a modified digital version of three paper-and-pencil tests, widely used to detect signs of USN, namely: Bells Cancellation, Line Bisection and Five Elements Drawing Test. Administration and data processing is fully automatic. Twelve right brain-damaged patients (six with and six without USN) and 12 age- and education-balanced healthy participants were enrolled in the study. All participants were administered both the computerized and the paper-and-pencil versions of the tests. The results of this preliminary study showed good sensitivity, specificity, and usability of Neurit.Space, suggesting that these digital tests are a promising tool for the evaluation of USN, both in clinical and in research settings. [ABSTRACT FROM AUTHOR]

Unilateral spatial neglect is a common sensorimotor disorder following the occurrence of a stroke, for which prismatic adaptation is a promising rehabilitation method. However, the use of prisms for rehabilitation often requires the use of specific equipment that may not be available in clinics. To address this limitation, we developed a new software package that allows for the quantification and rehabilitation of unilateral spatial neglect using immersive virtual reality. In this study, we compared the effects of virtual and real prisms in healthy subjects and evaluated the performance of our virtual reality tool (HTC Vive) against a validated motion capture tool. Ten healthy subjects were randomly exposed to virtual and real prisms, and measurements were taken before and after exposure. Our findings indicate that virtual prisms are at least as effective as real prisms in inducing aftereffects (4.39° ± 2.91° with the virtual prisms compared to 4.30° ± 3.49° with the real prisms), but that these effects were not sustained beyond 2 h regardless of exposure modality. The virtual measurements obtained with our software showed excellent metrological qualities (ICC = 0.95, error = 0.52° ± 1.18°), demonstrating its validity and reliability for quantifying deviation during pointing movements. Overall, our results suggest that our virtual reality software (Virtualis, Montpellier, France) could provide an easy and reliable means of quantifying and rehabilitating spatial neglect. Further validation of these results is required in individuals with unilateral spatial neglect. [ABSTRACT FROM AUTHOR]

Background: Unilateral spatial neglect (USN) is a debilitating neuropsychological syndrome that often follows brain injury, in particular a stroke affecting the right hemisphere. In current clinical practice, the assessment of neglect is based on old-fashioned paper-and-pencil and behavioral tasks, and sometimes relies on the examiner's subjective judgment. Therefore, there is a need for more exhaustive, objective and ecological assessments of USN. Methods: In this paper, we present two tasks in immersive virtual reality to assess peripersonal and extrapersonal USN. The tasks are designed with several levels of difficulty to increase sensitivity of the assessment. We then validate the feasibility of both assessments in a group of healthy adult participants. Results: We report data from a study with a group of neurologically unimpaired participants (N = 39). The results yield positive feedback on comfort, usability and design of the tasks. We propose new objective scores based on participant's performance captured by head gaze and hand position information, including, for instance, time of exploration, moving time towards left/right and time-to-reach, which could be used for the evaluation of the attentional spatial bias with neurological patients. Together with the number of omissions, the new proposed parameters can result in lateralized index ratios as a measure of asymmetry in space exploration. Conclusions: We presented two innovative assessments for USN based on immersive virtual reality, evaluating the far and the near space, using ecological tasks in multimodal, realistic environments. The proposed protocols and objective scores can help distinguish neurological patients with and without USN. [ABSTRACT FROM AUTHOR]

