Physiotherapy assessment of unilateral neglect: insight into procedures and clinical reasoning

ObjectivesAlthough unilateral neglect (ULN) can affect a person's ability to engage in and benefit from rehabilitation, little attention has been given to the assessment and diagnosis of this disorder by physiotherapy clinicians. The purpose of this study was to identify the procedures used by physiotherapists to assess and diagnose ULN after stroke.DesignQualitative research design employing focus groups and one-to-one interviews.SettingHealthcare and university departments, Melbourne, Australia.ParticipantsThirty-three physiotherapists, comprising both experienced neurological physiotherapists and novice clinicians.MethodsParticipants were asked to describe in detail how they determine whether a person has ULN, and how they differentially diagnose the different types of neglect as well as differentiating neglect from other impairments. Measurement and documentation were also discussed.ResultsThe findings revealed that observation is a key component of the assessment and that physiotherapists rely heavily on real task performance to evaluate the patient. Although physiotherapists are primarily concerned with the functional implications of ULN, the functional impact of the disorder is rarely measured. Physiotherapists appear to use both hypothesis testing and pattern recognition approaches to clinical reasoning in the assessment of ULN.ConclusionsThe physiotherapy clinicians in this sample do not routinely differentiate the different types of neglect during patient assessment. Education on the different types of neglect and the range of valid tools available to measure functional implications may be warranted.