Assessing chronic stroke survivors with aphasia sheds light on prevalence of spatial neglect

Abstract

Background: Stroke is a chronic disease. Standardized assessment is essential in order to determine areas for treatment. Individuals with aphasia are often excluded from research, because it is believed that their language impairments may impact their ability to provide informed consent. Thus, right spatial neglect could be under-diagnosed.

Objective: This study was developed to (1) determine the frequency of spatial neglect in chronic left-brain stroke survivors with aphasia, (2) determine the clinical utility of an aphasia-friendly consent form, and (3) determine any differences between neglect and no-neglect groups regarding activities of daily living (ADL) performance and community independence.

Methods: Forty-six people were consented at community center. Three were screen failures secondary to the exclusion criteria. A novel, aphasia-friendly consent form was developed to facilitate participation of individuals with aphasia. This enabled 93% or 40 out of the 43 recruited participants to be included in this study. The Behavioral Inattention Test-conventional and the Catherine Bergego Scale via Kessler Foundation Neglect Assessment Process (CBS via KF-NAP) were utilized to determine neglect. The Life Space Questionnaire was used to determine community mobility and independence. The Barthel Index (BI) was used for objective clarification of performance in ADL.

Results: Successful use of the consent form resulted in determination that five out of 40 (12.5%) met criteria for spatial neglect; (on the CBS via KF-NAP). The neglect group had lower scores on the Life Space, suggesting less community mobility and independence, however, it was not statistically significant (p = 0.16). Differences in BI scores were also not significant (p = .013) but the neglect group did have reduced independence.

Conclusions: This study demonstrates the need to administer functional neglect assessments in left-brain stroke and to include individuals with aphasia in research.

Keywords:

• Stroke
• Aphasia
• Right spatial neglect
• Left spatial neglect
• Spatial neglect
• Assessment

Acknowledgements

We are very grateful to the Adler Aphasia Center staff members, especially Wendy Greenspan and Karen Tucker, for their help and support. We would also like to thank the Adler Aphasia Center members for donating their time and participating in our study.