Abstract
BackgroundUnilateral spatial neglect (USN), a highly prevalent and disabling post-stroke impairment, has been shown to affect the recovery of locomotor and navigation skills needed for community mobility. We recently found that USN alters goal-directed locomotion in conditions of different cognitive/perceptual demands. However, sensorimotor post-stroke dysfunction (e.g. decreased walking speed) could have influenced the results.Analogous to a previously used goal-directed locomotor paradigm, a seated, joystick-driven navigation experiment, minimizing locomotor demands, was employed in individuals with and without post-stroke USN (USN+ and USN-, respectively) and healthy controls (HC).MethodsParticipants (n = 15 per group) performed a seated, joystick-driven navigation and detection time task to targets 7 m away at 0°, ±15°/30° in actual (visually-guided), remembered (memory-guided) and shifting (visually-guided with representational updating component) conditions while immersed in a 3D virtual reality environment.ResultsGreater end-point mediolateral errors to left-sided targets (remembered and shifting conditions) and overall lengthier onsets in reorientation strategy (shifting condition) were found for USN+ vs. USN- and vs. HC (p < 0.05). USN+ individuals mostly overshot left targets (− 15°/− 30°). Greater delays in detection time for target locations across the visual spectrum (left, middle and right) were found in USN+ vs. USN- and HC groups (p < 0.05).ConclusionUSN-related attentional-perceptual deficits alter navigation abilities in memory-guided and shifting conditions, independently of post-stroke locomotor deficits. Lateralized and non-lateralized deficits in object detection are found. The employed paradigm could be considered in the design and development of sensitive and functional assessment methods for neglect; thereby addressing the drawbacks of currently used traditional paper-and-pencil tools.
Highlights
Unilateral spatial neglect (USN), a highly prevalent and disabling post-stroke impairment, has been shown to affect the recovery of locomotor and navigation skills needed for community mobility
No significant between-group differences were found on all baseline characteristics across the 3 study groups; with exception of walking speed where USN+ individuals were slower walkers vs. USN- and healthy controls (HC) groups (p < 0.05) Table 1
We identified that even in the absence of biomechanical demands of locomotion, goal-directed navigation is affected in a memory-guided condition and in a task requiring representational updating component in individuals with USN
Summary
Unilateral spatial neglect (USN), a highly prevalent and disabling post-stroke impairment, has been shown to affect the recovery of locomotor and navigation skills needed for community mobility. Our team has recently demonstrated that individuals with post-stroke USN vs stroke individuals without USN show defective goal-directed walking abilities when heading towards left located (contralesional/ “neglected”) and right located (ipsilesional/“non-neglected”) targets in conditions of variable cognitive/perceptual demands: where the visual target could remain stationary, disappear or shift position during walking. The main premise behind this paradigm is that the use of a joystick for navigation with the non-paretic hand, performed in sitting, minimizes the biomechanical demands of locomotion and its concurrent sensorimotor aspects. It permits to essentially examine the role of attentionalperceptual abilities involved by eliminating potential confounding factors related to gait capacity, such as walking speed. The joystick-driven task could potentially be more suitable to be implemented in the clinical setting
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