Effect of Prism Adaptation Therapy on the Activities of Daily Living and Awareness for Spatial Neglect: A Secondary Analysis of the Randomized, Controlled Trial.

Katsuhiro Mizuno,Tetsuya Tsuji,Kengo Tsujimoto

doi:10.3390/brainsci11030347

Katsuhiro Mizuno, Tetsuya Tsuji + Show 1 more

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https://doi.org/10.3390/brainsci11030347

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Abstract

Background: Rehabilitation for unilateral spatial neglect (USN) using prism adaptation (PA) is one of the most widely used methods, and the effectiveness of PA is well-evidenced. Although the effect of PA generalized various neglect symptoms, the effectiveness for some aspects of neglect is not fully proven. The Catherine Bergego Scale (CBS) was developed to identify problems with the activities of daily living (ADL) caused by USN. The CBS is composed of 10 observation assessments and a self-assessment questionnaire. To assess the self-awareness of USN, the anosognosia score is calculated as the difference between the observational scores and the self-assessment scores. To investigate how PA affects ADL and self-awareness in subacute USN patients during rehabilitation, we analyzed each item of the CBS and self-awareness from a randomized, controlled trial (RCT) that we previously conducted (Mizuno et al., 2011). Methods: A double-masked randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN in 8 hospitals in Japan. We compared each item of the CBS, anosognosia score, and absolute value of the anosognosia score between the prism group and the control group. Results: Two of ten items (gaze orientation and exploration of personal belongings) were significantly improved in the prism group compared with those in the control group. The absolute value of the anosognosia score was significantly improved by PA. Conclusions: Improvement of oculomotor exploration by PA may generalize the behavioral level in a daily living environment. This study suggested that PA could accelerate the self-awareness of neglect during subacute rehabilitation.

Highlights

Unilateral spatial neglect (USN) can be defined as a failure to orient to contralesional stimuli, when this failure cannot be attributed to either sensory or motor defects [1]
It was reported that a 2-week Prism adaptation (PA) therapy and following conventional rehabilitation significantly improved the rehabilitation outcome of activities of daily living (ADL) in subacute stroke patients with
Vocat et al [27] reported that the observational scores and self-assessment scores of the Catherine Bergego Scale (CBS) in patients with right hemisphere lesions are not correlated in the acute phase, while they are strongly correlated in the chronic phase. These results suggested that most patients with USN were unaware of their neglect in the acute phase, and both their neglect and awareness were improved in the chronic phase

Summary

Introduction

Unilateral spatial neglect (USN) can be defined as a failure to orient to contralesional stimuli, when this failure cannot be attributed to either sensory or motor defects [1]. It has been reported that USN occurs in approximately 50% of right brain-damaged and 30%. Of left brain-damaged stroke patients [2,3]. Prism adaptation (PA) therapy was first described by Rossetti et al [16]. Individuals repeatedly perform goal-directed pointing movements wearing glasses or goggles with prism lenses that induce a rightward or leftward optical shift [17]. After the prisms are removed, a pointing error opposite to the prismatic shift, so-called “after-effect,” is observed. Rossetti et al [16] demonstrated a significant reduction in the spatial neglect following a brief period of PA with rightward prisms. It was reported that a 2-week PA therapy and following conventional rehabilitation significantly improved the rehabilitation outcome of ADLs in subacute stroke patients with

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