Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study.

PURPOSE: To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home. METHODS: A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke, <1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a 'mixing matrix' and integrated by 'following threads'. Finally, a synthesis was written into a vignette. RESULTS: The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants. CONCLUSION: Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect. Implications for Rehabilitation Findings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation. Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient's own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient's daily life context. The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying.