Abstract
Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.
Highlights
Spatial neglect is characterized as a failure to report, respond or orient to stimuli presented in the side of space contralateral to the injured cerebral hemisphere, which cannot be explained by primary sensory or motor deficits [1]
While this neuropsychological syndrome has been mostly studied in stroke survivors, with the prevalence of 30–50% in acute-to-subacute stages [6,7,8], it can be caused by other forms of brain pathology such as traumatic brain injury [9], neurodegenerative disease [10] or tumor resection [11]
Our findings were comparable to theirs. This suggests that visuomotor training with sham/flat goggles was effective to certain extent, and that intensive rehabilitation programs that had been in place in both studies may have been successful in improving visuospatial abilities and functional outcomes related to spatial neglect
Summary
Spatial neglect is characterized as a failure to report, respond or orient to stimuli presented in the side of space contralateral to the injured cerebral hemisphere, which cannot be explained by primary sensory or motor deficits [1]. The disorder is caused by damaged neural networks critical to spatial attention and related cognitive and motor functions, leading to a variety of symptoms [2,3,4,5]. While this neuropsychological syndrome has been mostly studied in stroke survivors, with the prevalence of 30–50% in acute-to-subacute stages [6,7,8], it can be caused by other forms of brain pathology such as traumatic brain injury [9], neurodegenerative disease [10] or tumor resection [11]. Repeated sessions of prism adaptation may consolidate enhanced neural activation with strengthened brain connectivity among regions within and between ventral and dorsal attention networks that are impaired or dysfunctional in clinical populations, especially patients with spatial neglect. Benefits lasting months to years of prism adaptation have been documented [28, 29] with positive effects on visuospatial abilities [24, 30, 31] and on postural balance [32], motor functions [33], and activities of daily life (for a recent systematic review, see [34])
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