The recovery of independent gait represents one of the main functional goals of the rehabilitative interventions after stroke but it can be hindered by the presence of unilateral spatial neglect (USN). The aim of the paper is to study if the presence of USN in stroke patients affects lower limb gait parameters between the two body sides, differently from what could be expected by the motor impairment alone, and to explore whether USN is associated to specific gait asymmetry. Thirty-five stroke patients (right or left lesion and ischemic or hemorrhagic etiology) who regained independent gait were assessed for global cognitive functioning and USN. All patients underwent a gait analysis session by using a wearable inertial system, kinematic parameters were computed. Enrolled patients presented altered motion parameters. Stroke patients with USN showed specific asymmetries in the following parameters: stance phase, swing phase, and knee range of motion. No differences in the clinical scores were found as the presence of USN. The presence of USN was associated with a specific form of altered gait symmetry. These findings may help clinicians to develop more tailored rehabilitative training to enhance gait efficacy of patients with motor defects complicated by the presence of selected cognitive impairments. Overview of the experiment setup. The workflow shows: diagnosis of unilateral spatial neglect by the neuropsychologist, sensors placement, gait analysis protocol and evaluation of the gait asymmetry together with the statistically significant features [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of disability among adults in Europe. Complications following stroke include limb paresis and unilateral spatial neglect (USN) syndrome. These complications significantly reduce the patient’s ability to function normally both in the short and long term. The chance to regain function is rehabilitation. One of the techniques in USN’s rehabilitation is repetitive visual scanning training, and the effects of rehabilitation can be enhanced by limb activation, such as moving objects from one side to the other. However, rehabilitation carried out in this way is monotonous, and the assistance of a physiotherapist is necessary. This paper proposes an alternative method of rehabilitation, using virtual reality. The created application contains the most important element that occurs during rehabilitation, which is a movement pattern. At the same time, it diversifies the rehabilitation process and allows rehabilitation without constant contact with a physiotherapist. This paper presents the most important strategies to minimize the occurrence of cybersickness, which were applied in the developed application. The created application was approved by a physician and tested with the participation of five post-stroke patients. The first results were positive. Increased motivation was observed among patients using VR in therapy. Patients noticed an improvement in motor function, as well as a reduction in reaction times. In addition, physiotherapists observed an improvement in the range of motion during virtual reality therapy compared to traditional therapy. This gives hope that the app can be used in clinical practice. However, in order for the app to be incorporated into clinical practice, it is necessary to conduct studies with a larger group of patients.

Simple Summary: Awake craniotomy (AC) with brain mapping by direct electrical stimulation for tumors within or adjacent to eloquent brain regions is a surgical approach for minimizing the risk of postoperative neurologic deficits and preserving the patient's health-related quality of life. Language and motor functions are frequently mapped, but mapping is less frequent for more complex functions, such as visuospatial and social cognition, despite the importance of these functions for daily life activities. This lack of mapping for these functions results at least in part from a lack of tasks fully compatible with the restrictive environment of an operating room and AC procedures. We show here that the use of a virtual reality headset with eye tracking opens up new possibilities for the mapping of these complex functions. Background: Awake craniotomy (AC) with brain mapping for language and motor functions is often performed for tumors within or adjacent to eloquent brain regions. However, other important functions, such as vision and visuospatial and social cognition, are less frequently mapped, at least partly due to the difficulty of defining tasks suitable for the constrained AC environment. Objective: The aim of this retrospective study was to demonstrate, through illustrative cases, how a virtual reality headset (VRH) equipped with eye tracking can open up new possibilities for the mapping of language, the visual field and complex cognitive functions in the operating room. Methods: Virtual reality (VR) tasks performed during 69 ACs were evaluated retrospectively. Three types of VR tasks were used: VR-DO80 for language evaluation, VR-Esterman for visual field assessment and VR-TANGO for the evaluation of visuospatial and social functions. Results: Surgery was performed on the right hemisphere for 29 of the 69 ACs performed (42.0%). One AC (1.5%) was performed with all three VR tasks, 14 ACs (20.3%) were performed with two VR tasks and 54 ACs (78.3%) were performed with one VR task. The median duration of VRH use per patient was 15.5 min. None of the patients had "VR sickness". Only transitory focal seizures of no consequence and unrelated to VRH use were observed during AC. Patients were able to perform all VR tasks. Eye tracking was functional, enabling the medical team to analyze the patients' attention and exploration of the visual field of the VRH directly. Conclusions: This preliminary experiment shows that VR approaches can provide neurosurgeons with a way of investigating various functions, including social cognition during AC. Given the rapid advances in VR technology and the unbelievable sense of immersion provided by the most recent devices, there is a need for ongoing reflection and discussions of the ethical and methodological considerations associated with the use of these advanced technologies in AC and brain mapping procedures. [ABSTRACT FROM AUTHOR]

