Computer-based assessment of visuospatial attention following stroke

Giannakou, Ioanna ORCID: 0000-0002-2480-3989 (2025). Computer-based assessment of visuospatial attention following stroke. University of Birmingham. Ph.D.

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Abstract

Unilateral spatial neglect is an attentional disorder and is among the most prevalent of cognitive impairments following stroke. Affected patients typically fail to attend to sensory input on the side of space opposite their brain lesion with significant implications for their function, independence and rehabilitation. Over the years there has been substantial research interest in this condition and how it is assessed. Despite the lack of a gold standard assessment, USN is traditionally evaluated using pen-and-paper tests; however multiple lines of evidence have highlighted the limitations of this approach and a growing research interest in computer-based assessment has demonstrated that this method could potentially overcome these shortcomings by providing greater sensitivity. This thesis aimed to investigate computer-based assessment for USN following stroke by examining our current knowledge, understanding the benefits and barriers of their implementation in clinical settings, and exploring ways to enhance their applicability for potential clinical use.

Results revealed a wide variety of computer-based tasks utilised in research over the last three decades, varying in type, task demands, duration, and sensitivity. The findings highlight the practical advantage of tasks with shorter durations with minimum equipment requirements, while more complex tasks exhibited greater sensitivity. Tasks with strong research foundation were identified, and adapted versions were tested with unimpaired populations, confirming their user-friendliness, acceptability, and sensitivity in detecting the presence of age-related changes in performance. These results were also corroborated with clinical populations in clinical environments demonstrating not only the feasibility of the approach but also its superiority compared with widely used pen-and-paper tasks.

Finally, following a shift in focus, the thesis explored the effect of transcranial direct current stimulation (tDCS) of the parietal lobe on spatial attention in unimpaired participants, but no effects were observed in contrast to previous studies.

Collectively, these results highlight the benefits and challenges of using computer-based assessments for visual attention. They demonstrate how computer-based assessments can be more sensitive than conventional methods and suggest their introduction into clinical practice could enhance related assessment methods, with important implications for patient care. While traditional methods are currently preferred by clinicians due to their ease of use and accessibility, computer-based tasks can be utilised not only to uncover cases overlooked by conventional methods but also to complement them by offering insights to patients' progress and response to treatment. The findings highlight the importance of refining these tools, identifying the best way to implement them for clinical use, and establishing clear clinical guidelines determining when and how to use them in conjunction with traditional methods. Finally, the results presented here support the continued development of this approach, aiming to improve it in a way that is not only valuable for research but also clinically meaningful.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):