The DRESS trial: a feasibility randomized controlled trial of a neuropsychological approach to dressing therapy for stroke inpatients

OBJECTIVE

To investigate two approaches to treating patients with persistent dressing problems and cognitive difficulties following stroke.

DESIGN

Pilot randomized controlled trial.

SETTING

Inpatient stroke rehabilitation service.

SUBJECTS

Seventy consecutive stroke patients with persistent dressing problems and accompanying cognitive difficulties at two weeks after their stroke.

INTERVENTIONS

Patients were randomly allocated to six weeks of either a systematic neuropsychological approach, based on analysis of dressing problems and further cognitive testing, or to the control group who received conventional (functional) dressing practice. Both groups received treatment three times a week in accordance with two separately prepared manuals.

MAIN MEASURES

Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after randomization by an independent assessor masked to group allocation.

RESULTS

Both neuropsychological and functional groups improved performance on the NSDA over the treatment period (31% and 22%, respectively) but there was no significant difference between groups at six weeks. However, the neuropsychological group showed a significantly greater improvement on a line cancellation test of visual neglect (t(62) = 2.1, P < 0.05) and a planned subanalysis for those with right hemisphere damage showed a trend towards better dressing outcome (P = 0.07, one-tailed).

CONCLUSIONS

Results demonstrate the potential benefits of a systematic neuropsychological approach to dressing therapy, particularly for patients with right hemisphere damage. This study suggests the need for a phase III study evaluating the efficacy of a systematic neuropsychological approach in treating dressing difficulties, targeting patients with right hemisphere stroke and visuospatial impairments.

Use of fresnel prism glasses to treat stroke patients with hemispatial neglect

OBJECTIVE

To explore the functional effects of prism adaptation training on patients with hemispatial neglect after stroke.

DESIGN

Observational study.

SETTING

Inpatient rehabilitation unit in rural Australia.

PARTICIPANTS

Four subjects with hemispatial neglect, recruited from consecutive admissions of patients less than 60 days poststroke.

INTERVENTION

Prism adaptation treatment, consisting of five 10-minute training sessions over 12 to 17 days.

MAIN OUTCOME MEASURES

The FIM instrument, Catherine Bergego Scale (CBS), subjective straight ahead pointing, Albert's line cancellation, letter cancellation, and line bisection. Ambulatory patients also performed the Timed Up & Go test.

RESULTS

Immediate effects of prism adaptation training included improvements in both subjective straight ahead pointing and in the Albert's line cancellation task. Letter cancellation, line bisection, FIM, and CBS scores improved in all subjects. Improvements in a functional task were also observed immediately following prism adaptation treatment. Obstacle avoidance while walking improved after prism adaptation training in 2 ambulatory subjects.

CONCLUSIONS

Prism adaptation training shows promise as a new treatment to supplement current strategies for the clinical management of hemispatial neglect after stroke. This study is limited by small sample size and absence of a control group. Further research will be needed to demonstrate efficacy for this inexpensive and relatively safe device.