Ask the experts how to treat individuals with spatial neglect: a survey study

Abstract

Purpose: Spatial neglect (SN) impedes rehabilitation success and leaves long-term consequences. We asked experts to provide their opinions in addressing SN by scenario (ideal vs. reality) and by recovery phase (earliest, acute, subacute, and chronic). Experts were individuals who have assessed or treated patients with SN clinically.

Materials and methods: This study was conducted using an anonymous survey on the Internet with 189 responders over 3 months. Located in 23 different countries, 127 experts of seven disciplines were included (occupational therapy, physical therapy, nursing, speech and language pathology or therapy, neurology, physical medicine and rehabilitation, and psychology or neuropsychology).

Results: Comparing the two scenarios, more treatments were selected in the ideal than in the reality scenario for all recovery phases except for the chronic phase. In both scenarios, (1) more treatments were selected in acute and subacute phases than in earliest or chronic phases, (2) less experienced experts selected diverse treatment options more often, and (3) highly experienced experts were more likely to provide their reasons of treatment selection, suggestions of treatment delivery methods, and other insights. Finally, 83.7% reported obstacles in treating SN.

Conclusions: Experts’ treatment selections are consistent with current evidence and practice guidelines. Recognizing the limitation of evidence, their opinions may help generate ideas in various topics (e.g., dosing, integrative intervention, and treatment implementation) to be examined in future studies.

Implications for Rehabilitation

• Clinicians with experience in treating people with spatial neglect (i.e., experts as defined in the present study) recognized the limitation of evidence but nonetheless suggested specific treatments by recovery phase.

• In both the reality and ideal scenarios, experts included visual scanning, active limb activation, and sustained attention training in the top-five selections. Prism adaptation was in the top-five selections in the ideal scenario, while in the reality scenario, it was in the top-five in all phases except for the earliest phase where it was the sixth most selected.

• They also shared their valuable opinions in when to use which treatment to address spatial neglect and how to deliver certain interventions, which may help to generate ideas in various topics (e.g., dosing, integrative intervention, knowledge dissemination, and treatment implementation) that can be examined in future studies.

• We suggest that (1) clinicians consider collective expert opinions reported here to enhance their clinical judgment and practices, (2) researchers develop studies focused on treatments with limited evidence but selected here by experts, and (3) funding agencies provide the means to research and implementation projects that will generate rich information for improving practice guidelines and rehabilitation outcomes for patients with spatial neglect.

• The majority of the experts reported some obstacles in providing treatment for spatial neglect, and time and equipment shortages were the most common barriers, which should be addressed at the system level to determine whether removing those barriers have long-term beneficial impacts on both patients and healthcare systems.

Keywords:

• (MeSH): Hemispatial neglect
• rehabilitation
• qualitative research
• stroke
• brain injuries
• occupational therapy
• physical therapy
• neuropsychology
• neurology
• nursing
• speech and language pathology

Acknowledgements

The authors thank Salma Omai and Michele Barry for collecting email accounts of clinical experts, and Kimberly Hreha and Amanda Botticello for finalizing the survey wording. We also thank the International Neuropsychological Society and New Jersey Occupational Therapy Association for posting the survey invitation on their Internet-based media with no charge. We are grateful to all participants for their time and effort in completing the survey and for sharing their clinical experience and opinions.

Disclosure statement

The study was financially supported by the Kessler Foundation and the Wallerstein Foundation for Geriatric Improvement.

Additional information

Funding

The study was financially supported by the Kessler Foundation and the Wallerstein Foundation for Geriatric Improvement.