# Combined Effects of Visual Scanning Training and Electrical Stimulation During Walking on Activities of Daily Living in a Subacute Stroke Patient With Unilateral Spatial Neglect: A Case Study

## TL;DR

This case study shows that combining visual training and electrical stimulation during walking can improve daily living activities in a stroke patient with spatial neglect.

## Contribution

The study introduces a novel combination of visual scanning training and electrical stimulation during walking for unilateral spatial neglect.

## Key findings

- The patient's BIT-c and CBS scores improved significantly after the intervention.
- The patient rarely overlooked objects while walking post-intervention.
- Improvements in bottom-up attention were observed and maintained at follow-up.

## Abstract

Interventions to improve activities of daily living (ADL) remain undeveloped for unilateral spatial neglect (USN). This case study examined the effects of combining visual scanning training (VST) and electrical stimulation during walking on ADL for USN. The patient was a 62-year-old right-handed man with dissection and occlusion of the right middle cerebral artery, who was transferred to our hospital on the 11th day from stroke onset. After approximately two months of conventional therapy, he was able to walk without an aid, but frequently overlooked objects and people on the left, requiring assistance. Thereafter, he underwent 14 days of combined VST with transcutaneous electrical nerve stimulation on his left posterior neck muscle during walking in addition to conventional physical therapy. The effectiveness of the intervention was assessed using the Behavior Inattention Test conventional subtest (BIT-c), Catherine Bergego Scale (CBS), and a computer-based assessment of top-down and bottom-up attention. Following the intervention, the BIT-c and CBS scores improved from 141 to 145 and from 11 to 2, respectively, and he rarely overlooked objects while walking. In addition, there was an improvement in attention automatically directed by external stimuli (bottom-up attention). These improvements were maintained at two-week follow-up. These findings suggest that the combined training during walking may have contributed to the improvement of ambulatory ADL in this stroke patient with USN, highlighting its potential relevance for functional independence in similar cases.