Rehabilitation of very severe unilateral neglect by visuo-spatio-motor cueing: Two single case studies

Abstract

Robertson, North, and Geggie (1992) have suggested that the voluntary activation of the left upper limb in the left hemispace (spatio-motor cueing) could reduce unilateral neglect. This study assesses the efficacy of visuo-spatio-motor cueing, and particularly the generalisation to daily-life activities, in two patients with very severe neglect who had failed to improve with scanning training. The patients were included in the trial 4 and 7 months after a severe unilateral right hemispheric stroke. They both suffered from disabling unilateral neglect despite intensive conventional therapy. A single-case experimental ABAB design was used (A = baseline with conventional treatment; B = visuo-spatio-motor cueing; each period = 2 weeks). A randomisation test was used to assess the presence of a specific therapeutic effect. In both cases, there was a statistically significant treatment-related improvement on a line bisection test. A parallel improvement was found on neglect behaviourin daily life, as assessed by the Catherine Bergego Scale (Azouvi et al., 1996). The therapeutic effect was maintained at 1-month follow up. These results suggest that visuo-spatio-motor cueing may be efficient in very severe neglect and may help in obtaining generalisation to daily-life activities.