Specifying time courses of subtypes of spatial neglect after stroke: Necessary or not?

Spatial neglect is a heterogeneous post-stroke disorder with subtypes differing in reference frames, processing stages, and spatial domains. While egocentric peri-personal neglect recovery has been studied, recovery trajectories of allocentric peri-personal visuospatial and personal neglect remain unclear. This study investigated recovery time courses of egocentric and allocentric peri-personal visuospatial and personal neglect during the first 12 weeks post-stroke; whether initial severity predicts recovery and defines distinct patient clusters; and how subtypes interrelate over time.

Forty-one first-ever stroke patients were evaluated at weeks 3, 5, 8, and 12 post-stroke using the Broken Hearts Test, Line Bisection Test, Visuospatial Search Time Test, and Fluff Test. Recovery was analyzed using linear mixed models, clustering with Gaussian finite mixture models, and interrelationships using Spearman correlations.

Significant improvements occurred in egocentric and allocentric peri-personal visuospatial and personal neglect, primarily between weeks 3 and 5, followed by a plateau. The Line Bisection Test detected no changes. Higher initial severity predicted greater residual impairment. Cluster analysis identified near-normal, mild, and moderate-to-severe baseline subgroups with distinct recovery trajectories. Moderate-to-good correlations (ρ = 0.33 - 0.55) emerged between egocentric and allocentric neglect at week 3 and when timepoints were pooled.

Neglect improved mainly between weeks 3 and 5 after which recovery plateaued, mirroring motor and language recovery and suggesting a shared time-limited window. Initial severity was a determinant of recovery, highlighting the value of early severity stratification to monitor and support recovery potential after stroke. As subtypes are distinctive, assessment should include multiple neglect tests.