A comparison of prism adaptation, optokinetic stimulation and visuo-spatial training in the rehabilitation of spatial neglect

Abstract

Prism adaptation (PA) is one of the most investigated and effective therapy among those for the rehabilitation of unilateral spatial neglect. Two other techniques have received the higher degree of efficacy from the literature analysis: visuo-spatial training (VST) and optokinetic stimulation (OKS). The aim of this study was to compare the effectiveness of these rehabilitation methods between and within two groups of neglect patients. Two groups of post-acute spatial neglect patients (of 12 and 8 participants), who have never been received rehabilitation, were subjected to different rehabilitation procedures: PA and OKS for the first group and PA and VST for the second group. Within each group a crossover design was applied for the sequence of the two therapies. Each therapy was applied for 10 sessions, twice a day. Neuropsychological assessments were performed before the first type of training, between the first and the second training, after the second training and two weeks after the end of treatment. All three methods induced an improvement. The first group showed a significant effect of the first training, independently from which type. Similar trend of results was show in the second group. Overall the sequential application PA-VST seems to be more effective than VST-PA. The results suggest that bottom-up techniques (PA and OKS) induce higher amelioration of neglect patients than VST, at least for a short therapy. OKS and PA showed a comparable degree of efficacy in the first session of rehabilitation. Finally, a first treatment with a bottom-up technique and a subsequent top-down method seems to show the high efficacy in rehabilitation of neglect.