Let's do groceries - a novel virtual assessment for post-stroke unilateral spatial neglect Effects of virtual scene complexity and knowledge translation initiatives

Background: Unilateral spatial neglect (USN), a highly prevalent post-stroke impairment, has been strongly associated with poor functional outcomes in self-care and instrumental activities of daily living. Hence, its sensitive detection is crucial. Yet, conventional USN assessments present with significant limitations, often leading to misdiagnosis. Virtual reality (VR) can be used to counteract those issues and increase detection sensitivity. Objective: To examine the feasibility, refine development and promote future implementation of a novel Ecological VR-based Evaluation of Neglect Symptoms (EVENS). Methods: EVENS consists of two (simple and complex) immersive, 3-D scenes, depicting grocery shopping shelves, where object-detection and navigation tasks are performed using a joystick. Through a cross-sectional study, the effects of virtual scene complexity on navigational and detection abilities in patients with (USN+) and without (USN-) post-stroke USN and in healthy controls (HC) were determined. These findings were complimented by gathering the opinion of clinicians and experts in the field as to the barriers/facilitators to the use of VR and the features for an optimal assessment. Results: Longer detection times and larger mediolateral deviations from ideal paths were found in USN+ vs. USN- and HC groups. Several barriers/facilitators for clinical VR use and features of an optimal VR-based tool were identified. Conclusion: Navigation and detection abilities are affected by environmental complexity of the VR scene in individuals with post-stroke USN and can be employed for USN assessment. The present knowledge translation initiatives can refine EVENS' design and promote its future application and adherence to its use in clinical settings.