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Spatial neglect is a post‐stroke attention deficit for which there is no evidence‐based intervention. Immersive virtual reality (IVR) may increase treatment efficacy, as it allows to train spatial attention in a rich environment. This study evaluated the efficacy and feasibility of an IVR patient‐tailored training (HEMIRehApp). Using a cross‐over design, an active (spatially biased) and placebo (spatially unbiased) IVR intervention were compared. We aimed to recruit 8 per‐protocol left‐sided neglect patients. The primary outcome was response times on the Posner cueing task. To evaluate feasibility, we documented the number of recruited patients, cybersickness and patients' experience with HEMIRehApp. After 2 years of recruitment, we were able to enrol 6 patients, of whom 2 completed the full protocol. The target sample size was not feasible due to a lower than expected prevalence of left‐sided neglect and a higher than expected drop‐out rate. The planned group‐level analysis was therefore replaced by a single‐case analysis. The results in the 2 per‐protocol cases suggest a superior effect of spatially biased IVR training than unbiased IVR training inside IVR. IVR training was feasible as all 6 enrolled patients were able to complete 10 IVR training sessions, but the cross‐over protocol itself was unfeasible. While the low sample size prevented us from conclusively evaluating the efficacy of HEMIRehApp, our preliminary single‐case results suggest that neglect patients were able to improve attentional orientation towards eccentric target locations in IVR. Follow‐up studies are needed to further validate these findings. [ABSTRACT FROM AUTHOR]

Introduction: Neck muscle vibration (NMV) has been proposed as a bottom-up intervention to enhance visuospatial exploration in post-stroke patients with unilateral spatial neglect (USN). While some studies report enlarged visual exploration during NMV application, others find no significant impact, highlighting inconsistencies in the literature. The diversity in NMV application methods and the variation in visuospatial outcome measures may contribute to these conflicting findings. This study aimed to overview the methodological approaches used to investigate NMV's effects on visuospatial behavior in USN patients, focusing on aspects beyond sample size and study design. Methods: Among the seven databases, studies that applied NMV and assessed visual or perceptual outcomes were included in the analysis. Two independent reviewers screened titles and abstracts to select the studies to analyze. Data about the publication, population, modalities of application, and outcomes were extracted and synthesized. Results: Twenty-five publications from 1988 to 2023 were included, involving a total of 512 participants, of whom 114 (22.3%) had USN. The presence of USN was assessed based on paper-and-pencil tests. The frequency of NMV was set between 80 and 125 hz. In 22 studies, NMV were applied on the left side of the neck muscles. Six studies proposed multiple NMV sessions, lasting between 5 and 50 minutes/day, 3–5 times/week, for 2–4 weeks. One study included a follow-up period of up to 1.4 years. The tasks during NMV often involved indicating the subjective straight ahead (SSA, n = 8), pointing out targets, or no specific activity (n = 7, each). The SSA and cancellation tests were the most frequent outcomes. Conclusions: NMV application modalities varied widely across studies, with only vibration frequency showing consistency. The tasks performed during NMV and the outcome measures were diverse and generally unrelated to activities of daily living. Therefore, NMV effects during more ecologically valid tasks should be explored. [ABSTRACT FROM AUTHOR]

• Stimulus response task using virtual reality can improve spatial reactivity. • Background shift emphasizes the intervention effect of neglected space. • The combination of sudden stimulus and background shift is effective for unilateral spatial neglect. • Changes in egocentric center position may not affect reactivity. To investigate the effects of a stimulus response task using virtual reality (VR) for unilateral spatial neglect (USN). Double-blind randomized controlled trial. Acute phase hospital where stroke patients are hospitalized. The participants were 42 patients (N=42) with right-hemisphere cerebral damage who had been experiencing USN in their daily lives. They were randomly assigned to 3 groups: a stimulus response task with a background shift (SR+BS group), a stimulus response task without a background shift (SR group), and an object gazing task (control group). The stimulus response task was to search for balloons that suddenly appeared on the VR screen. A background shift was added to highlight the search in the neglected space. The control task was to maintain a controlled gaze on a balloon that appeared on the VR screen. The intervention period was 5 days. The primary outcome was the participants' scores on a stimulus-driven attention test (SAT) using the reaction time. The stimuli of the SAT were divided into 6 blocks of 3 lines on each side (−3 to +3). The secondary outcomes were their scores on the Behavioral Intention Test conventional, Catherine Bergego Scale, and straight ahead pointing tests. In the SAT, there were significant interaction effects of reaction time between time and group factors in left−2, right+2, and right+3. The SR+BS and SR groups showed significant improvements in the reaction time of left−2 and right+3 compared with the control group. Moreover, the SR+BS group showed a significant improvement in the reaction time of left−2, which was the neglected space, compared with the SR group. However, there were no significant interaction effects of Behavioral Intention Test conventional, Catherine Bergego Scale, and straight ahead pointing. Our results suggest that the use of stimulus response tasks using VR combined with background shifts may improve left-sided USN. [ABSTRACT FROM AUTHOR]

In all vertebrates, visual signals from each visual field project to the opposite midbrain tectum (called the superior colliculus in mammals). The tectum/colliculus computes visual salience to select targets for context-contingent visually guided behavior: a frog will orient toward a small, moving stimulus (insect prey) but away from a large, looming stimulus (a predator). In mammals, visual signals competing for behavioral salience are also transmitted to the visual cortex, where they are integrated with collicular signals and then projected via the dorsal visual stream to the parietal and frontal cortices. To control visually guided behavior, visual signals must be encoded in body-centered (egocentric) coordinates, and so visual signals must be integrated with information encoding eye position in the orbit—where the individual is looking. Eye position information is derived from copies of eye movement signals transmitted from the colliculus to the frontal and parietal cortices. In the intraparietal cortex of the dorsal stream, eye movement signals from the colliculus are used to predict the sensory consequences of action. These eye position signals are integrated with retinotopic visual signals to generate scaffolding for a visual scene that contains goal-relevant objects that are seen to have spatial relationships with each other and with the observer. Patients with degeneration of the superior colliculus, although they can see, behave as though they are blind. Bilateral damage to the intraparietal cortex of the dorsal stream causes the visual scene to disappear, leaving awareness of only one object that is lost in space. This tutorial considers what we have learned from patients with damage to the colliculus, or to the intraparietal cortex, about how the phylogenetically older midbrain and the newer mammalian dorsal cortical visual stream jointly coordinate the experience of a spatially and temporally coherent visual scene. [ABSTRACT FROM AUTHOR]

We investigated the effects of offline anosognosia for hemispatial neglect on neglect severity, functional ability, mobility, and motor recovery in left hemispatial neglect (HN) patients with right hemisphere injury. Eighty-five patients were included in this retrospective study. All patients had undergone a routine neglect rehabilitation programme. Neglect and anosognosia severities were determined by the Catherine Bergego Scale. Functional Independence Measure (FIM) scores, Functional Ambulation Classification (FAC) levels, and Brunnstrom motor recovery stages were noted. The prevalence of anosognosia for HN was 81.2% (69 of 85 patients). Neglect and neglect anosognosia severities were strongly correlated (r = 0.85, p < 0.001). Patients with anosognosia had more severe hemispatial neglect. There was no difference in median FIM score between those with and without anosognosia. The severity of anosognosia negatively correlated with FIM and FAC scores. Linear mixed model analysis revealed a significant decrease in neglect scores in patients with anosognosia than in those without. Anosognosia severity also decreased through rehabilitation and the decrease in anosognosia significantly predicted neglect improvement. Our study emphasizes that neglect anosognosia is related to severe hemispatial neglect, poor functional ability, and limited mobility. Addressing neglect anosognosia may be a valuable component of neglect rehabilitation. NCT05145855. [ABSTRACT FROM AUTHOR]

