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Favetta M, Romano A, Valè N, Cieslik B, Federico S, Girolami A, Mazzarotto D, Pregnolato G, Righetti A, Salvalaggio S, Castelli E, Smania N, Bargellesi S, Kiper P, Petrarca M. A scoping review of scientific concepts concerning motor recovery after stroke as employed in clinical trials. Front Neurol 2023; 14:1221656. [PMID: 38146442 PMCID: PMC10749504 DOI: 10.3389/fneur.2023.1221656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023] Open
Abstract
The scientific literature on poststroke rehabilitation is remarkably vast. Over the last decades, dozens of rehabilitation approaches have been investigated. However, sometimes it is challenging to trace new experimental interventions back to some of the known models of motor control and sensorimotor learning. This scoping review aimed to investigate motor control models' diffusion among the literature on motor recovery after stroke. We performed a literature search on Medline, Cochrane, Web of Science, Embase, and Scopus databases. The last search was conducted in September 2023. This scoping review included full-text articles published in English in peer-reviewed journals that provided rehabilitation interventions based on motor control or motor learning frameworks for at least one individual with stroke. For each study, we identified the theoretical framework the authors used to design the experimental treatment. To this aim, we used a previously proposed classification of the known models of motor control, dividing them into the following categories: neuroanatomy, robotics, self-organization, and ecological context. In total, 2,185 studies were originally considered in this scoping review. After the screening process, we included and analyzed 45 studies: 20 studies were randomized controlled trials, 12 were case series, 4 were case reports, 8 were observational longitudinal pilot studies, and 1 was an uncontrolled trial. Only 10 studies explicitly declared the reference theoretical model. Considering their classification, 21 studies referred to the robotics motor control model, 12 to the self-organization model, 8 to the neuroanatomy model, and 4 to the ecological model. Our results showed that most of the rehabilitative interventions purposed in stroke rehabilitation have no clear theoretical bases on motor control and motor learning models. We suggest this is an issue that deserves attention when designing new experimental interventions in stroke rehabilitation.
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Affiliation(s)
- Martina Favetta
- Movement Analysis and Robotics Laboratory (MARlab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Romano
- Movement Analysis and Robotics Laboratory (MARlab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Health Systems Management, Ariel University, Ariel, Israel
| | - Nicola Valè
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Blazej Cieslik
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Alessia Girolami
- Spondilos Lab Centro Medico and Riabilitazione, Pordenone, Italy
| | - Deborah Mazzarotto
- Medicina Fisica e Riabilitazione, ULSS 4 Veneto Orientale, Jesolo, Italy
| | - Giorgia Pregnolato
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Anna Righetti
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia Salvalaggio
- Laboratory of Computational Neuroimaging, IRCCS San Camillo Hospital, Venice, Italy
- Padova Neuroscience Center, Università Degli Studi di Padova, Padua, Italy
| | - Enrico Castelli
- Movement Analysis and Robotics Laboratory (MARlab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Bargellesi
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, Venezia, Italy
| | - Pawel Kiper
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Venice, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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2
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Umeonwuka CI, Roos R, Ntsiea V. Clinical and demographic predictors of unilateral spatial neglect recovery after prism therapy among stroke survivors in the sub-acute phase of recovery. Neuropsychol Rehabil 2023; 33:1624-1649. [PMID: 36242544 DOI: 10.1080/09602011.2022.2131582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS: Unilateral Spatial Neglect (USN) affects the rehabilitation process and leads to poor outcomes after stroke. Factors that influence USN recovery following prism adaptation therapy have not been investigated. This study investigated predictors of USN recovery after prism therapy at the sub-acute phase of recovery. METHODS: This study was a randomized controlled trial. USN was assessed with the Behavioural Inattention Test and Catherine Bergego scale. Seventy-four patients with USN were divided into control and intervention group (prism). The prism group used 20 dioptre prism lenses for repeated aiming for 12 sessions while the control group used neutral lenses for aiming training. Regression analysis was conducted to establish clinical and sociodemographic factors that influence USN recovery. RESULTS: Gender, age, years of education, race, employment status, handedness, type of stroke, time since stroke and site of stroke (p > 0.005) showed no significant influence on USN recovery following PA treatment. Higher Cognitive function (OR = 1.52, CI = 1.08-2.14, p = 0.016) and group allocationng (being in the prism group) (OR = 63.10, CI = 9.70-410.59, P < 0.001) were found to significantly influence USN recovery following PA treatment session. CONCLUSIONS: A significant modulating effect on general cognitive ability was found in this study. This suggests that prism adaptation therapy's effect on neural activity and spatial neglect depends on the cognitive function of stroke survivors.Trial registration: Pan African Clinical Trial Registry identifier: PACTR201903732473573.
