Prevalence of spatial neglect prompts call for screening survivors of right and left brain strokes
Researchers determined that spatial neglect affects 29% of survivors of unilateral strokes and is more prevalent following right brain stroke and in the early stages of recovery
East Hanover, NJ. September 27, 2021. A team of experts in stroke rehabilitation provided much-needed clarity regarding the prevalence of spatial neglect among individuals who experienced a stroke, showing that nearly 30 percent of this population is affected, regardless of lesion location, diagnostic method, or time post-stroke. When observing stroke survivors during daily activities that number rises to more than 50 percent.
Caption: Copied figures on the right show the effect of the neglect of the left space.
The article, “Prevalence of spatial neglect post-stroke: a systematic review” (DOI: 10.1016/j.rehab.2020.10.010) was published online on September 24, 2021 in a special issue of Annals of Physical and Rehabilitation Medicine. Authors of the article are Peii Chen, PhD, senior research scientist at Kessler Foundation’s Center for Stroke Rehabilitation Research, Grigoriy Shekhtman, MS, formerly of Kessler Foundation’s Center for Stroke Rehabilitation Research, and Emily Esposito, MS, of University of California, Riverside. Peii Chen, PhD, is also guest editor of this issue and a co-author of the issue’s editorial, “A special issue on cognitive rehabilitation”.
Spatial neglect is a post-stroke condition affecting the neural networks critical to spatial attention and related cognitive and motor functions. Often, it impedes how people experience their orientation in space: people with damage to the right brain pay insufficient attention to the left side of space, and vice versa. Spatial neglect can lead to problems with balance and navigation as well as memory, reading, and other cognitive processes. In addition, spatial neglect slows rehabilitation progress and functional recovery, increases the risk for injury, and increases the burden and stress of caregivers.
Identifying therapies to manage spatial neglect would profoundly improve the quality of life of affected individuals and their families. However, there is no scientific consensus on the prevalence of spatial neglect. This lack of knowledge impedes the design and execution of new studies to explore effective therapies, and leaves clinicians and their patients without research-informed assessment tools or evidence-based treatment options.
In this study, researchers conducted a systematic review of 41 peer-reviewed research articles, that described observational studies and reported specific diagnostic methods for spatial neglect. In all, this body of research comprised 6,324 participants with post-stroke brain damage.
In their analysis of the data, researchers established the prevalence of spatial neglect based on the injured cerebral hemisphere, recovery stage post-stroke, and diagnostic methodology. Their results show that the overall prevalence of spatial neglect in people with unilateral stroke was 29 percent. Individuals with damage to the right brain were more likely to experience spatial neglect (38 percent) versus those with damage to the left brain (18 percent).
When ecological assessments were included, which are tests that relate to everyday functions, the overall prevalence of spatial neglect after stroke rose to 53 percent. Ecological assessment has shown greater sensitivity than conventional neuropsychological tests in detecting spatial neglect, but there is no gold standard approach to screening or diagnosis. Still, because the ability to perform everyday functions is so integral to quality of life, the implication that more than half of people with post-stroke brain damage are affected by spatial neglect is significant.
“Our findings are alarming because the presence of spatial neglect at early stages is associated with poor long-term recovery,” said Dr. Chen. “Many clinicians misunderstand spatial neglect as a visual dysfunction rather than acknowledging it as a cognitive disorder. As a result, spatial neglect is often under-diagnosed and under-treated, contributing to poor outcomes.
Future research needs to focus on individuals with left-brain stroke, according to Dr. Chen. “The knowledge gap between right and left brain stroke needs to be addressed, “she emphasized. “Although spatial neglect is less common after left-brain stroke, the adverse effects on rehabilitation outcomes are the same. Stroke survivors should be screened for spatial neglect regardless of which hemisphere is affected.”
Funding sources: Part of this work was supported under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; grant number no. 90IFDV0001). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS) of the United States.
About Kessler Foundation: Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility, and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities.
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