Objectives: The 'attentional spotlight' can be adjusted depending on the task requirements, resulting in processing information at either the local or global level. Stroke can lead to local or global processing biases, or the inability to simultaneously attend both levels. In this study, we assessed the (1) prevalence of abnormal local and global biases following stroke, (2) differences between left- and right-sided brain damaged patients, and (3) relations between local and global interference, the ability to attend local and global levels simultaneously, and lateralized attention, search organization, search speed, visuo-construction, executive functioning, and verbal (working) memory. Methods: Stroke patients admitted for inpatient rehabilitation completed directed (N  = 192 total; N = 46 left-sided/ N = 48 right-sided lesion) and divided (N = 258 total; N = 67 left-sided/ N = 66 right-sided lesion) local–global processing tasks, as well as a conventional neuropsychological assessment. Processing biases and interference effects were separately computed for directed and divided tasks. Results: On the local–global tasks, 7.8–10.9% of patients showed an abnormal local bias and 6.3–8.3% an abnormal global bias for directed attention, and 5.4–10.1% an abnormal local bias and 6.6–15.9% an abnormal global bias for divided attention. There was no significant difference between patients with left- and right-sided brain damage. There was a moderate positive relation between local interference and search speed, and a small positive relation between global interference and neglect. Conclusions: Abnormal local and global biases can occur after stroke and might relate to a range of cognitive functions. A specific bias might require a different approach in assessment, psycho-education, and treatment. [ABSTRACT FROM AUTHOR]

Objective: To make an initial assessment of the correlation between immersive virtual reality–based (ILBT) line bisection testing and paper-and-pencil–based line bisection (PLBT) testing in healthy subjects. Design: Diagnostic study. Setting: Research laboratory. Participants: Twenty healthy adults (51.5 [11.0] years old, 55% women; N=20). Interventions: Participants underwent an ILBT and a conventional PLBT in near space (NS) and more distant space (MDS). Correlations between the ILBT and PLBT, deviation rates in the NS and MDS, horizontal gaze distribution, and presence of virtual reality sickness (VRS) were evaluated. Main Outcome Measures: Correlation between the deviation rates of the PLBT and ILBT. Results: There was no significant correlation between the ILBT and PLBT for evaluating the deviation rate of the line bisection test (LBT). There was no significant difference in the deviation rate of the LBTs between the NS and MDS, but there was a significant difference in the horizontal line-of-sight distribution. VRS was not observed as an adverse event. Conclusions: In healthy adult subjects, our results suggested that there was no significant correlation between the deviation rates of the ILBT and PLBT. We also found that the ILBT is a useful and safe method for evaluating the horizontal line-of-sight distribution and percentage deviation of line segments from the center in the NS and MDS without inducing VRS.

BACKROUND: Spatial neglect (SN) after traumatic brain injury (TBI) is common, hindering rehabilitation progress and functional outcomes. Most research has focused on SN treatment after stroke with few published instances of post-TBI SN treated using prism adaptation treatment (PAT) in inpatient rehabilitation. OBJECTIVE: This case series characterizes the dose, after-effect, and treatment response of PAT in patients with SN after severe TBI. METHODS: Six patients exhibiting severe (n = 2), moderate (n = 2), or mild (n = 2) SN after severe TBI received 5 to 10 PAT sessions during their inpatient rehabilitation stay. Functional improvement in SN was measured by the Catherine Bergego Scale (CBS). RESULTS: Patients presented with a mean initial CBS score of 16.8 (range: 8.8–24.3). Prism after-effect was present after PAT. Following 5–10 sessions, the mean CBS score improved by 11.6 points to 5.2 (range: 7.8–21.8); the change in initial versus final CBS scores was significant (P = 0.031). CONCLUSION: This study is the first to demonstrate prism after-effect and functional SN improvement in individual patients with TBI. Patients showed a clinically meaningful improvement in mild, moderate, and severe SN following 5 to 10 PAT sessions. Additional studies are needed to assess tolerability, benefit, and optimal PAT dose for SN after TBI. [ABSTRACT FROM AUTHOR]

According to L.A. Paul, conscious experiences can be transformative. But can unconscious experiences also be transformative? After a preliminary clarification of what it means to have an unconscious experience, we marshal three cases of unconscious experiences to support the idea that unconscious experiences can be transformative: one inspired by Anna Karenina, another by a case of Freud’s, and a third by the medical condition hemispatial neglect. Such examples, we argue, suggest not only that you may have had more transformative experiences than you are aware of, but also that the sphere of the authentic subject, from a first-person perspective, outstrips what is in her consciousness at any time. A full account of transformative decision making, we suggest, must take this into consideration. [ABSTRACT FROM AUTHOR]

In all vertebrates, visual signals from each visual field project to the opposite midbrain tectum (called the superior colliculus in mammals). The tectum/colliculus computes visual salience to select targets for context-contingent visually guided behavior: a frog will orient toward a small, moving stimulus (insect prey) but away from a large, looming stimulus (a predator). In mammals, visual signals competing for behavioral salience are also transmitted to the visual cortex, where they are integrated with collicular signals and then projected via the dorsal visual stream to the parietal and frontal cortices. To control visually guided behavior, visual signals must be encoded in body-centered (egocentric) coordinates, and so visual signals must be integrated with information encoding eye position in the orbit—where the individual is looking. Eye position information is derived from copies of eye movement signals transmitted from the colliculus to the frontal and parietal cortices. In the intraparietal cortex of the dorsal stream, eye movement signals from the colliculus are used to predict the sensory consequences of action. These eye position signals are integrated with retinotopic visual signals to generate scaffolding for a visual scene that contains goal-relevant objects that are seen to have spatial relationships with each other and with the observer. Patients with degeneration of the superior colliculus, although they can see, behave as though they are blind. Bilateral damage to the intraparietal cortex of the dorsal stream causes the visual scene to disappear, leaving awareness of only one object that is lost in space. This tutorial considers what we have learned from patients with damage to the colliculus, or to the intraparietal cortex, about how the phylogenetically older midbrain and the newer mammalian dorsal cortical visual stream jointly coordinate the experience of a spatially and temporally coherent visual scene.

