Rehabilitation after stroke is imperative for patients with spatial neglect as it can help improve behavioural, social and cognitive outcomes in these patients, and therefore reduce the financial burden on public health services. The main aim of this review is to investigate the effectiveness of active pursuit eye movements for rehabilitation interventions in patients with spatial neglect following stroke. Potential papers for inclusion were gathered by searching key terms in four main databases (AMED, Global Health, PubMed/Medline and PsychInfo) in addition to screening relevant reference lists. Two reviewers independently selected papers for inclusion based on agreed inclusion criteria (n = 9 with 147 participants). Risk of bias was assessed using the QUADAS-2 tool. All papers reported a statistically significant result in patients who received an intervention which used pursuit eye movements, and this was reported both as a short-term (immediate) effect and as a sustained effect up to 8 weeks after treatment. These effects were also reported in comparison with interventions using saccadic eye movements. One study also reported increased neural activity in a number of brain regions following pursuit-based intervention. Overall, there is good evidence in support of pursuit intervention used in the rehabilitation of stroke and spatial neglect over and above traditional interventions based on saccadic eye movements. Future research should aim to increase sample sizes, provide information on statistical power, record accurate eye movement responses and use randomised designs to reduce selection bias.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Abbott A. Dementia: a problem for our age. Nature. 2011;475(7355):S2–4.
Andersen RA, Snyder LH, Bradley DC, Xing J. Multimodal representation of space in the posterior parietal cortex and its use in planning movements. Annu Rev Neurosci. 1997;20(1):303–30.
Appelros P, Karlsson GM, Seiger A, Nydevik I. Neglect and anosognosia after first-ever stroke: incidence and relationship to disability. J Rehabil Med. 2002;34(5):215–20.
Barnes GR, Asselman PT. The mechanism of prediction in human smooth pursuit eye movements. J Physiol. 1991;439:439–61.
Baumann O, Ziemus B, Luerding R, Schuierer G, Bogdahn U, Greenlee MW. Differences in cortical activation during smooth pursuit and saccadic eye movements following cerebellar lesions. Exp Brain Res. 2007;181:237–47.
Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14(5):365–76.
Buxbaum LJ, Ferraro MK, Veramonti T, Farne A, Whyte J, Ladavas E, et al. Hemispatial neglect Subtypes, neuroanatomy, and disability. Neurology. 2004;62(5):749–56.
Dieterich M, Bucher SF, Seelos KC, Brandt T. Cerebellar activation during optokinetic stimulation and saccades. Neurology. 2000;54(1):148.
Di Monaco M, Schintu S, Dotta M, Barba S, Tappero R, Gindri P. Severity of unilateral spatial neglect is an independent predictor of functional outcome after acute inpatient rehabilitation in individuals with right hemispheric stroke. Arch Phys Med Rehabil. 2011;92(8):1250–6.
Dong W, Yan B, Johnson BP, Millist L, Davis S, Fielding J, et al. Ischaemic stroke: the ocular motor system as a sensitive marker for motor and cognitive recovery. J Neurol Neurosurg Psychiatry. 2013;84(3):337–41.
Doricchi F, Thiebaut de Schotten M, Tomaiuolo F, Bartolomeo P. White matter(dis)connections and gray matter (dys)functions in visual neglect: gaining insights into the brain networks of spatial awareness. Cortex. 2008;44:983–95.
Farne A, Buxbaum LJ, Ferraro M, Frassinetti F, Whyte J, Veramonti T, et al. Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients. J Neurol Neurosurg Psychiatry. 2004;75(10):1401–10.
Halligan PW, Cockburn J, Wilson BA. The behavioural assessment of visual neglect. Neuropsychol Rehabil. 1991;1(1):5–32.
Heide W, Kurzidim K, Kömpf D. Deficits of smooth pursuit eye movements after frontal and parietal lesions. Brain. 1996;119(6):1951–69.
Jehkonen M, Ahonen JP, Dastidar P, Koivisto AM, Laippala P, Vilkki J, et al. Visual neglect as a predictor of functional outcome one year after stroke. Acta Neurol Scand. 2000;101(3):195–201.
Karnath HO, Fruhmann BM, Kuker W, Rorden C. The anatomy of spatial neglect based on voxelwise statistical analysis: a study of 140 patients. Cereb Cortex. 2004;14:1164–72.
Keller I, Lefin-Rank G, Lösch J, Kerkhoff G. Combination of pursuit eye movement training with prism adaptation and arm movements in neglect therapy: a pilot study. Neurorehabil Neural Repair. 2009;23(1):58–66.
Kerkhoff G. Hemispatial neglect in man. Prog Neurobiol. 2001;63:1–27.
Kerkhoff G, Bucher L, Brasse M, Leonhart E, Holzgraefe M, Völzke V, et al. Smooth Pursuit “Bedside” Training Reduces Disability and Unawareness During the Activities of Daily Living in Neglect A Randomized Controlled Trial. Neurorehabil Neural Repair. 2014;28:554–63.
Kerkhoff G, Keller I, Artinger F, Hildebrandt H, Marquardt C, Reinhart S, et al. Recovery from auditory and visual neglect after optokinetic stimulation with pursuit eye movements-Transient modulation and enduring treatment effects. Neuropsychologia. 2012;50(6):1164–77.
