Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial

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.

Fig 1. Flow chart of the randomized feasibility and pilot trial.

Fig 2

Results, from T1 to T4, each two weeks apart, of a) CBS via KF-NAP, b) lateralized omission discrepancy in the Bells Test, c) deviation (mm) in line bisection, and d) accuracy score of the Scene Copying test. The gray bar between T1 and T2 indicates the treatment period. Each data point denotes the median with the error bar representing the IQR.

Fig 3. Occurrence rates of spatial neglect at each time point based on the criterion of a given outcome measure.

The gray bar between T1 and T2 indicates the treatment period. CBS: Catherine Bergego Scale; B_l: Bells Test–lateralized omission discrepancy; B_s: Bells Test: starting column; LB: Line Bisection; S_e: Scene Copying–egocentric asymmetry; S_a: Scene Copying–allocentric asymmetry.