Background: Hemispatial neglect (HSN) was diagnosed using a virtual realitybased test (FOPR test) that explores the field of perception (FOP) and field of regard (FOR). Here, we developed virtual reality-visual exploration therapy (VRVET) combining elements from the FOPR test and visual exploration therapy (VET) and examined its efficacy for HSN rehabilitation following stroke. Methods: Eleven participants were randomly assigned to different groups, training with VR-VET first then waiting without VR-VET training (TW), or vice versa (WT). The TW group completed 20 sessions of a VR-VET program using a headmounted display followed by 4 weeks of waiting, while the WT group completed the opposite regimen. Clinical HSN measurements [line bisection test (LBT), star cancellation test (SCT), Catherine Bergego Scale (CBS), CBS perceptualattentional (CBS-PA), and CBS motor-explanatory (CBS-ME)] and FOPR tests [response time (RT), success rate (SR), and head movement (HM) for both FOP and FOR] were assessed by blinded face-to-face assessments. Results: Five and six participants were allocated to the TW and WT groups, respectively, and no dropout occurred throughout the study. VR-VET considerably improved LBT scores, FOR variables (FOR-RT, FOR-SR), FOP-LEFT variables (FOP-LEFT-RT, FOP-LEFT-SR), and FOR-LEFT variables (FOR-LEFTRT, FOR-LEFT-SR) compared to waiting without VR-VET. Additionally, VR-VET extensively improved FOP-SR, CBS, and CBS-PA, where waiting failed to make a significant change. The VR-VET made more improvements in the left hemispace than in the right hemispace in FOP-RT, FOP-SR, FOR-RT, and FOR-SR. Conclusion: The observed improvements in clinical assessments and FOPR tests represent the translatability of these improvements to real-world function and the multi-dimensional effects of VR-VET training. [ABSTRACT FROM AUTHOR]

When interacting with the environment, the sensorimotor system faces temporal and spatial discrepancies between sensory inputs, such as delay in sensory information transmission, and asymmetrical visual inputs across space. These discrepancies can affect motor control and the representation of space. We recently showed that adaptation to a laterally asymmetric delay in the visual feedback induces neglect-like effects in blind drawing movements, expressed by asymmetrical elongation of circles that are drawn in different workspaces and directions; this establishes a possible connection between delayed feedback and asymmetrical spatial processing in the control of action. In the current study, we investigate whether such adaptation also influences visual perception. In addition, we examined transfer to another motor task - a line bisection task that is commonly used to detect spatial disorders, and extend these results to examine the mapping of these neglect-like effects. We performed two sets of experiments in which participants executed lateral reaching movements, and were exposed to visual feedback delay only in the left workspace. We examined transfer of adaptation to a perceptual line bisection task - answers about the perceived midline of lines that were presented in different directions and workspaces, and to a blind motor line bisection task - reaching movements toward the centers of similar lines. We found that the adaptation to the asymmetrical delay transferred to the control of lateral movements, but did not affect the perceived location of the midlines. Our results clarify the effect of asymmetrical delayed visual feedback on perception and action, and provide potential insights on the link between visuomotor delay and neurological disorders such as the hemispatial neglect syndrome.

The present study examined the effects of unilateral stimulus presentation on the right hemisphere preponderance of the stimulus‐preceding negativity (SPN) in the event‐related potential (ERP) experiment, and aimed to elucidate whether unilateral stimulus presentation affected activations in the bilateral anterior insula in the functional magnetic resonance imaging (fMRI) experiment. Separate fMRI and ERP experiments were conducted using visual and auditory stimuli by manipulating the position of stimulus presentation (left side or right side) with the time estimation task. The ERP experiment revealed a significant right hemisphere preponderance during left stimulation and no laterality during the right stimulation. The fMRI experiment revealed that the left anterior insula was activated only in the right stimulation of auditory and visual stimuli whereas the right anterior insula was activated by both left and right stimulations. The visual condition retained a contralateral dominance, but the auditory condition showed a right hemisphere dominance in a localized area. The results of this study indicate that the SPN reflects perceptual anticipation, and also that the anterior insula is involved in its occurrence. The underlying neural mechanisms of the right hemisphere dominance in attention allocation to hemispaces that causes a hemispatial neglect are still unclear. Our study added a new finding that the right anterior insula plays a pivotal role for the right hemisphere dominance by showing congruent results of both ERP and fMRI experiments. [ABSTRACT FROM AUTHOR]

Phenomenology has been adapted for use in qualitative health research, where it's often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach to conducting this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants' experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations. [ABSTRACT FROM AUTHOR]

Objective: To provide a retrospective evaluation of a new eye and vision rehabilitation care pathway in a U.S. multi-site inpatient rehabilitation network involving the occupational therapy (OT) staff and a consulting doctor of optometry (OD) specializing in vision rehabilitation. Design: Retrospective study. Setting: Two Inpatient Rehabilitation Facilities (IRFs) and 1 Long Term Acute Care Hospital (LTACH). Participants: There were 2083 records reviewed (44% women, avg. age 59 years). The most common diagnoses were hemispatial neglect (19.2%), homonymous field defects (18.5%), and oculomotor cranial nerve palsies (16.7%) (N=2083). Interventions: Clinical care was reviewed where diagnosis-specific protocols were developed and training was provided to OTs in order to reinforce OD-prescribed interventions during daily treatment sessions, including (1) third, fourth, and sixth ocular cranial nerve palsies (OCNPs) with prisms fitted for full time, postural adaptation training, and oculomotor re-education using pursuits, saccades, head-rotations, and binocular vision exercises including alternate cover and vergence; (2) homonymous hemianopia with training awareness of field loss, eccentric viewing, and fitting of Peli lens for optical field expansion; and (3) prism adaptation therapy (PAT) for left hemispatial neglect. Main Outcome Measures: Frequency of diagnoses. Hypothesis: Diagnoses with developed protocols were most common. Secondarily, feasibility and efficacy by anonymous OT survey. Results: 2083 vision consults were performed over 5 years. The most common diagnoses were hemispatial neglect (n=399, 19.2%), homonymous field defects (n=386, 18.5%), and OCNPs (n=347, 16.7%). None of the OTs reported the protocols were infeasible and 63% (IQR 38%-69%) reported their patients benefited from the interventions. The survey suggested prism for OCNPs helped in 42%, and Peli lens and PAT both helped in 38%. Conclusions: Data support the feasibility of this inpatient eye and vision rehabilitation care pathway which may be used as a foundation for creating or refining similar programs elsewhere. Uniform administration of IRF-based visual neuro-rehabilitation care could provide a substrate for future clinical trials to evaluate efficacy.

In daily interactions, our sensorimotor system accounts for spatial and temporal discrepancies between the senses. Functional lateralization between hemispheres causes differences in attention and in the control of action across the left and right workspaces. In addition, differences in transmission delays between modalities affect movement control and internal representations. Studies on motor impairments such as hemispatial neglect syndrome suggested a link between lateral spatial biases and temporal processing. To understand this link, we computationally modeled and experimentally validated the effect of laterally asymmetric delay in visual feedback on motor learning and its transfer to the control of drawing movements without visual feedback. In the behavioral experiments, we asked healthy participants to perform lateral reaching movements while adapting to delayed visual feedback in either left, right, or both workspaces. We found that the adaptation transferred to blind drawing and caused movement elongation, which is consistent with a state representation of the delay. However, the pattern of the spatial effect varied between conditions: whereas adaptation to delay in only the left workspace or in the whole workspace caused selective leftward elongation, adaptation to delay in only the right workspace caused drawing elongation in both directions. We simulated arm movements according to different models of perceptual and motor spatial asymmetry in the representation of delay and found that the best model that accounts for our results combines both perceptual and motor asymmetry between the hemispheres. These results provide direct evidence for an asymmetrical processing of delayed visual feedback that is associated with both perceptual and motor biases that are similar to those observed in hemispatial neglect syndrome.

