Hemispatial neglect following right hemisphere stroke: clinical course and sensitivity of diagnostic tasks

Background: Stroke patients with severe symptoms of hemispatial neglect (HN) are known to experience a weaker recovery than those less affected from the outset. Correct identification of HN is therefore important throughout the course of rehabilitation. Objectives: To explore: (i) the course of clinical symptoms in stroke patients with moderate/severe HN from acute setting to home, (ii) changes in sensitivity of diagnostic tasks over time, and (iii) agreement between the researcher's and patients' HN assessments. Methods: Out of 79 consecutive patients, we included 23 patients with moderate/severe HN following right hemisphere stroke. The Catherine Bergego Scale was used as a benchmark for HN and to measure the congruence between the researcher's and patients' HN assessments. Diagnostic tasks included star cancellation, line crossing, line bisection, m-fluff test, figure copying, and clock drawing. Data were collected at t1: sub-acute stroke (days: M +/- SD=10.35.25), t2: during rehabilitation (days: M +/- SD=51 +/- 8), and t3: following discharge (days: M +/- SD=141.5 +/- 47.3). Results: (i) 20 out of 23 patients had HN at t3. Associated stroke challenges included paralysis, sensory loss, visual deficits, and extinction. (ii) Combining the star cancellation and figure copying yielded the highest sensitivity at all time points, even in patients with mild HN at t3. (iii) Patients' HN scores differed from the researcher's at t1. The difference was insignificant at t3. Conclusions: Joint consideration of stroke severity, functional difficulties, and patients' insight into neglect provides new knowledge to increase clinicians' recognition of HN. More extensive studies are needed to validate bedside screening with star cancellation and figure copying.