Background: Unilateral spatial neglect (USN) is a complex neurological syndrome that often reduces rehabilitation outcomes, prolongs patients' hospital stays, and decreases their quality of life. However, the current therapies for USN have varying effcacy. We will explore a new treatment option that combines prism adaptation (PA) with eye movement training (EMT) for the treatment of USN after stroke. Methods: We will conduct a single-blind, prospective, randomized controlled trial to assess the effcacy of the combined intervention (PA & EMT) on USN in an inpatient rehabilitation setting. The study aims to recruit 88 patients with USN after an ischemic or hemorrhagic stroke. Participants will be randomly assigned to the following four groups: (1) PA group (n = 22), (2) EMT group (n = 22), (3) PA and EMT group (n = 22), and (4) control group (n = 22). All groups will receive 10 sessions of interventions over 2 weeks, 5 times per week. Blinded assessors will conduct a baseline assessment, a post-intervention assessment, and a follow-up assessment (2 weeks post- intervention). The primary outcomemeasure will use the Behavioral Inattention Test-Conventional Subset (BIT-C) and Catherine Bergego Scale (CBS) to assess the levels of USN. Secondary outcomemeasures will assess the patient's ability to perform activities of daily living using the Modified Barthel Index (MBI). Patients who completed all treatment and assessment sessions will be included in the final analysis. Discussion: This study will explore the effects of 10 sessions of combined interventions (PA & EMT) on USN and functional capacity. This study has the potential to identify a new, evidence-based treatment option and provide new ideas for the treatment of USN. Ethics and dissemination: The study protocol has been approved by the Nanchong Central Hospital. Written informed consent will be obtained from all the participants. The results of this study will be disseminated to the public through scientific conferences and a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

We developed a system to conduct posture‐measurable virtual prism adaptation therapy using an inside‐out tracking stand‐alone virtual reality system. This system enables the construction of a unilateral spatial neglect (USN) treatment room that is closed off from external stimuli from all surroundings in a hospital or home. Furthermore, it expands the prism adaptation body adaptive site, which was previously limited to the hand, to include the whole body using a symbolic body. This expansion allows for utilization of the new prism adaptation therapy in which giving postural feedback and the head is spontaneously turned to the neglected side. This prism adaptation is expected to improve the posture of patients with USN and turn the field of vision itself toward the neglected space. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Unilateral spatial neglect (USN) causes difficulties in disengaging attention from the right side to unexpected targets on the left. However, the relationship between egocentric spatial position and attentional disengagement remains unclear. Therefore, this study aimed to clarify the relationship between trunk position and attentional disengagement. Thirty-eight patients with early stroke onset were classified as follows: USN (n = 18), right brain damage without USN (n = 10), and left brain damage (n = 10). The primary outcome was reaction time (RT) in the modified Posner task (MPT). The MPT comprised a condition in which the preceding cue and target direction were the same (valid condition) and a condition in which the directions were opposite (invalid condition). RT to the target was calculated. The MPT was performed in three different trunk positions (trunk midline, left, and right). In each group, the RT was compared on the basis of the stimulus conditions and trunk position. The RT was delayed in the valid and invalid left conditions, especially in the invalid left condition. The RT of the trunk right condition was significantly reduced compared with that of trunk midline and left conditions in the invalid left condition. Thus, trunk position influences attentional disengagement. This study contributes to the rehabilitation of patients with neglect symptoms. [ABSTRACT FROM AUTHOR]

