Spatial exploration strategy training for spatial neglect: A pilot study

Abstract

Spatial neglect is a syndrome due to impaired neural networks critical for spatial attention and related cognitive and motor functions. Affected individuals also have impaired self-awareness of their own neglect symptoms. The present randomized controlled study was the first proof-of-concept pilot examining the multi-context treatment approach using a protocol of spatial exploration strategy training in one brief session (20-30 minutes). The therapist provided supportive feedback and semi-structured guidance to promote strategy learning and self-discovery of omission errors. 40 patients with left-sided neglect after right brain stroke were included. The results showed that the treatment reduced lateralized bias toward the ipsilesional side of space but did not improve overall detection performance. Impaired general self-awareness of daily-life spatial difficulties was found independent of treatment outcome. This implies that judgment regarding responsiveness to treatment should not be made based on an awareness interview or the severity of neglect symptoms. Lastly, the treatment showed the potential of improving online contextual self-awareness of spatial abilities. A collaborative and interactive approach that focuses on helping the patient self-discover, monitor and self-manage their errors, appears to have a potential for decreasing neglect symptoms. Future studies are required to examine additional aspects of the multi-context treatment approach.

Keywords: Anosognosia; Brain injury; Cognitive rehabilitation; Occupational therapy; Stroke rehabilitation.

Figure 1.

Sequence of the activities in the present study.

Figure 2.

Sequence and conditions of the 12-page object search task.

Figure 3.

Examples of stimuli used in the object search task: a) small page without distractor and b) small page with distractors.

Figure 4.

Treatment efficacy on spatial neglect severity in terms of a) detection score and b) laterality of the spatial neglect assessment battery before and after intervention. The higher the detection score, the better the visuospatial performance. The higher the laterality index, the more symmetrical the performance (less bias toward the ipsilesional side of space). Error bar = SE

Figure 5.

Performance during intervention in terms of a) numbers of objects detected, b) laterality index, and c) initial search location across the four consecutive task conditions: small page without distractor (S w/o D), large page without distractor (L w/o D), small page with distractors (S w/ D), and large page with distractors (L w/ D) over 12 pages. Each data point is the median value of each group corresponding to a given trial. The white circles and dash lines represent the control group, and the black circles and solid lines represent the treatment group.