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

ABSTRACT

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.

KEYWORDS:

• Stroke
• Visuospatial neglect
• Functional impact
• Attention
• Occupational therapy

Acknowledgements

We would like to express our sincere gratitude and admiration to the late Prof Glyn W Humphreys, who initiated the OCS work. The OCS study was supported by the National Institute for Health Research Clinical Research Network. We also acknowledge the contributions to data collection and curation made by Ms Rachel Teal, Ms Grace Chiu, Ms Romina Basting, and the occupational therapy team at the John Radcliffe Hospital’s Hyper Acute Stroke Ward.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

In line with Contributor Roles Taxonomy (CRediT) guidelines, MJM was responsible for Formal Analysis, Investigation, Visualization, Writing – Original Draft, and Writing – Editing & Reviewing. BD contributed to Data Curation, Investigation, and Writing – Original Draft. MC aided in Data Curation, Investigation, Formal Analysis, and Writing – Original Draft. OH was responsible for qualitative analysis Supervision. Finally, ND was responsible for project Conceptualization, Supervision, and Writing – Reviewing and Editing.

Data availability statement

All anonymized data and analysis code is available on request from the authors.

Additional information

Funding

This work was funded by Stroke Association UK awards to ND (TSA2015_LECT02; TSA 2011/02) and MJM (SA PGF 18\100031), and was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) based at Oxford University Hospitals NHS Trust.