The present study established the norms of the 3 s Spreadsheet Test version 2 (3S-v2 Test) with 186 healthy adults, compared performance of 23 individuals with spatial neglect after right brain stroke to the norms, and examined the extent that allocentric neglect is independent from egocentric neglect. The task required in the 3S-v2 Test is to cross out the target digit "3" in a spreadsheet that contained 10 columns and 14 rows of digit strings, including 120 target digits and 720 non-target digits. Each target is categorized with respect to its location on the page (egocentric viewer-centered) and its position within the digit string (allocentric stimulus-centered). Patients completed the 3S-v2 Test, the Apples Test, and Scene Copying Test (a five-object figure copying test). Based on the neglect classification criteria of these three tests, 18 patients (78.3%) were identified with both forms of neglect, three patients (13.0%) had isolated egocentric neglect, and two (8.7%) had isolated allocentric neglect. Among patients who were determined as having allocentric neglect by a given test, we found no significant correlation between severity of allocentric neglect and stimulus location in the egocentric reference frame. Based on the present findings, we suggest that including the 3S-v2 Test, a functionally relevant task and different from the currently available tests, may increase the comprehensiveness of neglect assessment. In addition, allocentric neglect symptoms are independent of egocentric locations. [ABSTRACT FROM AUTHOR]

Unilateral spatial neglect (USN), which can occur post-stroke, significantly impacts patients' daily lives. We explored the process by which patients become aware of the facets of their USN from the acute to subacute phase using a qualitative method. Participant observations, semi-structured interviews, and medical-record surveys were conducted with eight patients with USN and thirty healthcare professionals. We identified three themes regarding the patients' USN awareness process: inconsistency between present symptoms and perception of the left side, reconsidering the reasons for a vagueness on the left side, and acceptance of neglecting the left side. Additionally, healthcare professionals' support consisted of four strategies: assessing patients' perception of stimuli on their left side, compensating for patients' behaviours, promoting awareness of USN, and promoting activities that involve the use of residual functions after a cerebrovascular accident. Patients with USN gradually became aware of their deficits through interactions with others, and they responded by creating and practicing their own self-developed management strategies. These findings indicate that recovery from USN requires a series of experiences and social interactions. A comprehensive understanding of the process of awareness and adaption to USN from onset to recovery can help provide support for patients with USN. [ABSTRACT FROM AUTHOR]

Background: Unilateral spatial neglect (USN) is common and associated with poormotor and cognitive outcomes as well as impaired quality of life following stroke. Traditionally, the neural substrates underlying USN have been thought to be cortical areas, such as the posterior parietal cortex. However, patients with stroke involving only subcortical structures may also present with USN. While only a few studies have reported on USN in subcortical stroke, the involvement of white matter tracts related to brain networks of visuospatial attention is one possible explanation for subcortical neglect. Therefore, this study aimed to investigate which specific white matter tracts are neural substrates for USN in patients with subcortical stroke. Methods: Twenty-two patients with subcortical stroke without cortical involvement who were admitted to the Department of Rehabilitation Medicine at Seoul National University Bundang Hospital were retrospectively enrolled. Nine subjects were subclassified into a "USN(+)" group, as they had at least two positive results on three tests (the Schenkenberg line bisection test, Albert's test, and house drawing test) and a score of 1 or higher on the Catherine Bergego scale. The remaining 13 subjects without abnormalities on those tests were subclassified into the "USN(-)" group. Stroke lesions on MRI were manually drawn using MRIcron software. Lesion overlapping and atlas-based analyses of MRI images were conducted. The correlation was analyzed between the overlapped lesion volumes with white matter tracts and the severity of USN (in the Albert test and the Catherine Bergego scale). Results: Lesions were more widespread in the USN(+) group than in the USN(-) group, although their locations in the right hemisphere were similar. The atlas-based analyses identified that the right cingulum in the cingulate cortex, the temporal projection of the superior longitudinal fasciculus, and the forceps minor significantly overlapped with the lesions in the USN(+) group than in the USN(-) group. The score of the Catherine Bergego scale correlated with the volume of the involved white matter tracts. Conclusion: In this study, white matter tracts associated with USN were identified in patients with subcortical stroke without any cortical involvement. Our study results, along with previous findings on subcortical USN, support that USN may result from damage to white matter pathways. [ABSTRACT FROM AUTHOR]