Background and purpose: The Oxford Cognitive Screen is a stroke-specific screen to evaluate attention, executive functions, memory, praxis, language, and numeric cognition. It was originally validated in England for acute stroke patients. In this study, we examined the psychometric properties of the Dutch OCS (OCS-NL). Methods: A total of 193 (99 acute stroke unit, 94 rehabilitation unit) patients were included in our study. A subset of patients (n = 128) completed a retest with the parallel version of the OCS-NL. Results: First, we did not find evidence for a difference in prevalence of impairment between patients in the acute stroke versus rehabilitation unit on all but one of the subtests. For praxis, we observed a 14% lower prevalence of impairment in the rehabilitation than the acute stroke unit. Second, the parallel-form reliability ranged from weak to excellent across subtests. Third, in stroke patients below age 60, the OCS-NL had a 92% sensitivity relative to the MoCA, while the MoCA had a 55% sensitivity relative to the OCS-NL. Last, although left-hemispheric stroke patients performed worse on almost all MoCA subdomains, they performed similarly to right-hemispheric stroke patients on non-language domains on the OCS-NL. Conclusions: Our results suggest that the OCS-NL is a reliable cognitive screen that can be used in acute stroke and rehabilitation units. The OCS-NL may be more sensitive to detect cognitive impairment in young stroke patients and less likely to underestimate cognitive abilities in left-hemispheric stroke patients than the MoCA. [ABSTRACT FROM AUTHOR]

Immersive virtual reality (IVR) may boost neglect recovery, as it can provide an engaging experience in a 3D environment. We designed an IVR rehabilitation game for neglect patients using the Oculus Rift. Multisensory cues were presented in the neglected visual field in a patient-tailored way. We acquired pilot data in 15 neurologically healthy controls and 7 stroke patients. First, we compared cybersickness before and after VR exposure. Second, we assessed the user experience through a questionnaire. Third, we tested whether neglect symptoms corresponded between the VR game and a computerized cancelation task. Fourth, we evaluated the effect of the multisensory cueing on target discrimination. Last, we tested two algorithms to tailor the game to the characteristics of the neglected visual field. Cybersickness significantly reduced after VR exposure in six stroke patients and was low in healthy controls. Patients rated the user experience neutral to positive. In addition, neglect symptoms were consistent between a computerized cancelation and VR rehabilitation task. The multisensory cue positively affected target discrimination in the game and we successfully presented sensory stimulation to the neglected visual field in a patient-tailored way. Our results show that it is promising to use gamified patient-tailored immersive VR for neglect rehabilitation. [ABSTRACT FROM AUTHOR]

Background and purpose: Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time‐limited clinical environments. Methods: Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations. Results: A total of 512 articles were screened, and 42 were included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copying, reading/writing, and behavioral. Cancellation tasks were most frequently used (97.6% of studies), followed by bisection, copying, behavioral, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying, and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, the literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible. Conclusions: This study provides consensus recommendations for rapid bedside detection of neglect in real‐world, clinical environments. [ABSTRACT FROM AUTHOR]

One evidence-based treatment for spatial neglect is prism adaptation (PA) treatment. PA after-effects, i.e., the implicit shifts in the arm reaching position toward the neglected side of space after prism removal, are considered fundamental to PA treatment effects. In the present study, the arm reaching position was shifted through a visuomotor misalignment procedure using immersive virtual reality (VR). To examine whether this procedure might have a beneficial impact on spatial neglect, we conducted a multi-baseline experiment in three individuals with chronic left-sided neglect post stroke. Improved spatial neglect was observed in all participants immediately after 5 sessions with two rounds in each. Two participants demonstrated lasting or continuous improvement two weeks later. Participants' pattern of brain lesions did not appear to clearly explain performance differences. The findings suggest that VR-induced visuomotor misalignment may improve spatial neglect immediately after a multi-session treatment course. The optimal number of sessions will be determined by future studies with a larger sample size, which may also elucidate the number of sessions sufficient for sustained improvement in most patients. Further investigations will identify the neural mechanisms underlying VR-induced visuomotor misalignment, which may or may not be identical to PA after-effects. [ABSTRACT FROM AUTHOR]

It is clear already that in current and future years more people will suffer from stroke, whether related to COVID-19 or not, and given its prevalence, many more people's lives will be affected by neglect. Here we hope to have contributed to its possible amelioration with highlights of the latest thinking on neglect diagnosis, prevalence and treatment. [ABSTRACT FROM AUTHOR]

Unilateral spatial neglect (USN) may lead to poor functional rehabilitation outcomes. However, studies investigating the rehabilitation outcomes of right-sided USN are lacking. We aimed to investigate (1) the clinical impacts of USN, including right-sided USN, for stroke patients in sub-acute rehabilitation, and (2) evaluate the differences in clinical characteristics and rehabilitation outcomes between right- and left-sided USN patients. We retrospectively screened the medical records of 297 inpatients at the Tokyo-Bay Rehabilitation Hospital who experienced a cerebrovascular accident with supratentorial lesions between January 1st, 2014 and December 31st, 2016. We performed independent multiple regression analysis in patients with left and right hemisphere damage. The Behavioral Inattention Test was a significant independent variable for predicting the motor, cognitive, and total functional independence measure (FIM), compared to the Stroke Impairment Assessment Set and Mini-Mental State Examination. USN affects motor FIM recovery more than cognitive FIM recovery regardless of the damaged hemisphere. Our study results confirm that both right- and left-sided USN influence the functional recovery of stroke patients. USN occurs, slightly less frequently, following a left hemisphere stroke. However, USN negatively affected rehabilitation outcomes, regardless of the neglected side. Therefore, USN treatment is necessary for patients with left and right hemisphere damage. [ABSTRACT FROM AUTHOR]

Hyponatremia is one of the major conditions that mimic stroke. Hyponatremia is known to cause focal neurological deficits; however, reported herein is a rare neurologic manifestation of hyponatremia, which mimics a proximal posterior cerebral artery occlusion. A 70-year-old man was admitted to our emergency unit with an acute history of vomiting, confusion, and impaired vision. Neurologic examination showed impaired orientation, left homonymous hemianopia, and left-sided hemispatial neglect. Hyponatremia was detected, and magnetic resonance imaging showed no abnormalities. The patient recovered completely after the correction of the serum sodium levels. This case illustrates that the clinical presentation of acute hemispatial neglect and homonymous hemianopia, which commonly implies a stroke, may result from hyponatremia. Hyponatremia should be considered in patients presenting with focal neurologic deficits, for which imaging evidence of a stroke cannot be shown.

Objective: Traditionally, asymmetric spatial processing (i.e., hemispatial neglect) has been assessed with paper-and-pencil tasks, but growing evidence indicates that computer-based methods are a more sensitive assessment modality. It is not known, however, whether simply converting well-established paper-and-pencil methods into a digital format is the best option. The aim of the present study was to compare sensitivity in detecting contralesional omissions of two different computer-based methods: a "digitally converted" cancellation task was compared with a computer-based Visual and Auditory dual-tasking approach, which has already proved to be very sensitive. Methods: Participants included 40 patients with chronic unilateral stroke in either the right hemisphere (RH patients, N = 20) or the left hemisphere (LH patients, N = 20) and 20 age-matched healthy controls. The cancellation task was implemented on a very large format (173 cm × 277 cm) or in a smaller (A4) paper-and-pencil version. The computer-based dual-tasks were implemented on a 15′′ monitor and required the detection of unilateral and bilateral briefly presented lateralized targets. Results: Neither version of the cancellation task was able to show spatial bias in RH patients. In contrast, in the Visual dual-task RH patients missed significantly more left-sided targets than controls in both unilateral and bilateral trials. They also missed significantly more left-sided than right-sided targets only in the bilateral trials of the Auditory dual-task. Conclusion: The dual-task setting outperforms the cancellation task approach even when the latter is implemented on a (large) screen. Attentionally demanding methods are useful for revealing mild forms of contralesional visuospatial deficits. [ABSTRACT FROM AUTHOR]

