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Computerised assessment of visuo-spatial neglect following stroke

School of Sport, Exercise and Rehabilitation Sciences

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About the Project

Following a stroke, it is common for people to have problems with spatial awareness (also referred to as ’visuo-spatial neglect’, or just ‘neglect’). Affected individuals can have difficulties with many activities as a result. Examples include bumping into objects on one side of space, only reading text on one side of a page and only eating food from one side of a plate. The impact of neglect on everyday functional activities is pervasive; stroke survivors who have neglect make a poorer recovery than those who do not have neglect (e.g. they are less likely to learn to walk again) and the problem also hampers typical approaches to rehabilitation. Given the importance of recognising and addressing the problem of neglect, it is critical that stroke survivors are screened for the deficit and assessment procedures are optimal. National stroke guidelines currently recommend that stroke survivors are assessed for neglect using a standardised test battery (e.g. the Behavioural Inattention Test). These tests were developed in the 1970s and 1980s and largely involve pen and paper tests, often requiring the individual to search for targets on a page. While these tests represented a marked improvement in assessment when they were introduced, they have many weaknesses. For example, many of the tests lack precision while others are rather crude and fail to detect problems in some people. Also, completing a battery of tests can be very time-consuming. Over the years, scientists have developed computer-based tasks that are capable of assessing neglect in a more precise, sensitive and efficient way than existing clinical tools. In turn, the rapid and ongoing growth of computer use and affordable software has created an environment that can now support the introduction of these improved assessment techniques into clinical practice. However, to date this has not happened.
This programme of study will evaluate the use of computerised tests to assess neglect in different environments and analyse the relative merits of computerised vs. existing tests. While existing evidence strongly suggests that computerised tests will be superior in detecting problems and providing a precise and objective measure of related difficulties, we recognise that these issues alone are unlikely to change practice for the benefit of patients. Accordingly, research will also aim to gather the views of stroke survivors and healthcare professionals in order to establish the acceptability and usability of these tests.

This research will involve working closely with stroke survivors in a range of different environments. Having a clinical background is not a requirement but demonstrating skills needed for this challenging work is important. The research will also involve developing computerised tasks and while programming experience is not essential, an inclination to develop related skills is.

Further reading

Deouell, L. Y., Y. Sacher and N. Soroker (2005). "Assessment of spatial attention after brain damage with a dynamic reaction time test." J Int Neuropsychol Soc 11: 697-707.
Erez, A. B., N. Katz, H. Ring and N. Soroker (2009). "Assessment of spatial neglect using computerised feature and conjunction visual search tasks." Neuropsychol Rehabil 19: 677-695.
Intercollegiate Stroke Working Party (2016). National clinical guideline for stroke. London, Royal College of Physicians.
Rengachary, J., G. d’Avossa, A. Sapir, G. L. Shulman and M. Corbetta (2009). "Is the posner reaction time test more accurate than clinical tests in detecting left neglect in acute and chronic stroke?" Arch.Phys.Med.Rehabil 90: 2081-2088.
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