The clinical assessment and rehabilitation of hemineglect in elderly stroke patients
Unilateral neglect (UN) frequently occurs following stroke, and the presence of neglect can adversely affect functional recovery. It is important that physiotherapists are able to assess the common manifestations of neglect, and to provide effective rehabilitation for these patients. The main aims of this thesis were (i) to investigate how physiotherapists in the UK assess and treat visual neglect, (ii) to design and pilot a new test battery for assessing neglect at the impairment and activity levels, for use by therapists in the clinical setting, (iii) to establish the extent of reliability of three common tests for unilateral visual neglect, and (iv) to evaluate whether scanning and cueing, and limb activation strategies, would reduce unilateral visual neglect (UVN) in elderly stroke patients. The findings showed that (i) observation was the most frequently reported method to assess UVN, and that some effective strategies known to reduce UVN were infrequently listed by respondents; (ii) the Everyday Test Battery demonstrated validity and reliability in a small sample of elderly stroke patient with UVN; (iii) the Star Cancellation and Line Bisection tests, and the Baking Tray task demonstrated acceptable test-retest stability, which was highest when used with stroke patients with moderate to severe UVN; (iv) a significant reduction in UVN, in at least one of three tests for UVN, was demonstrated, in a series of single case experimental designs, by 10 of the 12 stroke patients who received one or other of the two treatment approaches stated above. The implications of this research are that clinical tests which enable assessment of neglect at the impairment and activity levels should be routinely used by physiotherapists in clinical practice, that results of repeated testing for neglect may need to be cautiously interpreted due to variability of performance over time, and that scanning and cueing, and limb activation strategies offer promise in the rehabilitation of elderly stroke patients suffering from UVN.