Increasing Insight in Spatial Neglect: Unraveling Its Longitudinal Interaction With Motor Function After Stroke
Condition: Stroke; Spatial Neglect; Postural Control
MeSH terms: Stroke; Perceptual Disorders
Study type: Observational

Summary: 
      Goal: Various studies suggest a negative association between spatial neglect and motor
      outcomes after stroke (Barrett & Muzaffar 2014) (Kwakkel 2014). Our goal is to assess:

        -  The longitudinal interaction of the recovery of spatial neglect with the recovery of
           motor function and outcomes (such as paresis, sitting balance and standing balance)

        -  Whether the association is different across the different subtypes of spatial neglect
           (visuospatial/personal/ADL-related)

        -  The role of compensation strategies for balance control in patients with spatial neglect

      To do so, we will perform a longitudinal cohort study in which we will repetitively assess
      post-stroke patients using a comprehensive assessment approach for both spatial neglect and
      motor outcomes. With regards to neglect, we will evaluate various aspects of both
      visuospatial and personal neglect. For motor outcomes, we will combine clinical and
      instrumented (biomechanical) assessment methods to evaluate post-stroke recovery of leg
      paresis, (sitting and standing) balance and gait.
    

Detailed description: 
      Spatial neglect is a post-stroke disorder characterized by impaired awareness for stimuli
      located on the contralesional side of space. This neglect results in problems with reporting,
      responding or orienting toward contralesional stimuli, which cannot be explained by sensory
      or motor impairments. It can be present after a right- or left-sided brain lesion but is more
      frequently present in right-sided brain lesions. Within the first 2 weeks post-stroke, it
      occurs in approximately 50% of patients. Spontaneous neurological recovery of neglect follows
      a natural logistic pattern of improvement within the first 12 to 14 weeks post-stroke.
      Afterward, the curve flattens and the severity remains merely invariant, leaving 40% of
      patients with initial neglect still with symptoms at 1 year post-stroke.

      The high frequency and persistence of spatial neglect might have major consequences; indeed,
      various studies suggest a negative association between spatial neglect and post-stroke
      recovery of motor function and abilities. Apart from the seemingly suppressive influence of
      VSN on the recovery of upper-limb strength and synergy acquisition, lower limb motor
      recovery, balance and functional mobility might also be affected. However, the longitudinal
      interactions between spatial neglect and lower limb motor recovery are complex and only
      partially understood, owing to a lack of prospective cohort studies evaluating this.
      Additionally, also the association between spatial neglect and balance and functional
      mobility is currently unclear. A comprehensive overview is lacking, even though both balance
      and functional mobility are likely to be affected in these patients. Indeed, spatial neglect
      is characterised by a spatial (orientational) bias of attention. This bias might reflect a
      disruption in spatial information processing, which is a neural process incorporating sensory
      information from multiple modalities, resolving sensory ambiguity and integrating afferent
      and efferent information. A bias in this information processing might impede postural control
      and therefore also balance and mobility. However, whether spatial neglect and these motor
      outcomes are longitudinally associated, and whether such association is similar for the
      different spatial neglect subtypes, is still unknown.

      Our goal is to assess:

        -  The longitudinal interaction of the recovery of spatial neglect with the recovery of
           motor function and outcomes (such as paresis, sitting balance and standing balance)

        -  Whether the association is different across the different subtypes of spatial neglect
           (visuospatial/personal/ADL-related)

        -  The role of compensation strategies for balance control in patients with spatial neglect

      To do so, we will perform a longitudinal cohort study in which we will repetitively assess
      post-stroke patients using a comprehensive assessment approach for both spatial neglect and
      motor outcomes. With regards to neglect, we will evaluate various aspects of both
      visuospatial and personal neglect. For motor outcomes, we will combine clinical and
      instrumented (biomechanical) assessment methods to evaluate post-stroke recovery of leg
      paresis, (sitting and standing) balance and gait.

      Recruitment: as early as possible after stroke on fixed time-points post-stroke as
      recommended by the Stroke Recovery and Rehabilitation Roundtable (internationally renowned
      field experts). We include patients at: ≤14 days, 3 weeks, or 5 weeks post-stroke. Inclusion
      in RevArte rehabilitation hospital, UZA, GZA St-Augustinus, GZA St-Vincentius and Reva Geel.

      Outcome measures: include measures for spatial neglect, motor function and balance/mobility.

      Data analysis: linear mixed models will be fitted to evaluate study results and therefore
      mean change over time.
    

Intervention name(s): No intervention
Intervention type(s): Other
Intervention description(s): No intervention
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        First-ever stroke patients (inpatient or outpatient)
      
Keywords: Stroke; Postural control; Spatial neglect