Kerkhoff G, Keller I, Ritter V, Marquardt C. Repetitive optokinetic stimulation induces lasting recovery from visual neglect. Restor Neurol Neurosci. 2006;24(4):357–69.
Kerkhoff G, Reinhart S, Ziegler W, Artinger F, Marquardt C, Keller I. Smooth pursuit eye movement training promotes recovery from auditory and visual neglect: a randomized controlled study. Neurorehabil Neural Repair. 2013;27(9):789–98.
Kinchla RA, Wolfe JM. The order of visual processing: “Top-down”, “bottom-up”, or “middle-out”. Percept Psychophys. 1979;25(3):225–31.
Krauzlis RJ. Recasting the smooth pursuit eye movement system. J Neurophysiol. 2004;91(2):591–603.
Lisa LP, Jughters A, Kerckhofs E. The effectiveness of different treatment modalities for the rehabilitation of unilateral neglect in stroke patients: A systematic review. NeuroRehabilitation. 2013;33(4):611–20.
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713–21.
Martinez-Conde S, Macknik SL, Hubel DH. The role of fixational eye movements in visual perception. Nat Rev Neurosci. 2004;5(3):229–40.
Mort DJ, Malhotra P, Mannan SK, Rorden C, Pambakian A, Kennard C, et al. The anatomy of visual neglect. Brain. 2003;126:1986–97.
de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129–33.
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349(9061):1269–76.
Nijboer TC, Olthoff L, Van der Stigchel S, Visser-Meily JM. Prism adaptation improves postural imbalance in neglect patients. NeuroReport. 2014;25(5):307–11.
Odgaard-Jensen J, Vist GE, Timmer A, Kunz R, Akl EA, Schünemann H, et al. Randomisation to protect against selection bias in healthcare trials. Cochrane Database System Review. 2011;4:MR000012.
Paolucci S, Antonucci G, Grasso MG, Pizzamiglio L. The role of unilateral spatial neglect in rehabilitation of right brain -damaged ischemic stroke patients: A matched comparison. Arch Phys Med Rehabil. 2001;82(6):743–9.
Petit L, Haxby JV. Functional anatomy of pursuit eye movements in humans as revealed by fMRI. J Neurophysiol. 1999;82(1):463–71.
Pitteri M, Kerkhoff G, Keller I, Meneghello F, Priftis K. Extra-powerful on the visuo-perceptual space, but variable on the number space: different effects of optokinetic stimulation in neglect patients. J Neuropsychol. 2014. doi:10.1111/jnp.12051.
Pitzalis S, Spinelli D, Vallar G, Di Russo F. Transcutaneous electrical nerve stimulation effects on neglect: a visual-evoked potential study. Front Hum Neurosci. 2013;7(111):1–9.
Priftis K, Pitteri M, Meneghello F, Umiltà C, Zorzi M. Optokinetic stimulation modulates neglect for the number space: evidence from mental number interval bisection. Front Hum Neurosci. 2012;6:23.
Reinhart S, Schindler I, Kerkhoff G. Optokinetic stimulation affects word omissions but not stimulus-centered reading errors in paragraph reading in neglect dyslexia. Neuropsychologia. 2011;49(9):2728–35.
Rengachary J, He BJ, Shulman GL, Corbetta M. A behavioral analysis of spatial neglect and its recovery after stroke. Front Hum Neurosci. 2011;5:29.
Schindler I, Kerkhoff G, Karnath HO, Keller I, Goldenberg G. Neck muscle vibration induces lasting recovery in spatial neglect. J Neurol Neurosurg Psychiatry. 2002;73(4):412–9.
Schröder A, Wist ER, Hömberg V. TENS and optokinetic stimulation in neglect therapy after cerebrovascular accident: a randomized controlled study. Eur J Neurol. 2008;15(9):922–7.
Sherrington C, Herbert RD, Maher CG, Moseley AM. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Man Ther. 2000;5(4):223–6.
Thimm M, Fink GR, Küst J, Karbe H, Willmes K, Sturm W. Recovery from hemineglect: differential neurobiological effects of optokinetic stimulation and alertness training. Cortex. 2009;45(7):850–62.
Vernet M, Quentin R, Chanes L, Mitsumasu A, Valero-Cabré A. Frontal eye field, where art thou? Anatomy, function, and non-invasive manipulation of frontal regions involved in eye movements and associated cognitive operations. Front Integr Neurosci. 2014;8.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.
Wilson B, Cockburn J, Halligan P. Development of a behavioral test of visuospatial neglect. Arch Phys Med Rehabil. 1987;68(2):98–102.
Wright KW, Spiegel PH, Thompson LS, editors. Handbook of Pediatric Strabismus and Amblyopia (Vol. 5). New York: Springer; 2006.
Compliance with Ethical Standards
Conflict of Interest
Dr. M Burke declares that she has no conflict of interest; Ms. D Hill declares that she has no conflict of interest; Ms. M Halstead declares that she has no conflict of interest; and Dr. R Coats declares that she has no conflict of interest. This article does not contain any studies with human participants or animals performed by any of the authors.
About this article
Cite this article
Hill, D., Coats, R.O., Halstead, A. et al. A Systematic Research Review Assessing the Effectiveness of Pursuit Interventions in Spatial Neglect Following Stroke. Transl. Stroke Res. 6, 410–420 (2015). https://doi.org/10.1007/s12975-015-0420-z
- Eye movements
- Cerebrovascular accident