RESUMEN

BACKGROUND: Patients with neglect ignore or respond slower to contralesional stimuli. Neglect negatively influences independence in activities of daily living (ADL). Prism adaptation (PA) is one of the most frequently studied treatments, yet there is little evidence regarding positive effects on neglect behavior in ADL. OBJECTIVE: To assess whether PA in the subacute phase ameliorates neglect in situations of varying complexity. METHODS: A total of 70 neglect patients admitted for inpatient stroke rehabilitation received either PA or sham adaptation (SA) for 2 weeks, with full access to standard treatment. There were 7 time-dependent measurements (baseline and 1-4, 6, and 14 weeks after start of treatment). The primary outcome was change of neglect as observed during basic ADL with the Catherine Bergego Scale (CBS). Secondary outcomes were changes in performance on a dynamic multitask (ie, the Mobility Assessment Course [MAC]) and a static paper-and-pencil task (ie, a shape cancellation task [SC]). RESULTS: In all, 34 patients received PA and 35 SA. There were significant time-dependent improvements in performance as measured with the CBS, MAC, and SC (all F > 15.57; P < .001). There was no significant difference in magnitude of improvement between groups on the CBS, MAC, and SC (all F < 2.54; P > .113]. CONCLUSIONS: No beneficial effects of PA over SA in the subacute phase poststroke were observed, which was comparable for situations of varying complexity. Heterogeneity of the syndrome, time post-stroke onset, and the content of treatment as usual are discussed. Basic knowledge on subtypes and recovery patterns would aid the development of tailored treatment.

Asunto(s)

Lentes , Trastornos de la Percepción/rehabilitación , Rehabilitación de Accidente Cerebrovascular , Adaptación Fisiológica , Adaptación Psicológica , Método Doble Ciego , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Percepción/etiología , Accidente Cerebrovascular/complicaciones , Factores de Tiempo , Insuficiencia del Tratamiento

RESUMEN

Visuospatial neglect has been observed in the horizontal (left/right) and vertical (up/down) dimension and depends on the distance at which a task is presented (near/far). Previously, studies have mainly focused on investigating the overall severity of neglect in near and far space in a group of neglect patients instead of examining subgroups of neglect patients with different types of distance-specific neglect. We investigated the spatial specificity (near vs. far space), frequency, and severity of neglect in the horizontal and vertical dimensions in a large group of stroke patients. We used three tasks to assess neglect in near (30 cm) and far (120 cm) space: a shape cancellation, letter cancellation, and a line bisection task. Patients were divided into four groups based on their performance: a group without neglect (N-F-), a near only neglect (N+F-), a far only neglect (N-F+), and a near and far neglect group (N+F+). About 40% of our sample showed neglect. Depending on the task, N+F- was observed in 8 to 22% of the sample, whereas N-F+ varied between 8% and 11%, and N+F+ varied between 11% to 14% of the sample. The current findings indicate that horizontal and vertical biases in performance can be confined to one region of space and are task dependent. We recommend testing for far space neglect during neuropsychological assessments in clinical practice, because this cannot be diagnosed using standard paper-and-pencil tasks.

Asunto(s)

Lateralidad Funcional/fisiología , Trastornos de la Percepción/etiología , Percepción Espacial/fisiología , Accidente Cerebrovascular/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Trastornos de la Percepción/fisiopatología , Accidente Cerebrovascular/fisiopatología

RESUMEN

INTRODUCTION: There is wide interest in transferring paper-and-pencil tests to a computer-based setting, resulting in more precise recording of performance. Here, we investigated the feasibility of computer-based testing and computer-based prism adaptation (PA) to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center. METHODS: Thirty-three neglect patients were included. PA was performed with a pair of goggles with wide-field point-to-point prismatic lenses inducing an ipsilesional optical shift of 10°. A variety of digitalized neuropsychological tests were performed using an interactive tablet immediately before and after PA. RESULTS: All 33 patients [mean age 60.36 (SD 13.30)], [mean days post-stroke 63.73 (SD 37.74)] were able to work with the tablet and to understand, perform, and complete the digitalized tests within the proposed time-frame, indicating that there is feasibility of computer-based assessment in this stage post-stroke. Analyses of the efficacy of PA indicated no significant change on any of the outcome measures, except time. DISCUSSION: In conclusion, there is feasibility of computer-based testing in such an early stage, which makes the computer-based setting a promising technique for evaluating more ecologically valid tasks. Secondly, the computer-based PA can be considered as a reliable procedure. We can conclude from our analysis, addressing the efficacy of PA, that the effectiveness of single session PA may not be sufficient to produce short-term effects on our static tasks. Further studies, however, need to be done to evaluate the computer-based efficacy with more ecologically valid assessments in an intensive double-blind, sham-controlled multiple PA treatment design.