Using Technology in the Assessment and Rehabilitation of Spatial Neglect

Spatial neglect is characterised by inattention to stimuli in the contralesional side of space. The complexity of the condition (manifesting in personal, near, and far space) make it difficult to assess, with some subtypes not commonly assessed. And, due to the low quality of the current evidence, no single intervention can be formally recommended to effectively rehabilitate neglect. However, technology may offer an opportunity to improve the sensitivity of assessments and facilitate self-administration of rehabilitation at home. In Chapter 1, results from 179 healthy adults (aged 18-94 years-old) revealed that performance on the Computerised Extrapersonal Neglect Test (CENT)’s visuospatial tasks (cancellation, line bisection) were related, sensitive to age-related decline, and sex differences in extrapersonal (far) space. Age-graded normative data was produced to inform the detection of spatial neglect in extrapersonal space in stroke survivors. Chapter 2 found CENT’s cancellation test had excellent diagnostic accuracy, sensitivity and validity compared to the widely used, validated paper-and-pencil neglect tests. In a group of 57 stroke survivors, CENT identified 18 cases of extrapersonal neglect which would otherwise go undetected. The results demonstrate the capabilities of a computerised assessment in providing additional attentional measures, as well as the necessity of carrying out a comprehensive assessment of neglect subtypes to inform rehabilitation strategies. Finally, Chapter 3 found that it was feasible for NHS staff to set-up and train 7 participants to self-administer the computerised Spatial Inattention Grasping Home-based Therapy (c-SIGHT) intervention. Though the sample was small and underpowered, there was preliminary evidence of the positive effects of c-SIGHT. This trial demonstrates the value of feasibility studies in providing recommendations to inform future studies. Together these studies offer practical recommendations and novel findings demonstrating the usefulness of technology in detecting spatial neglect and delivering rehabilitation at home to better support and improve people’s lives after stroke