Peggy Chen on Stroke and Spatial Neglect

In this episode of Kessler Foundation's podcast, we are talking with Dr. Peii (Peggy) Chen. She is a senior research scientist in the Center for Stroke Rehabilitation Research and the intellectual property liaison at Kessler Foundation. She spoke with Rob Gerth, the Foundation's communications director.

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Below is an excerpt from the conversation.

Rob Gerth: Do people recover fully from a stroke, or does it depend?

Peggy Chen: I think it depend on what do you mean by recovery. If you think about-- if it's a physical recovery, it's easier to measure, and some people, they want to get back to their old self. So for example, I had a study participant. He wanted to play guitar again. It would be difficult. But he could do everything else in life. So from a lot of clinical standard, this person is fully recovered, but for himself, he cannot play guitar, and then, that's not recovery.

RG: You said something about spatial neglect, was trying to find the quote here in my papers. What was the line you had? It was so good.

PC: I think I said they see everything, but they don't perceive everything.

RG: What would be a characteristic of somebody who had spatial neglect?

PC: If you don't ask them to do anything-- when you talk to them, you may not notice it. Usually, it is when you ask them to do something about visual information. For example, they may have difficulty to read a sentence because they will miss the beginning of the sentence if they have left-sided neglect, or they will have difficulty to doing certain activities of self-care. Some men may just shave the right side of their face if they're neglecting the left side of the space. And I actually saw these examples a couple times in different men. They just show up to the appointment without shaving the left side of their face. For women, they will put makeup on the right side of their face and didn't do much on the left side.

RG: Everybody wants to talk about virtual reality these days. Is it playing a role in spatial neglect?

PC: I consider it as a tool to allow rehab researchers to create new treatment or certain treatment they could do in real life but now they want to do in virtual reality world. Yeah. So it's a tool. It's a new platform to provide treatment. And the virtual reality system that we are developing here at Kessler Foundation, the project I am leading, is to use the technology to create new treatment. Well, of course, I could create treatments that can be easily done in reality, but that's not fun for me [laughter]. So I want to create new treatment actually that you're unable to do in reality.

RG: You taught me at some point that you had to look at stroke and spatial neglect through three sets of eyes: the survivor's eyes, the caregiver's eyes, and the professional's eyes, whether it's the doctor or whether it's the rehab expert. Why is that?

PC: I think for rehabilitation in general, all three stakeholders should be involved. I think right now, maybe it's too centralized on the clinician part, or we put a lot of burden on them, but patients and their family members can definitely contribute to patients' recovery, so that's why there's a huge push. It's going on for many years now for so-called patient-centered outcome. So rather than use a outcome measure that's so-called clinical or standardized, we should consider what patient wants, and then, the therapist can select activities toward that goal, specific to that patient.