Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? A prospective longitudinal cohort study

Abstract

Abstract Background Although visuospatial neglect (VSN) has been suggested to limit recovery of standing balance post-stroke, recovery studies investigating this association by means of repeated within-subjects measurements early post-stroke are lacking. Therefore, this cohort study evaluated prospectively if VSN severity is longitudinally associated with (I) an inability to standing independently and (II) impaired postural control and an asymmetric weight-bearing in the first 12 weeks post-stroke. Methods Thirty-six hemiplegic individuals after a first-ever unilateral stroke were evaluated serially at weeks 3, 5, 8 and 12 post-stroke. Egocentric and allocentric VSN severity were evaluated using the Broken Hearts Test. The standing unperturbed item of the Berg Balance Scale (BBS-s) was used to evaluate standing independence. Posturographic measure of center-of-pressure velocities (COPvel−ML, COPvel−AP) and ground reactions forces during quiet standing were used as metrics reflecting postural control and weight-bearing asymmetry (WBA), respectively. Linear mixed models were used to examine associations between egocentric and allocentric VSN, and BBS-s, COPvelML, COPvel−AP and WBA within the first 12 weeks post-stroke. Results Egocentric (β= -0.08, 95%CI[-0.15;-0.01], P = .029) and allocentric VSN (β= -0.09, 95%CI[-0.15; -0.04], P = .002) were significant, independent factors for BBS-s scores in the first 12 weeks post-stroke. On the other hand, egocentric and allocentric VSN were no longer significant for COPvel−ML, COPvel−AP and WBA in the first 12 weeks post-stroke, after correction for covariates age, muscle strength in the most-affected leg, and contralesional sensory loss. Conclusions Allocentric and egocentric VSN seem to contribute to a decreased standing independence, but not to impaired postural control or greater WBA in the early subacute post-stroke phase. The latter may result from VSN measures being not sensitive enough to detect fine-grained, residual attentional deficits once the individuals regained standing ability. Clinical Trial Registration. Clinicaltrials.gov. unique identifier NCT05060458.