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PLoS One. 2018 Jul 2;13(7):e0198755. doi: 10.1371/journal.pone.0198755. eCollection 2018.

Impact of clinical severity of stroke on the severity and recovery of visuospatial neglect.

Author information

Utrecht University, Experimental Psychology, Utrecht, the Netherlands.
University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, the Netherlands.
Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and de Hoogstraat Rehabilitation Center, Utrecht, the Netherlands.
Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
Amsterdam Neuroscience Campus, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Neurorehabilitation, Centre of Rehabilitation and Rheumatology READE, Amsterdam, The Netherlands.
Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America.



There is growing evidence that visuospatial neglect (VSN) is associated with lower functional performance in other modalities and is not restricted to the lesioned hemisphere alone, and may also affect the non-lesioned hemisphere in severe first-ever strokes. We aimed to investigate the longitudinal association between the severity of VSN, as reflected by the extent of ipsilesional and contralesional spatial attention deficit, and clinical severity of stroke.


This is a secondary data analysis with merged data from two prospective cohort studies. Resulting in 90 patients and 8 longitudinal measurements at 1, 2, 3, 4, 5, 8, 12, and 26 weeks post-stroke onset. A letter cancellation test (LCT) was used as the primary outcome measure to demonstrate presence and severity of VSN. The clinical severity of stroke was classified using the Bamford Classification.


No significant association between clinical severity and the number of ipsilesional, as well as contralesional, omissions on the LCT was observed. Recovery of VSN at the contralesional hemiplegic, as well as ipsilesional non-hemiplegic side, was only dependent on 'time' as a reflection of spontaneous neurobiological recovery post-stroke. The recovery of the ipsilesional extension of VSN was significantly slower for the total anterior circulation infarct (TACI) group compared to the non-TACI group.


Larger strokes have a significant negative impact on recovery of visual attention at the non-hemiplegic side. No clinical determinants that regulate spontaneous time-dependent recovery of VSN were found. While early 'stroke severity' has been regarded as a strong predictor of functional outcome at a group level, other prognostic factors (demographic, stroke related) need to be determined.


EXPLICIT-stroke Trial: Stroke Intensity Trial:

Conflict of interest statement

The authors have declared that no competing interests exist.

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