The Fluff test is a simple test to assess evidence of personal neglect (PN) in brain-damaged patients. While blindfolded, patients are asked to remove targets previously attached to their body and the number of targets detached provides information about possible spatial bias. This test has been widely used for clinical and research purposes. However, the current scoring system presents some limitations, which make difficult to interpret patients' performance in terms of both contralalesional and ipsilesional PN when they omit targets on the ipsilesional side. Moreover, it does not consider possible confounding variables, such as non-spatial cognitive deficits or lack of compliance that may affect patients' performance and lead to incorrect diagnosis. The present paper proposes a new scoring method overcoming the limitations mentioned above and it analyses data from a large sample of 243 brain-damaged patients. Findings showed that contralesional PN was significantly more severe, but not more frequent, following right (31%) than left (21%) brain damage. We also found evidence of left ipsilesional PN and cases of potential mis-diagnosis that would have passed unnoticed with the original scoring system. The new scoring method allows to identify different degrees of contralesional and ipsilesional PN and potential confounding variable. [ABSTRACT FROM AUTHOR]

Objective To determine the relationship between line bisection test (LBT) performance time and prognosis of hemispatial neglect (HSN) in stroke patients. Methods Data on stroke patients with HSN were prospectively collected. After patient recruitment and eligibility screening, the LBT, Motor-Free Visual Perception Test 3rd edition, and Korean version of Mini-Mental State Examination were performed at the time of admission and 4 weeks thereafter. The LBT performance time was also measured. All patients received conventional rehabilitation for 4 weeks. Based on the improvements in their LBT grades, the patients were divided into improved and non-improved groups. The evaluation results of the two groups were compared using Mann–Whitney U-tests and logistic regression was performed to predict the independence of each outcome. Results In total, 26 stroke patients with HSN were included, with 13 patients in each group. Significant differences were observed in the baseline LBT performance times between the improved and non-improved groups (p

Objective: Traditionally, asymmetric spatial processing (i.e., hemispatial neglect) has been assessed with paper-and-pencil tasks, but growing evidence indicates that computer-based methods are a more sensitive assessment modality. It is not known, however, whether simply converting well-established paper-and-pencil methods into a digital format is the best option. The aim of the present study was to compare sensitivity in detecting contralesional omissions of two different computer-based methods: a “digitally converted” cancellation task was compared with a computer-based Visual and Auditory dual-tasking approach, which has already proved to be very sensitive.Methods: Participants included 40 patients with chronic unilateral stroke in either the right hemisphere (RH patients, N = 20) or the left hemisphere (LH patients, N = 20) and 20 age-matched healthy controls. The cancellation task was implemented on a very large format (173 cm × 277 cm) or in a smaller (A4) paper-and-pencil version. The computer-based dual-tasks were implemented on a 15′′ monitor and required the detection of unilateral and bilateral briefly presented lateralized targets.Results: Neither version of the cancellation task was able to show spatial bias in RH patients. In contrast, in the Visual dual-task RH patients missed significantly more left-sided targets than controls in both unilateral and bilateral trials. They also missed significantly more left-sided than right-sided targets only in the bilateral trials of the Auditory dual-task.Conclusion: The dual-task setting outperforms the cancellation task approach even when the latter is implemented on a (large) screen. Attentionally demanding methods are useful for revealing mild forms of contralesional visuospatial deficits.

Objective: The Clock Drawing Test (CDT) is a widely used test for cognitive screening as its execution taps into a large number of cognitive functions. Because of the involvement of visuospatial abilities, the CDT is also commonly used to assess hemispatial neglect. In the present study, we introduce a new quantitative scoring method for the CDT that aims to measure the use of space for each half of the clock face and asymmetries of space use., Method: Two measures are introduced: the explored space (ES) and used space (US) for each half of the clock, as well as two derived asymmetry indices. Such new measures were applied to CDTs of four groups of participants: right brain-damaged patients without visuospatial neglect, two groups of right brain-damaged patients with varying degrees of visuospatial neglect, and a group of neurologically healthy participants., Results: Analyses showed that only neglect patients explored and used the left clock half significantly less than the right one. This result was also confirmed by the asymmetry indices, where neglect patients showed a stronger rightward bias. For neglect patients, the US asymmetry index correlated with the patients' scores on the neuropsychological tests. The analyses of receiver operating characteristic curves showed that left US and left ES scores had good accuracy in categorizing neglect patients., Conclusions: The present work provides new quantitative indices of CDT space usage in hemispatial neglect. Cutoffs are provided for clinical practice., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: Virtual reality (VR) and eye tracking may provide detailed insights into spatial cognition. We hypothesized that virtual reality and eye tracking may be used to assess sub-types of spatial neglect in stroke patients not readily available from conventional assessments. Method: Eighteen stroke patients with spatial neglect and 16 age and gender matched healthy subjects wearing VR headsets were asked to look around freely in a symmetric 3D museum scene with three pictures. Asymmetry of performance was analyzed to reveal group-level differences and possible neglect sub-types on an individual level. Results: Four out of six VR and eye tracking measures revealed significant differences between patients and controls in this free-viewing task. Gaze-asymmetry between-pictures (including fixation time and count) and head orientation were most sensitive to spatial neglect behavior on a group level analysis. Gaze-asymmetry and head orientation each identified 10 out of 18 (56%), compared to 12 out of 18 (67%) for the best conventional test. Two neglect patients without deviant performance on conventional measures were captured by the VR and eyetracking measures. On the individual level, five stroke patients revealed deviant gaze-asymmetry within-pictures and six patients revealed deviant eye orientation in either direction that were not captured by the group-level analysis. Conclusion: This study is a first step in using VR in combination with eye tracking measures as individual differential neglect subtype diagnostics. This may pave the way for more sensitive and elaborate sub-type diagnostics of spatial neglect that may respond differently to various treatment approaches. [ABSTRACT FROM AUTHOR]

Purpose: Virtual reality (VR) and eye tracking may provide detailed insights into spatial cognition. We hypothesized that virtual reality and eye tracking may be used to assess sub-types of spatial neglect in stroke patients not readily available from conventional assessments.Method: Eighteen stroke patients with spatial neglect and 16 age and gender matched healthy subjects wearing VR headsets were asked to look around freely in a symmetric 3D museum scene with three pictures. Asymmetry of performance was analyzed to reveal group-level differences and possible neglect sub-types on an individual level.Results: Four out of six VR and eye tracking measures revealed significant differences between patients and controls in this free-viewing task. Gaze-asymmetry between-pictures (including fixation time and count) and head orientation were most sensitive to spatial neglect behavior on a group level analysis. Gaze-asymmetry and head orientation each identified 10 out of 18 (56%), compared to 12 out of 18 (67%) for the best conventional test. Two neglect patients without deviant performance on conventional measures were captured by the VR and eyetracking measures. On the individual level, five stroke patients revealed deviant gaze-asymmetry within-pictures and six patients revealed deviant eye orientation in either direction that were not captured by the group-level analysis.Conclusion: This study is a first step in using VR in combination with eye tracking measures as individual differential neglect subtype diagnostics. This may pave the way for more sensitive and elaborate sub-type diagnostics of spatial neglect that may respond differently to various treatment approaches.

