Abstract
Purpose: Virtual reality (VR) and eye tracking may provide detailed insights into spatial cognition. We hypothesized that virtual reality and eye tracking may be used to assess sub-types of spatial neglect in stroke patients not readily available from conventional assessments.Method: Eighteen stroke patients with spatial neglect and 16 age and gender matched healthy subjects wearing VR headsets were asked to look around freely in a symmetric 3D museum scene with three pictures. Asymmetry of performance was analyzed to reveal group-level differences and possible neglect sub-types on an individual level.Results: Four out of six VR and eye tracking measures revealed significant differences between patients and controls in this free-viewing task. Gaze-asymmetry between-pictures (including fixation time and count) and head orientation were most sensitive to spatial neglect behavior on a group level analysis. Gaze-asymmetry and head orientation each identified 10 out of 18 (56%), compared to 12 out of 18 (67%) for the best conventional test. Two neglect patients without deviant performance on conventional measures were captured by the VR and eyetracking measures. On the individual level, five stroke patients revealed deviant gaze-asymmetry within-pictures and six patients revealed deviant eye orientation in either direction that were not captured by the group-level analysis.Conclusion: This study is a first step in using VR in combination with eye tracking measures as individual differential neglect subtype diagnostics. This may pave the way for more sensitive and elaborate sub-type diagnostics of spatial neglect that may respond differently to various treatment approaches.
Highlights
There is an annual incidence of about 16.9 million first-ever strokes and 33 million stroke survivors (Feigin et al, 2014)
Stroke is a leading cause of cognitive impairments as approximately one third of stroke survivors live with life-long disability (Singh et al, 2018)
Contrary to setups in previous studies, this study provides both head-mounted immersive Virtual Reality (VR) and eye-tracking that allows for unconstraint head and eye movement
Summary
There is an annual incidence of about 16.9 million first-ever strokes and 33 million stroke survivors (Feigin et al, 2014). No single conventional neglect test can reliably diagnose all patients, i.e., one patient may pass the first four tests and fail the fifth, another may fail the first and pass the rest This often relates to different subtypes of neglect e.g., motor and sensory neglect or ego- and allocentric (body and object centered) neglect. Egocentric neglect manifests itself as inattention to stimuli presented in the contralesional hemispace of different body midlines (trunk, head and eyes) and allocentric neglect as inattention to the contralesional half part of objects regardless of their egocentric placement. Many of these subtypes differ in diagnostic measures and prognostic consequences. Ego- and allocentric neglect seem to have different recovery rates (Demeyere and Gillebert, 2019) and different neglect midlines may require different treatment approaches, e.g., oculomotor neglect
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