Introduction: The investigation of brainwave changes during the recovery process of unilateral spatial neglect (USN) has garnered considerable attention in recent years. This paper presents an updated overview of the evolving brainwave patterns during USN rehabilitation, aiming to predict clinical outcomes and guide the selection of effective recovery strategies., Methods: A systematic review was conducted, encompassing English literature published up to June 2024. Databases including PubMed, Web of Science, and clinical trials were utilized. The included studies assessed brainwaves using electroencephalography (EEG) in at least one group with USN. However, the diverse nature of these studies posed challenges for a quantitative synthesis., Results: The final quantitative synthesis comprised 36 studies, incorporating a total of 4517 data points. The analysis revealed abnormalities in alpha, beta, and gamma brainwave activity, along with alterations in the functional monitoring of the alpha band during USN rehabilitation. Additionally, reductions were observed in specific brainwave components such as P1, N1, P2, P300, early directing attention negativity (EDAN), late directing attention positivity (LDAP), and contingent negative variation (CNV). However, findings regarding measures of synchrony, connectivity, and evoked responses across different frequency bands exhibited variability., Conclusions: Various indicators of brainwave activity displayed changes at different stages of post-stroke neglect rehabilitation, highlighting the significance of neural network dysfunction in this process. Nonetheless, due to the diversity of the studies, further investigation is necessary to achieve a more comprehensive understanding in future research endeavors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Stroke survivors with right-brain damage (RBD) often present with attentional deficits such as left unilateral spatial neglect. Some patients also present with contralesional visual hemi-field deficits. A late detection of visual hemi-field deficits (VHFD) contributes to hampering neurorehabilitation and functional outcome of patients with neglect. The Brentano Illusion Test (BRIT) may be used for an early detection of VHFD during the neuropsychological assessment. In the present study, we determined the sensitivity and specificity of the BRIT for screening VHFD in patients with neglect. Sixty-four consecutive RBD patients were examined. Forty-five presented with neglect. Of these, 23 presented with VHFD (hemianopia or quadrantanopia) as detected by the Humphrey automated static visual field testing (reference standard). Consecutive patients also included 19 participants without neglect, who did not have any VHFD. The sensitivity and specificity of the BRIT for neglect patients were 78.3% (95% CI: 61.4–95.1) and 90.9 (95% CI: 78.9–100.0), respectively. Positive predictive value (PPV) was 89.6% (95% CI: 76.4–100.0); negative predictive value (NPV) 80.7% (95% CI: 65.2–96.2). No false positives in the group without neglect were identified. We conclude that the BRIT is an effective tool for clinical neuropsychologists to screen for possible VHFD in neglect patients during the neuropsychological assessment, allowing the refinement of the clinical picture in the neuropsychological report. An early detection of VHFD also allows referring the patient to standard diagnostics for a formal visual field examination, right from the first neuropsychological assessment.