We aimed to explore whether motor function and activities of daily life (ADL) could be improved with the application of visual deprivation in two patients with Pusher syndrome complicated by hemispatial neglect after right basal ganglia stroke. We assessed two stroke patients suffering from severe motor disturbances, both tilting heavily to the left, with diagnoses of Pusher syndrome and left hemispatial neglect. Vision in the left eye was deprived using patches during clinical rehabilitation. Motor function promotion was confirmed using the Burke Lateropulsion Scale (BLS), Fugl–Meyer Balance Scale (FMBS), and Holden grade (HG), while the Barthel index (BI) assessed ADL immediately and 1 week after intervention. Both patients regained standing balance immediately using visual deprivation, as well as walking ability, although both scored 0 on the FMBS and HG. After 1 week of treatment, one patient increased to 11 and 3 on the FMBS and HG, respectively, while the BLS score decreased from 12 to 2, and the ADL increased from 23 to 70. The other patient demonstrated increases to 10 and 3 on the FMBS and HG, respectively, with the BLS decreasing from 13 to 3, and the ADL increasing from 25 to 60. Therefore, in the rehabilitation treatment of Pusher syndrome complicated by hemispatial neglect due to basal ganglia stroke, visual deprivation can significantly improve motor function and shorten the treatment course.

We aimed to explore whether motor function and activities of daily life (ADL) could be improved with the application of visual deprivation in two patients with Pusher syndrome complicated by hemispatial neglect after right basal ganglia stroke. We assessed two stroke patients suffering from severe motor disturbances, both tilting heavily to the left, with diagnoses of Pusher syndrome and left hemispatial neglect. Vision in the left eye was deprived using patches during clinical rehabilitation. Motor function promotion was confirmed using the Burke Lateropulsion Scale (BLS), Fugl–Meyer Balance Scale (FMBS), and Holden grade (HG), while the Barthel index (BI) assessed ADL immediately and 1 week after intervention. Both patients regained standing balance immediately using visual deprivation, as well as walking ability, although both scored 0 on the FMBS and HG. After 1 week of treatment, one patient increased to 11 and 3 on the FMBS and HG, respectively, while the BLS score decreased from 12 to 2, and the ADL increased from 23 to 70. The other patient demonstrated increases to 10 and 3 on the FMBS and HG, respectively, with the BLS decreasing from 13 to 3, and the ADL increasing from 25 to 60. Therefore, in the rehabilitation treatment of Pusher syndrome complicated by hemispatial neglect due to basal ganglia stroke, visual deprivation can significantly improve motor function and shorten the treatment course. [ABSTRACT FROM AUTHOR]

Up to 80% of people who experience a right-hemisphere stroke suffer from hemispatial neglect. This syndrome is debilitating and impedes rehabilitation. We carried out a clinical feasibility trial of transcranial direct current stimulation (tDCS) and a behavioural rehabilitation programme, alone or in combination, in patients with neglect. Patients >4 weeks post right hemisphere stroke were randomized to 10 sessions of tDCS, 10 sessions of a behavioural intervention, combined intervention, or a control task. Primary outcomes were recruitment and retention rates, with secondary outcomes effect sizes on measures of neglect and quality of life, assessed directly after the interventions, and at 6 months follow up. Of 288 confirmed stroke cases referred (representing 7% of confirmed strokes), we randomized 8% (0.6% of stroke cases overall). The largest number of exclusions (91/288 (34%)) were due to medical comorbidities that prevented patients from undergoing 10 intervention sessions. We recruited 24 patients over 29 months, with 87% completing immediate post-intervention and 67% 6 month evaluations. We established poor feasibility of a clinical trial requiring repeated hospital-based tDCS within a UK hospital healthcare setting, either with or without behavioural training, over a sustained time period. Future trials should consider intensity, duration and location of tDCS neglect interventions. Trial registration: ClinicalTrials.gov identifier: NCT02401724. [ABSTRACT FROM AUTHOR]

Objective: To identify barriers and facilitators to achieving optimal inpatient rehabilitation outcome among individuals with spatial neglect (SN). Design: Cross-sectional, semistructured focus group discussions. Setting: Rehabilitation hospitals. Participants: A total of 15 occupational therapists and 14 physical therapists treating patients with SN on 3 campuses of a rehabilitation hospital system (N=29). Six focus group sessions were conducted and audio-recorded for transcription. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: Participants identified several patient-related characteristics that posed barriers to treatment, including the symptoms of SN itself, cognitive issues, physical weakness, comorbidities, and reduced therapy engagement. Supportive family members were considered a key facilitator, but lack of preparedness to assume caregiving roles, poor understanding of SN and rehabilitation goals, and inadequate levels of involvement were family-related barriers to successful treatment. Participants expressed that having resources and technologies available at their center to support SN treatment facilitated positive outcomes and perceived limited staff knowledge and skills and poor interclinician communication as barriers to treatment. At the health care system level, barriers included a lack of responsive measures of SN progress and insurer-related issues. Strong continuity of care between transitions was considered an important factor for enabling effective treatment. Conclusions: Barriers and facilitators to the current practice of SN care were identified from occupational and physical therapists’ point of view. Opportunities exist to promote identified facilitators and minimize barriers to improve SN rehabilitation. The present study makes a unique contribution in identifying specific needs for innovative interventions that involve family support and training, promotion of interdisciplinary collaboration, development of interprofessional vocabulary, and continuous treatment and follow-up assessment for SN through care transitions.

Background: Hemispatial neglect is a debilitating consequence of right hemispheric ischemic stroke (RIS), with evidence that patient-level factors influence neglect severity. Study objective: Determine if cardiac function is associated with presence and severity of neglect, independent of infarct size.Methods: Two hundred and eighteen non-demented, RIS with cerebral MRI and echocardiography who completed ≥1 of 4 tests evaluating neglect were included. Age- and sex- adjusted Z-scores defined neglect with severity categorized as no neglect, neglect on one or neglect on ≥2 tests. The dependent variable was presence of neglect (multivariable logistic regression), or neglect severity (multinomial logistic regression). The association with left ventricular (LV) structure/function (independent variable) was evaluated using separate nested adjustment models.Results: Patients were on average 61 yo (21–95), female (50%), black (53%), with an ejection fraction of 60% (IQR 20–75%). Fifty eight (27%) had neglect. Each 1 cm increase in LV systolic diameter was associated with a higher relative risk of having neglect on two tests compared to those with no neglect (RRR = 1.83, 95% CI 1.01–3.32), but not after adjusting for education and DWI volume (RRR = 1.68, 95% CI 0.89–3.19). Per 1 cm increase in left atrial (LA) diameter, the relative risk of having neglect on 2 tests vs. no neglect was over two times higher (95% CI 1.04–4.77), but lost significance in the final model (RRR = 1.73, 95% CI 0.76–3.94).Conclusions: We found an association between markers of diastolic dysfunction (enlarging LV, compensatory enlarging LA) and severity of neglect, suggesting that cardiac structure, and function affects not only lesion volume, but also the functional consequences of infarct volume.

