Can Patients with Unilateral Neglect following Stroke Drive Electrically Powered Wheelchairs?

People with unilateral neglect tend to have persisting disabilities and an increased probability of dependence following stroke. This preliminary research was designed to evaluate the potential use of an indoor electrically powered wheelchair with two people with unilateral neglect. Two male participants with a single-incident right hemisphere lesion were recruited; they were 32 days and 20 days post-stroke. Both had evidence of unilateral neglect on the Behavioural Inattention Test. An ABA single-subject experimental design was used, with a battery of measures administered every weekday for 6 weeks. The measures were the left collisions made and the time taken when negotiating an obstacle course in a powered wheelchair, and two tabletop tasks: the Star Cancellation Test and the Baking Tray Task. During the intervention phase (B), the participants were given 30 minutes of powered wheelchair training every weekday for 2 weeks. Both participants made marked improvements in driving accuracy by driving the wheelchair through an obstacle course for about 5 minutes each weekday for 2 weeks during phase A1. This improvement in driving accuracy unexpectedly occurred before the intervention phase (B), when the powered wheelchair training was introduced. Negligible changes in driving accuracy were seen during and after training had commenced. This suggests that negotiating the obstacle course, which was used as a measure, was acting as a form of treatment. The changes seen in the measures of unilateral neglect suggested that the participants learned to drive the powered wheelchair despite persisting neglect. Many patients with unilateral neglect are not given the chance to drive an electrically powered wheelchair owing to concerns about safety. This preliminary study suggests not only that this patient group can learn to drive indoors safely but also that this may be achieved with minimal therapeutic intervention. Further work needs to be carried out in this area.