Routines and Structure in the Assessment of Visuospatial Neglect in Rehabilitation Facilities: Current Practice in the Netherlands and the United Kingdom

Abstract

Visuospatial neglect (VSN) adversely impacts both the length of rehabilitation and activities of daily living (ADL) of patients after stroke and can reduce their participation in community activities. Therefore, it is important to assess VSN after stroke in neurorehabilitation facilities. The process of assessing VSN comprehensively in current geriatric rehabilitation remains unclear. This study examined the process of VSN in post-stroke assessment emphasizing the details of the (systematic) routines and structure of VSN assessment in current geriatric rehabilitation facilities in the Netherlands and rehabilitation facilities in the United Kingdom (UK). Health care professionals in geriatric rehabilitation facilities in the Netherlands (n = 6) and in stroke and neurorehabilitation facilities in the UK (n = 6) were interviewed. VSN was not routinely assessed in any of the geriatric rehabilitation facilities in the Netherlands, and only in half of the neurorehabilitation facilities in the UK. Healthcare teams in the Netherlands detected no patients with VSN over a two month period. Several VSN assessment tools were employed. Neuropsychological tests were most frequently used. Nine interviewees indicated the need to improve the process of VSN assessment in actual practice. The suggestions focused on improving the process of assessing VSN and developing relevant knowledge development and training. This study showed that in current rehabilitation practice, VSN was not always assessed in a routine (every stroke patient) and structured (who, when, and, which tests) manner. VSN was not routinely assessed with more than one test (neuropsychological and during daily activities), contrary to best practice recommendations. VSN remains probably underrecognized, especially in geriatric rehabilitation facilities. It is important to improve the current process, including selecting the most appropriate tools for assessing VSN.