• Acupuncture has positive effects in USN after stroke. • Acupuncture can significantly improve the cognitive function, ADL, motor function and reduce the degree of USN in patients with USN after stroke. • Acupuncture is an effective and safe method for patients with USN. To systematically evaluate the effects of acupuncture in patients with unilateral spatial neglect (USN) after stroke. Relevant English- and Chinese- language studies published until 12th February 2022, were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang, China Scientific Journals Database (VIP), SinoMed, PubMed, Cochrane Library, Embase, Web of Science and OVID. Randomized controlled trials (RCTs) assessing the effects of acupuncture in patients with USN after stroke were included. Two researchers independently identified eligible studies and extracted the data. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. Twelve studies (731 participants) were included. The meta-analysis found that compared with the control group, acupuncture increased MMSE, BI, MBI, and FMA scores and reduced the USN scores (all P < 0.05). These results indicated that acupuncture improved cognitive function, activities of daily living (ADLs), and motor function and relieved the degree of USN in patients with USN after stroke. Acupuncture could promote the rehabilitation of cognitive function, ADLs, and motor function and relieve the symptoms of USN in patients with USN after stroke. It may be a good complementary treatment to rehabilitation therapy for USN. [ABSTRACT FROM AUTHOR]

This review aimed to examine the bottom-up and top-down rehabilitation intervention effectiveness based on the functional outcome measure as immediate effect and long-term effect for unilateral spatial neglect conditions. The RCT studies were collected by searching in three databases J-Stage, PubMed, and PEDro from 2008 through 2018. The studies which used the following instruments: BI, CBS, FMA, and FIM, as the functional outcome with the PEDro score of six and above, were eligible for inclusion. A total of 492 participants in 13 studies included from 291 studies initially identified. The meta-analysis for overall ES revealed that BI and CBS had a significant mean of SMD = 0.65 (95% CI, 0.23–1.07; p = 0.003; I2 = 65%), and SMD = −0.23 (95% CI, −0.45 to −0.01; p = 0.04; I2 = 35%) respectively, while FMA and FIM had an insignificant mean of SMD = 0.14 (95% CI, −0.08–0.37; p = 0.22; I2 = 0%), and SMD = −0.22 (95% CI, −0.69–0.25; p = 0.37; I2 = 0%) respectively. Based on the results, although indicated the heterogeneity representation across studies, it showed that the top-down intervention approach of high-frequency rTMS was more effective in enhancing the functional abilities and ADL of unilateral spatial neglect patients on the immediate effects but not necessarily in the long-term effects. [ABSTRACT FROM AUTHOR]

Patients with left unilateral spatial neglect (USN) typically place the subjective midpoint to the right of the objective centre. Based on the previous findings (e.g., Ishiai et al. 1989, Brain, 112, 1485), we hypothesized that the patients with left USN may see the representational image of a line that extends equally towards either side of the subjective midpoint depending not upon the information about the leftward extent. The present study tested whether patients with left USN would place the subjective midpoint at the centre of their mental representation of the line. The participants were 10 patients with left USN and 10 neurologically healthy controls. We devised a new 'endpoint reproduction task' using a computer display with a touch panel to seek the representational image when patients with left USN bisect lines and asked the participants to reproduce the location of the right or left endpoint after bisecting lines. The results showed that the representational image of the bisected line depends primarily on the location of the objective right endpoint, not on the location of the objective left endpoint in space. The analyses of the estimated right and left representational extents confirmed our hypotheses that patients with left USN would bisect a line seeing the representational line image that centred across their subjective midpoint. We believe that the findings of the present study with the use of the endpoint reproduction task will contribute to a better understanding of the visuospatial process underlying line bisection of patients with left USN. [ABSTRACT FROM AUTHOR]