Background: Hemispatial neglect is a debilitating consequence of right hemispheric ischemic stroke (RIS), with evidence that patient-level factors influence neglect severity. Study objective: Determine if cardiac function is associated with presence and severity of neglect, independent of infarct size. Methods: Two hundred and eighteen non-demented, RIS with cerebral MRI and echocardiography who completed ≥1 of 4 tests evaluating neglect were included. Age- and sex- adjusted Z-scores defined neglect with severity categorized as no neglect, neglect on one or neglect on ≥2 tests. The dependent variable was presence of neglect (multivariable logistic regression), or neglect severity (multinomial logistic regression). The association with left ventricular (LV) structure/function (independent variable) was evaluated using separate nested adjustment models. Results: Patients were on average 61 yo (21–95), female (50%), black (53%), with an ejection fraction of 60% (IQR 20–75%). Fifty eight (27%) had neglect. Each 1 cm increase in LV systolic diameter was associated with a higher relative risk of having neglect on two tests compared to those with no neglect (RRR = 1.83, 95% CI 1.01–3.32), but not after adjusting for education and DWI volume (RRR = 1.68, 95% CI 0.89–3.19). Per 1 cm increase in left atrial (LA) diameter, the relative risk of having neglect on 2 tests vs. no neglect was over two times higher (95% CI 1.04–4.77), but lost significance in the final model (RRR = 1.73, 95% CI 0.76–3.94). Conclusions: We found an association between markers of diastolic dysfunction (enlarging LV, compensatory enlarging LA) and severity of neglect, suggesting that cardiac structure, and function affects not only lesion volume, but also the functional consequences of infarct volume. [ABSTRACT FROM AUTHOR]

The intraparietal sulcus (IPS) plays a key role in the distribution of attention across the visual field. In stroke patients, an imbalance between left and right IPS activity has been related to a spatial bias in visual attention characteristic of hemispatial neglect. In this study, we describe the development and implementation of a real-time functional magnetic resonance imaging neurofeedback protocol to noninvasively and volitionally control the interhemispheric IPS activity balance in neurologically healthy participants. Six participants performed three neurofeedback training sessions across three weeks. Half of them trained to voluntarily increase brain activity in left relative to right IPS, while the other half trained to regulate the IPS activity balance in the opposite direction. Before and after the training, we estimated the distribution of attention across the visual field using a whole and partial report task. Over the course of the training, two of the three participants in the left-IPS group increased the activity in the left relative to the right IPS, while the participants in the right-IPS group were not able to regulate the interhemispheric IPS activity balance. We found no evidence for a decrease in resting-state functional connectivity between left and right IPS, and the spatial distribution of attention did not change over the course of the experiment. This study indicates the possibility to voluntarily modulate the interhemispheric IPS activity balance. Further research is warranted to examine the effectiveness of this technique in the rehabilitation of post-stroke hemispatial neglect.

Introduction: Personal neglect (PN) refers to a form of hemi-inattention toward the contralesional body space and it usually occurs following a right brain lesion. Recent studies suggest that PN indicates a disorder of body representation. Specifically, patients with PN show difficulties in identifying differences between left and right hands and have an altered visuospatial body map, which is associated with disrupted mental body representations. However, the metric representation of the body, and in particular the hands, has not been systematically addressed in patients showing this form of neglect. Method: In the present study, we have investigated this representation by testing the perceived hands' width of 11 hemiplegic patients with right hemisphere cerebral lesions (5 with PN) and 12 healthy controls on a judgment of passability task. Patients and controls were asked to imagine inserting their hand (left and right) through a series of vertical apertures of different sizes and to judge whether their hand could fit through. Due to the heterogeneity of the data, both parametric and non-parametric approaches were used. Furthermore, additional single-case analyses were conducted. Results: Study findings showed that patients with PN showed a significant underestimation of the left hand compared with their right hand. In contrast, whilst the right hand was equally distorted in both patients' groups, the hemiplegic patients with no evidence of PN tended to perceive the affected hand as larger than their ipsilesional one. Conclusions: In line with the literature, our findings confirm an underlying distorted body representation following right brain damage. However, for the first time, we report both a quantitative and qualitative difference in impact of hemiplegia and PN on body representation of the contralesional body space. [ABSTRACT FROM AUTHOR]

Numerous tests of visuo-spatial neglect (VSN) have been developed. In this study, we propose a clustering of VSN tests by making a distinction between static tests with low levels of cognitive demand (i.e. tests without movement or time-restrictions, such as paper-and-pencil tests) and dynamic tests with high levels of cognitive demand (i.e. tests incorporating movement and time-restrictions, such as virtual reality tests). The concepts of static and dynamic tests have not been systematically investigated so far. Here, we investigated (1) whether we would find dissociations between patients showing VSN on test within the static cluster but not on tests within the dynamic cluster, and vice versa; (2) whether differences in demographic or clinical characteristics could be identified between these groups of patients; and (3) whether the underlying factor structure would correspond to our proposed distinction between static and dynamic clusters of tests. Sixty-one patients with VSN completed three static tests (shape cancellation, line bisection, letter cancellation) and three dynamic tests (Catherine Bergego Scale, Mobility Assessment Course, simulated driving test). Thirteen percent of patients showed VSN on tests within the static cluster, 33% on tests within the dynamic cluster, and 54% on tests within both clusters. Patients with VSN on the dynamic tests (alone or in addition to static tests) had poorer motor function, poorer walking abilities and were more dependent in daily life than patients showing VSN on the static cluster alone. The underlying factor structure corresponded to our proposed conceptual distinction between static and dynamic clusters of tests. Static and dynamic tests compose different clusters and double dissociations are shown between clusters. Future research involving data-driven approaches might result in a better understanding on how different tests of VSN relate to each other, and, more importantly, a better understanding of VSN and its phenotypes. [ABSTRACT FROM AUTHOR]

Purpose/aim: Spatial neglect is caused by damage to neural networks critical for spatial attention. Spatial neglect without proper treatment impedes rehabilitation outcomes. Prism adaptation treatment, a visuomotor protocol, has been used with stroke survivors with spatial neglect to improve function. This case report explored the feasibility and potential effects of prism adaptation treatment in an individual with spatial neglect after glioblastoma removal. Methods: Feasibility was designed and tested to include acceptability and implementation. Exploratory aim on the effectiveness of the intervention was determined using the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process, star cancellation, line bisection and scene copying. Results: The patient reported favouring the treatment. Eight sessions, one session a day, were completed over two weeks. The patient's spatial neglect symptoms reduced on all assessments. Conclusion: Prism adaptation treatment was feasible and effective; however, further research is needed to understand the complete benefits of prism adaptation treatment in this population. [ABSTRACT FROM AUTHOR]

Spatial neglect is characterized by a spatial bias in response to stimuli. The disorder is often assessed with a cancellation task, where several measures can be used to quantify the spatial bias of cancellation responses (e.g., the difference between cancellations on the left and right side, the average location of cancelled targets, and the total number of omissions). Typically, measures of cancellation performance are validated by studying the correlation with measures derived from other tasks to assess neglect (e.g., the directional bisection error derived from performance on the line bisection task). However, the foundation of cancellation performance measures is often more intuitive than theoretical. For instance, it is assumed that measures of cancellation performance isolate the spatial (e.g., the ipsilesional preference typical of spatial neglect) from the non‐spatial (e.g., deficits in working memory or sustained attention) sources of error, but this assumption has not been tested yet. Here we formulated a simple model with conceptually meaningful parameters to predict cancellation performance. Our model parameterizes the spatial and non‐spatial components of cancellation responses. This model allowed us to study the construct representation of commonly used measures of spatial neglect through the use of Monte Carlo simulations. The results showed that most of the cancellation performance measures are also dependent on non‐spatial error sources. The results deepen our understanding of the construct representation of cancellation performance measures, while also having implications for studies focused on the relationship between the spatial and non‐spatial attention deficits in spatial neglect. [ABSTRACT FROM AUTHOR]

