The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review

Elissa Embrechts; Tamaya Van Criekinge; Jonas Schröder; Tanja Nijboer; Christophe Lafosse; Steven Truijen; Wim Saeys

doi:10.1016/j.rehab.2020.10.003

The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review

Ann Phys Rehabil Med. 2021 Jul;64(4):101449. doi: 10.1016/j.rehab.2020.10.003. Epub 2020 Nov 22.

Authors

Elissa Embrechts¹, Tamaya Van Criekinge², Jonas Schröder², Tanja Nijboer³, Christophe Lafosse⁴, Steven Truijen², Wim Saeys⁵

Affiliations

¹ Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium. Electronic address: elissa.embrechts@uantwerpen.be.
² Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium.
³ Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
⁴ Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium.
⁵ Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium.

PMID: 33152521
DOI: 10.1016/j.rehab.2020.10.003

Abstract

Background: Although previous narrative reviews have highlighted a potential association between visuospatial neglect (VSN) and balance disorders, to what extent different areas of balance and mobility could be affected is still unclear.

Objectives: This systematic review updates previous literature findings and systematically reviews sitting balance, standing balance and mobility outcomes.

Methods: PubMed, Web of Science, ScienceDirect, Naric-Rehabdata, PEDro and the Cochrane Trials Library were systematically searched. Methodological quality was assessed by the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The association between VSN and sitting balance, standing balance and mobility (walking, stair climbing/descending and transfers) was investigated.

Results: In total, 48 studies were included (4595 stroke survivors): at least 1319 (29%) showed symptoms of VSN. VSN was associated with less independence during sitting, with an asymmetric posture toward the affected body side. For standing balance, we revealed a significant negative association between VSN and mediolateral stability and weight shifting, whereas only activities of daily living-related VSN was associated with weight-bearing asymmetry during static stance. While walking, patients with VSN laterally deviated from their path. Results were inconclusive regarding other aspects of mobility. The association between VSN and balance/mobility seemed to decrease over time.

Conclusions: Despite great heterogeneity in results, this study suggests that stroke survivors with VSN show specific deviations in posture and movement in the mediolateral direction. Although the association between VSN and balance/mobility has been extensively investigated, explanatory studies evaluating underlying mechanisms of the frequently present association are lacking. Future studies should address this by combining clinical and instrumented assessment of balance and gait performance, preferably longitudinally to investigate the associations over time.

Keywords: Balance; Mobility; Stroke; Visuospatial neglect; Walking.

Publication types

Review
Systematic Review

MeSH terms

Activities of Daily Living
Cross-Sectional Studies
Humans
Perceptual Disorders* / etiology
Postural Balance*
Stroke Rehabilitation*
Stroke* / complications