Bridging Occupation and Nature in Stroke Rehabilitation
Duke Occupational Therapy Doctorate (OTD) student Brian Gonzales Granados, OTD’26, recently presented a poster at the Society for the Study of Occupation: USA (SSO:USA) Annual Research Conference, held November 6–8 in Galveston, Texas. This year’s theme, “Occupations and Nature: Connections and Transactions,” provided the perfect backdrop for Brian to discuss spatial neglect and nature-based occupations.
Working with Kimberly Hreha, EdD, OTR/L, assistant professor of Orthopaedic Surgery; assistant professor and senior fellow at the Duke Center for the Study of Aging and Human Development; assistant professor of ophthalmology, and Antoine Bailliard, PhD, MS, OTR/L, FAOTA, professor of orthopaedic surgery, Brian examined the available literature on spatial neglect—a condition caused by impaired neural networks critical to spatial processing and attention control—which can impede rehabilitation progress and community re-integration to determine if it could also impact participation in nature-based activities. He used two occupation-based frameworks: the Occupational Justice Framework and the Doing, Being, Belonging, and Becoming Framework, to position spatial neglect as an occupational justice issue, underscoring the need for research that ensures equitable access to nature-based occupations for all individuals.
Reflecting on the experience, Brian shared: ‘The conference was a great opportunity to learn about the incredible work our professors are doing, as well as other fascinating topics and current advancements in occupational science. It truly encouraged me to think outside the box and deepened my understanding of the value of nature-based occupations and their potential role in supporting future patients.”
Beyond presenting this work, Brian valued the opportunity to network with leaders in the field. “It was amazing to connect with experienced OTs and even have lunch with the authors of our classroom textbooks,” he said. “The experience was both refreshing and inspiring—a welcome change of scenery from fieldwork.”
The SSO:USA conference is a leading event for occupational science scholars, focusing on sustainability and the role of nature in daily activities. By engaging with this year’s theme, Brian’s work emphasizes the importance of identifying occupational challenges faced by individuals with spatial neglect and increasing awareness of the research gaps in this area. It highlights Duke OTD’s dedication to advancing research that supports equity and participation in everyday life.
Sidebar: What Is Spatial Neglect?
Spatial neglect is a neurological condition often occurring after stroke or brain injury, where individuals fail to report, respond to, or orient toward stimuli presented or mentally represented on the side of space opposite the lesion—typically the left. This can negatively affect independence in daily activities, increase the risk of falls, prolong hospital stays, and increase caregiver burden. Understanding, assessing, and treating spatial neglect is essential, and occupational therapists should focus on this at all levels of care.