Visual attention can be spatially oriented, even in the absence of saccadic eye-movements, to facilitate the processing of incoming visual information. One behavioral proxy for this so-called covert visuospatial attention (CVSA) is the validity effect (VE): the reduction in reaction time (RT) to visual stimuli at attended locations and the increase in RT to stimuli at unattended locations. At the electrophysiological level, one correlate of CVSA is the lateralization in the occipital α -band oscillations, resulting from α -power increases ipsilateral and decreases contralateral to the attended hemifield. While this α -band lateralization has been considerably studied using electroencephalography (EEG) or magnetoencephalography (MEG), little is known about whether it can be trained to improve CVSA behaviorally. In this cross-over sham-controlled study we used continuous real-time feedback of the occipital α -lateralization to modulate behavioral and electrophysiological markers of covert attention. Fourteen subjects performed a cued CVSA task, involving fast responses to covertly attended stimuli. During real-time feedback runs, trials extended in time if subjects reached states of high α -lateralization. Crucially, the ongoing α -lateralization was fed back to the subject by changing the color of the attended stimulus. We hypothesized that this ability to self-monitor lapses in CVSA and thus being able to refocus attention accordingly would lead to improved CVSA performance during subsequent testing. We probed the effect of the intervention by evaluating the pre-post changes in the VE and the α -lateralization. Behaviorally, results showed a significant interaction between feedback (experimental–sham) and time (pre-post) for the validity effect, with an increase in performance only for the experimental condition. We did not find corresponding pre-post changes in the α -lateralization. Our findings suggest that EEG-based real-time feedback is a promising tool to enhance the level of covert visuospatial attention, especially with respect to behavioral changes. This opens up the exploration of applications of the proposed training method for the cognitive rehabilitation of attentional disorders. [ABSTRACT FROM AUTHOR]

Hyponatremia is one of the major conditions that mimic stroke. Hyponatremia is known to cause focal neurological deficits; however, reported herein is a rare neurologic manifestation of hyponatremia, which mimics a proximal posterior cerebral artery occlusion. A 70-year-old man was admitted to our emergency unit with an acute history of vomiting, confusion, and impaired vision. Neurologic examination showed impaired orientation, left homonymous hemianopia, and left-sided hemispatial neglect. Hyponatremia was detected, and magnetic resonance imaging showed no abnormalities. The patient recovered completely after the correction of the serum sodium levels. This case illustrates that the clinical presentation of acute hemispatial neglect and homonymous hemianopia, which commonly implies a stroke, may result from hyponatremia. Hyponatremia should be considered in patients presenting with focal neurologic deficits, for which imaging evidence of a stroke cannot be shown. [ABSTRACT FROM AUTHOR]

Objective: To review current knowledge of the perception of verticality, its normal function and disorders. This is based on an integrative graviceptive input from the vertical semicircular canals and the otolith organs.Methods: The special focus is on human psychophysics, neurophysiological and imaging data on the adjustments of subjective visual vertical (SVV) and the subjective postural vertical. Furthermore, examples of mathematical modeling of specific vestibular cell functions for orientation in space in rodents and in patients are briefly presented.Results: Pathological tilts of the SVV in the roll plane are most sensitive and frequent clinical vestibular signs of unilateral lesions extending from the labyrinths via the brainstem and thalamus to the parieto-insular vestibular cortex. Due to crossings of ascending graviceptive fibers, peripheral vestibular and pontomedullary lesions cause ipsilateral tilts of the SVV; ponto-mesencephalic lesions cause contralateral tilts. In contrast, SVV tilts, which are measured in unilateral vestibular lesions at thalamic and cortical levels, have two different characteristic features: (i) they may be ipsi- or contralateral, and (ii) they are smaller than those found in lower brainstem or peripheral lesions. Motor signs such as head tilt and body lateropulsion, components of ocular tilt reaction, are typical for vestibular lesions of the peripheral vestibular organ and the pontomedullary brainstem (vestibular nucleus). They are less frequent in midbrain lesions (interstitial nucleus of Cajal) and rare in cortical lesions. Isolated body lateropulsion is chiefly found in caudal lateral medullary brainstem lesions. Vestibular function in the roll plane and its disorders can be mathematically modeled by an attractor model of angular head velocity cell and head direction cell function. Disorders manifesting with misperception of the body vertical are the pusher syndrome, the progressive supranuclear palsy, or the normal pressure hydrocephalus; they may affect roll and/or pitch plane.Conclusion: Clinical determinations of the SVV are easy and reliable. They indicate acute unilateral vestibular dysfunctions, the causative lesion of which extends from labyrinth to cortex. They allow precise topographical diagnosis of side and level in unilateral brainstem or peripheral vestibular disorders. SVV tilts may coincide with or differ from the perception of body vertical, e.g., in isolated body lateropulsion.

Direct gaze has been shown to be a particularly important social cue, being preferentially processed even when unconsciously perceived. Results from several visual search tasks further suggest that direct gaze modulates attention, showing a faster orientation to faces perceived as looking toward us. The present study aimed to analyze putative modulation of spatial attention by eye gaze direction in patients with unilateral neglect. Eight right hemisphere stroke patients with neglect performed a target cancelation paradigm. Patients were instructed to cross all open-eyed pictures amidst closed eyed distractors. Target images were either in direct or averted gaze. Participants performed significantly better when observing targets with direct gaze supporting the hypothesis that this gaze direction captures attention. These findings further suggest that perception of direct gaze is able to diminish the visuospatial impairment seen in neglect patients.

Objective: To make an initial assessment of the correlation between immersive virtual reality-based (ILBT) line bisection testing and paper-and-pencil-based line bisection (PLBT) testing in healthy subjects., Design: Diagnostic study., Setting: Research laboratory., Participants: Twenty healthy adults (51.5 [11.0] years old, 55% women; N=20)., Interventions: Participants underwent an ILBT and a conventional PLBT in near space (NS) and more distant space (MDS). Correlations between the ILBT and PLBT, deviation rates in the NS and MDS, horizontal gaze distribution, and presence of virtual reality sickness (VRS) were evaluated., Main Outcome Measures: Correlation between the deviation rates of the PLBT and ILBT., Results: There was no significant correlation between the ILBT and PLBT for evaluating the deviation rate of the line bisection test (LBT). There was no significant difference in the deviation rate of the LBTs between the NS and MDS, but there was a significant difference in the horizontal line-of-sight distribution. VRS was not observed as an adverse event., Conclusions: In healthy adult subjects, our results suggested that there was no significant correlation between the deviation rates of the ILBT and PLBT. We also found that the ILBT is a useful and safe method for evaluating the horizontal line-of-sight distribution and percentage deviation of line segments from the center in the NS and MDS without inducing VRS., (© 2024 The Authors.)

Working memory refers to our ability to actively maintain and process a limited amount of information during a brief period of time. Often, not only the information itself but also its serial order is crucial for good task performance. It was recently proposed that serial order is grounded in spatial cognition. Here, we compared performance of a group of right hemisphere‐damaged patients with hemispatial neglect to healthy controls in verbal working memory tasks. Participants memorized sequences of consonants at span level and had to judge whether a target consonant belonged to the memorized sequence (item task) or whether a pair of consonants were presented in the same order as in the memorized sequence (order task). In line with this idea that serial order is grounded in spatial cognition, we found that neglect patients made significantly more errors in the order task than in the item task compared to healthy controls. Furthermore, this deficit seemed functionally related to neglect severity and was more frequently observed following right posterior brain damage. Interestingly, this specific impairment for serial order in verbal working memory was not lateralized. We advance the hypotheses of a potential contribution to the deficit of serial order in neglect patients of either or both (1) reduced spatial working memory capacity that enables to keep track of the spatial codes that provide memorized items with a positional context, (2) a spatial compression of these codes in the intact representational space. [ABSTRACT FROM AUTHOR]