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Affiliation(s)
- Chuka Ifeanyi Umeonwuka
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
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Székely O, Ten Brink AF, Mitchell AG, Bultitude JH, McIntosh RD. No short-term treatment effect of prism adaptation for spatial neglect: An inclusive meta-analysis. Neuropsychologia 2023; 189:108566. [PMID: 37149126 DOI: 10.1016/j.neuropsychologia.2023.108566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
Abstract
Despite 25 years of research on the topic, there is still no consensus on whether prism adaptation is an effective therapy for visuospatial neglect. We have addressed this question through a meta-analysis of the most well-controlled studies on the topic. Our main meta-analytic model included studies with a placebo/sham/treatment-as-usual control group from which data from right hemisphere stroke patients and left-sided neglect could be aggregated. The short-term treatment effects on the two commonly used standard tests for neglect, the conventional Behavioural Inattention Test (BIT-C) and cancellation test scores were combined into one random effect model justified by the fact that 89% of the BIT-C score is determined by cancellation tasks. With this approach, we were able to obtain a larger and more homogeneous dataset than previous meta-analyses: sixteen studies including 430 patients. No evidence for beneficial effects of prism adaptation was found. The secondary meta-analysis including data from the Catherine Bergego Scale, a functional measure of activities of daily living, also found no evidence for the therapeutic effects of prism adaptation, although half as many studies were available for this analysis. The results were consistent after the removal of influential outliers, after studies with high risk-of-bias were excluded, and when an alternative measure of effect size was considered. These results do not support the routine use of prism adaptation as a therapy for spatial neglect.
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Affiliation(s)
- Orsolya Székely
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK; Department of Psychology, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK.
| | - Antonia F Ten Brink
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 8, 3584, CS Utrecht, the Netherlands; Department of Psychology, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK; Centre for Pain Research, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK
| | - Alexandra G Mitchell
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK; Center of Functionally Integrative Neuroscience, Aarhus University, 1710, Universitetsbyen 3, 8000, Aarhus, Denmark
| | - Janet H Bultitude
- Department of Psychology, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK; Centre for Pain Research, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK
| | - Robert D McIntosh
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
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4
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Diaz-Segarra N, Steenburgh E, Broadley G, Teale A. Prism adaptation treatment improves spatial neglect after severe traumatic brain injury: A case series. NeuroRehabilitation 2023; 53:403-411. [PMID: 37458051 DOI: 10.3233/nre-230064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKROUND Spatial neglect (SN) after traumatic brain injury (TBI) is common, hindering rehabilitation progress and functional outcomes. Most research has focused on SN treatment after stroke with few published instances of post-TBI SN treated using prism adaptation treatment (PAT) in inpatient rehabilitation. OBJECTIVE This case series characterizes the dose, after-effect, and treatment response of PAT in patients with SN after severe TBI. METHODS Six patients exhibiting severe (n = 2), moderate (n = 2), or mild (n = 2) SN after severe TBI received 5 to 10 PAT sessions during their inpatient rehabilitation stay. Functional improvement in SN was measured by the Catherine Bergego Scale (CBS). RESULTS Patients presented with a mean initial CBS score of 16.8 (range: 8.8-24.3). Prism after-effect was present after PAT. Following 5-10 sessions, the mean CBS score improved by 11.6 points to 5.2 (range: 7.8-21.8); the change in initial versus final CBS scores was significant (P = 0.031). CONCLUSION This study is the first to demonstrate prism after-effect and functional SN improvement in individual patients with TBI. Patients showed a clinically meaningful improvement in mild, moderate, and severe SN following 5 to 10 PAT sessions. Additional studies are needed to assess tolerability, benefit, and optimal PAT dose for SN after TBI.
