Smooth Pursuit “Bedside” Training Reduces Disability and Unawareness During the Activities of Daily Living in Neglect

Abstract

We carried out an assessor-blinded, randomized controlled trial. The 24 participants were randomly allocated to either SPT or VST (n = 12 each). They received 20 treatment sessions lasting 30 minutes each at the bedside over 4 weeks. Outcome measures included the Functional Neglect Index (FNI) based on 4 tasks: find objects on a tray, stick bisection, picture search, and gaze orientation. In addition, the Unawareness and Behavioral Neglect Index (UBNI) with 6 items about unawareness and 4 about neglect in activities of daily living, the Help index (required assistance in 10 functional activities), the Barthel Index, and the rehabilitation phase were rated by treatment-blinded assessors. Outcome measures were obtained before and immediately after the end of the interventions and at a 2-week follow-up. Results Significantly greater improvements were obtained after SPT versus VST treatment in the FNI and UBNI, and there were continued improvements selectively in the SPT group 2 weeks later. Conclusions SPT accelerates recovery from functional neglect and reduces unawareness significantly. Bedside neglect treatment using SPT is effective and feasible early after stroke.

Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect

“…Therefore, the positive effects found here were specific to visuomotor feedback training and are not simply due to non-specific factors (e.g., amount of training or attention received) or conventional rehabilitation therapy. In addition, even though the effects were found with a relatively small sample size of 20 patients, it is important to note that this sample size is still amongst the largest ever reported in any neglect rehabilitation trial, including very recent studies by Kerkhoff et al (2013Kerkhoff et al ( , 2014 showing promising results of "smooth pursuit" training on samples of 50 and 30 patients respectively, and by Mizuno et al (2011) reporting prism adaptation effects in ADL on a sample of 38 patients.…”

Effects of non-invasive brain stimulation on attention: Current debates, cognitive studies and novel clinical applications

“…SPT is an important therapeutic tool in neglect rehabilitation, where patients are asked to pursuit, with both eyes, an array of stimuli moving from the ipsilesional to the contralesional hemispace. It has been shown to be quite effective in two recent randomized controlled treatment (RCT) studies (Kerkhoff et al, 2013(Kerkhoff et al, , 2014. Continuous cTBS also represents an effective approach in the treatment of neglect (Cazzoli et al, 2012).…”

Randomized Controlled Trial on Hemifield Eye Patching and Optokinetic Stimulation in Acute Spatial Neglect

“…There is good evidence for a beneficial impact of HEP and OKS when applied as monotherapies in chronic neglect patients. 10,15 That the concurrent application of HEP and OKS caused interferences in our study, is still unlikely, as these interventions act complementary based on their theoretical rationale. 6,9 The acute stage of stroke may be better explanation.…”

“…8 OKS, inducing contralesional smooth pursuit eye movements and a visual motion percept, is supposed to work as a correcting input signal for the ipsilesionally shifted subjective egocentric midline in neglect patients. 9,10 We a priori hypothesized that HEPOKS in acute stroke patients with neglect induces greater remission of neglect than in the spontaneous course. Beneficial effects, reflected by improvements in neuropsychological tests and functional disability scales, were expected to develop during the treatment period and be persistent at follow-up.…”