Impacts of Prism Adaptation Treatment on Spatial Neglect and Rehabilitation Outcome: Dosage Matters

Abstract

We examined whether number of prism adaptation treatment (PAT) sessions in regular clinical practice would predict spatial neglect (SN) improvement and rehabilitation outcomes. We reviewed clinical records from 16 U.S. rehabilitation hospitals where neurological patients were assessed for SN using the Catherine Bergego Scale (CBS) and if SN was detected, and may have received PAT. Multiple linear regression was used to predict CBS Change (indicating SN improvement) in 520 patients who received PAT while considering age, sex, diagnosis, time post diagnosis, CBS at baseline, neglected side of space, and length of stay. Another set of regression models including the same variables and adding Function Independent Measure (FIM®) at admission was used to predict FIM Gains (indicating rehabilitation outcomes) in 1720 patients receiving PAT or not. We found that greater number of PAT sessions predicted greater CBS Change, especially in patients with moderate-to-severe neglect. Number of PAT sessions also positively correlated with Total FIM, Motor FIM, and Cognitive FIM Gains regardless of SN severity classification at baseline. Furthermore, number of PAT sessions predicted CBS Change and FIM Gains among patients completing ≤8 PAT sessions but not among patients with ≥8 sessions, who however, showed greater CBS Change with increased PAT frequency (i.e., fewer days between two consecutive sessions). Receiving more once-daily PAT sessions predicted greater improvement in SN and rehabilitation outcomes. Receiving PAT at a higher frequency for 8 or more sessions predicted better SN improvement. Thus, dosage matters. The study provides practice-based evidence that PAT is appropriate for inpatient rehabilitation.

A Complex Intervention Integrating Prism Adaptation and Neck Vibration for Unilateral Neglect in Patients of Chronic Stroke: A Randomised Controlled Trial

“…According to Jeong and Park [ 36 ], for PA, the angle of the prism goggles is to be tilted at 10°; however, Chen et al [ 37 ] suggested that PA may reduce unilateral neglect when the treatment period and intensity were increased. Similarly, in our study, 10° tilted prism goggles were used, and as PA was performed every day for 4 weeks, unilateral neglect in patients was reduced, as predicted.…”

Therapies Targeting Stroke Recovery

“…Chen et al 8 performed a meta-analysis of 1720 patients with hemispatial neglect who received prism adaptation therapy and found that a higher number of treatment sessions was associated with greater improvement in unilateral neglect, especially in those with moderate–severe neglect. This report underscores the importance of a common theme in stroke recovery therapeutics research: the need to examine treatment effects in relation to dose and stroke severity.…”

The Implementation Process of Two Evidence-Based Protocols: A Spatial Neglect Network Initiative

“…The implementation information being tracked included de-identified patient clinical records. Patient outcomes were reported separately (36,37).…”

“…We evaluated the implementation outcomes using quantitative and qualitative information that was collected during the 4year period. The study also included collecting patient outcomes, which was reported separately (36,37).…”

“…In November 2020, we completed the collection of de-identified clinical records shared by participating sites. Note that patient outcomes (i.e., improvement in spatial neglect and rehabilitation outcomes) were reported in separate articles (36,37).…”