The purpose of this scoping review was to explore the current treatment approaches for patients with post-stroke unilateral spatial neglect. A three-step search strategy using the Johanna Briggs Institute (JBI) guidelines, was undertaken. PubMed, CINAHL, The Cochrane Central Register of Controlled Trial, SCOPUS, PROSPERO, JBI, Sport Discus, and Google Scholar databases were searched. Searches were limited to publications from January 1, 2008, to May 1, 2020. Critical appraisal was undertaken by two independent reviewers using a standardized critical appraisal instrument developed by JBI. Data were extracted using a study-specific charting table. A total of 3,648 articles were identified, 311 full-text articles were screened and 86 articles were critically appraised, with 83 articles included in the review. Intervention approaches for post-stroke unilateral spatial neglect symptom amelioration were identified and categorized as prism adaptation and visual scanning, mental practice and mirror therapy, electrical stimulation and robotics, combination therapy, pharmacological therapy, and other interventions. Both positive and negative results across identified interventions were identified without specific reference to the phase of recovery. This review provides insight into current interventions for post-stroke unilateral spatial neglect. A plethora of intervention studies have been explored to ameliorate neglect symptoms post-stroke. Prism adaptation (PA) and combination therapy are most commonly investigated intervention for unilateral spatial neglect (USN) and showed promise in ameliorating USN symptoms. No single treatment approach seems optimally superior in the rehabilitation of USN post-stroke. Evidence for the selection of treatment at a specific phase of recovery is not conclusive as both positive and negative outcome on neglect measure were observed across all treatment approaches without specific reference to the phase of recovery. Evidence for the long-term use of PA in USN rehabilitation appears to be modest. [ABSTRACT FROM AUTHOR]

Training with an eyepatch or eyeglasses is one of the effective approaches for unilateral spatial neglect (USN), and it usually uses a device that covers the right side. However, few approaches are available for the left side. In this study, we examine the effect of motor tasks with left/right monocular eyeglasses on visual search and line-bisection performance in people with left USN. Seven participants with left USN admitted to convalescent hospitals were included. We conducted the Bells test, line-crossing test, and line-bisection test of the behavioral inattention test before/after the motor task. Our analyses focused on the improvement or decline in these assessment scores and the achievement/errors/non-smoothness scores of the motor task. When using the left monocular eyeglasses, the percentages of participants categorized as "improvement," "unchanged," and "decline" were 71.4%, 28.6%, and 0%, respectively (when using the right one they were 14.3%, 85.7%, and 0%). In the motor task, when using the left monocular eyeglasses, total achievement scores in five of seven participants were greater than those when using the right one, and they performed efficiently with fewer movement errors. These results suggest that training with left monocular eyeglasses might improve visual search performance in people with left USN. [ABSTRACT FROM AUTHOR]

Unilateral spatial neglect is a common sensorimotor disorder following the occurrence of a stroke, for which prismatic adaptation is a promising rehabilitation method. However, the use of prisms for rehabilitation often requires the use of specific equipment that may not be available in clinics. To address this limitation, we developed a new software package that allows for the quantification and rehabilitation of unilateral spatial neglect using immersive virtual reality. In this study, we compared the effects of virtual and real prisms in healthy subjects and evaluated the performance of our virtual reality tool (HTC Vive) against a validated motion capture tool. Ten healthy subjects were randomly exposed to virtual and real prisms, and measurements were taken before and after exposure. Our findings indicate that virtual prisms are at least as effective as real prisms in inducing aftereffects (4.39° ± 2.91° with the virtual prisms compared to 4.30° ± 3.49° with the real prisms), but that these effects were not sustained beyond 2 h regardless of exposure modality. The virtual measurements obtained with our software showed excellent metrological qualities (ICC = 0.95, error = 0.52° ± 1.18°), demonstrating its validity and reliability for quantifying deviation during pointing movements. Overall, our results suggest that our virtual reality software (Virtualis, Montpellier, France) could provide an easy and reliable means of quantifying and rehabilitating spatial neglect. Further validation of these results is required in individuals with unilateral spatial neglect.

We investigated the effect of a 3-week intervention—wherein a patient with unilateral spatial neglect walks through a narrow opening while entering from the contralesional side—to improve walking ability or ADL. A 66-year-old man was diagnosed with right parietal subcortical hemorrhage. We used an ABA single-case design; period B was set as the intervention. The intervention improved the continuous walking distance and balance ability and decreased the number of collisions when walking through the narrow opening; however, it exerted minimal effect on ADL. Thus, the intervention may effectively improve continuous physical or spatial attention behavior, regardless of ADL improvement. [ABSTRACT FROM AUTHOR]