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

BACKGROUND: Visuospatial neglect (VSN) has been suggested to limit standing balance improvement post-stroke. However, studies investigating this association longitudinally by means of repeated within-subject measurements early post-stroke are lacking. This prospective longitudinal cohort study evaluates the longitudinal association of egocentric and allocentric VSN severity with 1) standing balance independence and 2) postural control and weight-bearing asymmetry (WBA) during quiet standing, in the first 12 weeks post-stroke. METHODS: Thirty-six hemiplegic individuals after a first-ever unilateral stroke were evaluated 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 clinically evaluate standing independence. Posturographic measures included measures of postural control (mediolateral (ML)/anteroposterior (AP) net center-of-pressure velocities (COPvel)) and WBA during quiet standing. A linear mixed model was used to examine longitudinal associations between egocentric and allocentric VSN, and BBS-s, COPvel-ML, COPvel-AP and WBA within the first 12 weeks post-stroke. RESULTS: Egocentric (ß = -0.08, 95%CI[-0.15;-0.01], P = .029) and allocentric VSN severity (ß = -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. Egocentric and allocentric VSN were no significant independent factors for COPvel-ML, COPvel-AP and WBA in the first 12 weeks post-stroke. CONCLUSIONS: Allocentric and egocentric VSN severity were significantly associated with decreased standing independence, but not impaired postural control or greater asymmetric weight-bearing, in the early subacute post-stroke phase. This may involve traditional VSN measures being not sensitive enough to detect fine-grained VSN deficits due to a ceiling effect between 5 and 8 weeks post-stroke, once the individual regains standing ability. Future studies may require more sensitive VSN measurements to detect such deficits. Trial registration Clinicaltrials.gov. unique identifier NCT05060458.

Just-in-Time Encoding Into Visual Working Memory Is Contingent Upon Constant Availability of External Information.

Humans maintain an intricate balance between storing information in visual working memory (VWM) and just-in-time sampling of the external world, rooted in a trade-off between the cost of maintaining items in VWM versus retrieving information as it is needed. Previous studies have consistently shown that one prerequisite of just-in-time sampling is a high degree of availability of external information, and that introducing a delay before being able to access information led participants to rely less on the external world and more on VWM. However, these studies manipulated availability in such a manner that the cost of sampling was stable and predictable. It is yet unclear whether participants become less reliant on external information when it is more difficult to factor in the cost of sampling that information. In two experiments, participants copied an example layout from the left to the right side of the screen. In Experiment 1, intermittent occlusion of the example layout led participants to attempt to encode more items per inspection than when the layout was constantly available, but this did not consistently result in more correct placements. However, these findings could potentially be explained by inherent differences in how long the example layout could be viewed. Therefore in Experiment 2, the example layout only became available after a gaze-contingent delay, which could be constant or variable. Here, the introduction of any delay led to increased VWM load compared to no delay, although the degree of variability in the delay did not alter behaviour. These results reaffirm that the nature of when we engage VWM is dynamical, and suggest that any disruption to the continuous availability of external information is the main driver of increased VWM usage relative to whether availability is predictable or not.