A Systematic Research Review Assessing the Effectiveness of Pursuit Interventions in Spatial Neglect Following Stroke


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.

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  1. 1.

    Abbott A. Dementia: a problem for our age. Nature. 2011;475(7355):S2–4.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    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.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    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.

    Article  PubMed  Google Scholar 

  4. 4.

    Barnes GR, Asselman PT. The mechanism of prediction in human smooth pursuit eye movements. J Physiol. 1991;439:439–61.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  5. 5.

    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.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    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.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    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.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Dieterich M, Bucher SF, Seelos KC, Brandt T. Cerebellar activation during optokinetic stimulation and saccades. Neurology. 2000;54(1):148.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    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.

    Article  PubMed  Google Scholar 

  10. 10.

    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.

    PubMed Central  Article  PubMed  Google Scholar 

  11. 11.

    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.

    Article  PubMed  Google Scholar 

  12. 12.

    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.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  13. 13.

    Halligan PW, Cockburn J, Wilson BA. The behavioural assessment of visual neglect. Neuropsychol Rehabil. 1991;1(1):5–32.

    Article  Google Scholar 

  14. 14.

    Heide W, Kurzidim K, Kömpf D. Deficits of smooth pursuit eye movements after frontal and parietal lesions. Brain. 1996;119(6):1951–69.

    Article  PubMed  Google Scholar 

  15. 15.

    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.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    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.

    Article  PubMed  Google Scholar 

  17. 17.

    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.

    Article  PubMed  Google Scholar 

  18. 18.

    Kerkhoff G. Hemispatial neglect in man. Prog Neurobiol. 2001;63:1–27.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    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.

    Article  PubMed  Google Scholar 

  20. 20.

    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.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    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.

    CAS  PubMed  Google Scholar 

  22. 22.

    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.

    Article  PubMed  Google Scholar 

  23. 23.

    Kinchla RA, Wolfe JM. The order of visual processing: “Top-down”, “bottom-up”, or “middle-out”. Percept Psychophys. 1979;25(3):225–31.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Krauzlis RJ. Recasting the smooth pursuit eye movement system. J Neurophysiol. 2004;91(2):591–603.

    Article  PubMed  Google Scholar 

  25. 25.

    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.

    PubMed  Google Scholar 

  26. 26.

    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.

    PubMed  Google Scholar 

  27. 27.

    Martinez-Conde S, Macknik SL, Hubel DH. The role of fixational eye movements in visual perception. Nat Rev Neurosci. 2004;5(3):229–40.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Mort DJ, Malhotra P, Mannan SK, Rorden C, Pambakian A, Kennard C, et al. The anatomy of visual neglect. Brain. 2003;126:1986–97.

    Article  PubMed  Google Scholar 

  29. 29.

    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.

    Article  PubMed  Google Scholar 

  30. 30.

    Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349(9061):1269–76.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    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.

    PubMed  Google Scholar 

  32. 32.

    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.

    Google Scholar 

  33. 33.

    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.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Petit L, Haxby JV. Functional anatomy of pursuit eye movements in humans as revealed by fMRI. J Neurophysiol. 1999;82(1):463–71.

    CAS  PubMed  Google Scholar 

  35. 35.

    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.

    PubMed  Google Scholar 

  36. 36.

    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.

    Google Scholar 

  37. 37.

    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.

    PubMed Central  Article  PubMed  Google Scholar 

  38. 38.

    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.

    Article  PubMed  Google Scholar 

  39. 39.

    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.

    PubMed Central  Article  PubMed  Google Scholar 

  40. 40.

    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.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  41. 41.

    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.

    Article  PubMed  Google Scholar 

  42. 42.

    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.

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    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.

    Article  PubMed  Google Scholar 

  44. 44.

    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.

  45. 45.

    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.

    Article  PubMed  Google Scholar 

  46. 46.

    Wilson B, Cockburn J, Halligan P. Development of a behavioral test of visuospatial neglect. Arch Phys Med Rehabil. 1987;68(2):98–102.

    CAS  PubMed  Google Scholar 

  47. 47.

    Wright KW, Spiegel PH, Thompson LS, editors. Handbook of Pediatric Strabismus and Amblyopia (Vol. 5). New York: Springer; 2006.

    Google Scholar 

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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.

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Correspondence to Melanie Rose Burke.



Table 1 Study characteristics and extracted data for SRR papers (N = 9), arranged by methodological quality (high to low)

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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

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  • Eye movements
  • Cerebrovascular accident
  • Intervention
  • Rehabilitation