Poststroke and Brain Injury Rehabilitation

Abstract

Barrett AM, Levy CE, Gonzalez Rothi LJ: Poststroke and brain injury rehabilitation: spatial neglect. Am J Phys Med Rehabil 2007;86:513–514. In last month’s issue (June 2007), we introduced the first of a four-issue special series of The American Journal of Physical Medicine & Rehabilitation, focused on innovative, physiologic treatments for stroke and traumatic brain injury. These disorders are leading causes of adult disability in the United States today, accounting for tremendous personal, social, and financial costs for survivors, caregivers, and society. Brain injury survivors with spatial neglect (defined as a failure to report, respond, or orient to unilateral stimuli, associated with functional disability) face special challenges. They may receive no evaluation relevant to their visual-spatial disorder, or only a brief screening for cognitive dysfunction. They may receive little counseling or management in the shortor long-term stages of recovery—and even if we assume that only 10% of people with spatial neglect have chronic symptoms, more than 200,000 United States stroke survivors may still have neglect-related disability. In this issue, we are very pleased to present two articles on treatment innovation for spatial neglect. Choi and colleagues discuss the effect of optikinetic stimulation on an impairment measure in spatial neglect, suggesting that a simple computerized visual stimulus may reduce the manifestations of this disabling disorder. Although not standard care, this low-risk, inexpensive intervention deserves further study. Buxbaum and colleagues examine treatment of spatial neglect with amantadine, an NMDA antagonist with anticholinergic-like effects that is also used to treat viral infections and Parkinson disease. Their study does not support the wide use of this agent to improve neglect symptoms, but they report important information on methodology for successful neglect treatment trials. In the August and September issues, we will present reports on pharmaceutical augmentation of rehabilitation and on refining existing physiologic treatment methods; we invite you to look for the continuation of this special series in those issues.