Galvanic vestibular stimulation in hemi-spatial neglect

Abstract

Hemi-spatial neglect is an attentional disorder in which the sufferer fails to acknowledge or respond to stimuli appearing in contralesional space. In recent years, it has become clear that a measurable reduction in contralesional neglect can occur during galvanic vestibular stimulation, a technique by which transmastoid, small amplitude current induces lateral, attentional shifts via asymmetric modulation of the left and right vestibular nerves. However, it remains unclear whether this reduction persists after stimulation is stopped. To estimate longevity of effect, we therefore conducted a double-blind, randomized, dose-response trial involving a group of stroke patients suffering from left-sided neglect (n = 52, mean age = 66 years). To determine whether repeated sessions of galvanic vestibular stimulation more effectively induce lasting relief than a single session, participants received 1, 5, or 10 sessions, each lasting 25 min, of sub-sensory, left-anodal right-cathodal noisy direct current (mean amplitude = 1 mA). Ninety five percent confidence intervals indicated that all three treatment arms showed a statistically significant improvement between the pre-stimulation baseline and the final day of stimulation on the primary outcome measure, the conventional tests of the Behavioral Inattention Test. More remarkably, this change (mean change = 28%, SD = 18) was still evident 1 month later. Secondary analyses indicated an allied increase of 20% in median Barthel Index (BI) score, a measure of functional capacity, in the absence of any adverse events or instances of participant non-compliance. Together these data suggest that galvanic vestibular stimulation, a simple, cheap technique suitable for home-based administration, may produce lasting reductions in neglect that are clinically important. Further protocol optimization is now needed ahead of a larger effectiveness study.

Keywords: clinical trial; hemi-inattention; neuro-stimulation; rehabilitation; stroke.

Figure 1

Consort statement.

Figure 2

Adjusted BIT mean scores and 95% confidence intervals showing change from baseline.

Figure 3

Adjusted Barthel Index median scores showing change from baseline. The boxes represent the inter-quartile range and are intersected at their median point. The whiskers extend to the most extreme point within 1.5 times of the inter-quartile range.

Figure 4

Barthel index data showing the numbers of participants within each treatment arm who scored 0, 5, 10, or 15 on the bowels, bladder, bathing, and transfer sub-scales.