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Affiliation(s)
- Nicole Diaz-Segarra
- Department of Physical Medicine and Rehabilitation, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Emily Steenburgh
- Department of Occupational Therapy, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Gabrielle Broadley
- Department of Occupational Therapy, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Amy Teale
- James A. Eddy Memorial Foundation Research Institute, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
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Vilimovsky T, Chen P, Hoidekrova K, Slavicek O, Harsa P. Prism Adaptation Treatment Predicts Improved Rehabilitation Responses in Stroke Patients with Spatial Neglect. Healthcare (Basel) 2022; 10:healthcare10102009. [PMID: 36292456 PMCID: PMC9601909 DOI: 10.3390/healthcare10102009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 01/07/2023] Open
Abstract
Spatial neglect (SN) impedes functional recovery after stroke, leading to reduced rehabilitation gains and slowed recovery. The objective of the present study was to investigate whether integrating prism adaptation treatment (PAT) into a highly intensive rehabilitation program eliminates the negative impact of spatial neglect on functional and motor recovery. We examined clinical data of the 355 consecutive first-time stroke patients admitted to a sub-acute inpatient neurorehabilitation program that integrated PAT. The 7-item Motor Functional Independence Measure, Berg Balance Scale, and Motor Activity Log were used as main outcome measures. We found that 84 patients (23.7%) had SN, as defined by a positive score on the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process (KF-NAP®). Although 71 patients (85%) received PAT, the presence of SN at baseline, regardless of PAT completion, was associated with lower functional independence, higher risk of falls, and a lower functional level of the affected upper limb both at admission and at discharge. The severity of SN was associated with inferior rehabilitation outcomes. Nonetheless, patients with SN who received PAT had similar rehabilitation gains compared to patients without SN. Thus, the present study suggests that integrating PAT in an intensive rehabilitation program will result in improved responses to regular therapies in patients with SN.
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Affiliation(s)
- Tomas Vilimovsky
- Department of Psychiatry, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
- Correspondence:
| | - Peii Chen
- Kessler Foundation, West Orange, NJ 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ 07101, USA
| | - Kristyna Hoidekrova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
- Rehabilitation Center Kladruby, 257 62 Kladruby, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Ondrej Slavicek
- Department of Informatics and Mathematics in Transport, Faculty of Transport Engineering, University of Pardubice, 532 10 Pardubice, Czech Republic
| | - Pavel Harsa
- Department of Psychiatry, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
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Chen P, Hreha K, Gonzalez-Snyder C, Rich TJ, Gillen RW, Parrott D, Barrett AM. Impacts of Prism Adaptation Treatment on Spatial Neglect and Rehabilitation Outcome: Dosage Matters. Neurorehabil Neural Repair 2022; 36:500-513. [PMID: 35673990 DOI: 10.1177/15459683221107891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Peii Chen
- Center for Stroke Rehabilitation Research, 158368Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Division of Occupational Therapy Doctorate, Department of Orthopaedic Surgery, School of Medicine, 12277Duke University, Durham, NC, USA
| | | | - Timothy J Rich
- Center for Stroke Rehabilitation Research, 158368Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Robert W Gillen
- Neuropsychology Department, 21489Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Devan Parrott
- Research, Training, and Outcome Center for Brain Injury, 24119Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - A M Barrett
- Department of Neurology, 1371Emory University School of Medicine, Atlanta, GA, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Decatur, GA, USA
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Scheffels JF, Lipinsky C, Korabova S, Eling P, Kastrup A, Hildebrandt H. The influence of clinical characteristics on prism adaptation training in visuospatial neglect: A post-hoc analysis of a randomized controlled trial. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-11. [PMID: 35416101 DOI: 10.1080/23279095.2022.2061353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Previous studies indicate that the effect of prism adaptation training (PAT) on unilateral neglect may depend on clinical characteristics. In this explorative work, we re-analyzed data from a previously conducted randomized controlled trial (N = 23) to investigate whether age, etiology, severity of motor impairments, and visual field deficits affect the efficacy of PAT. Additionally, we reviewed PAT studies that reported lesion maps and distinguished responders from non-responders. We transferred these maps into a common standard brain and added data from 12 patients from our study. We found patients suffering from subarachnoid bleeding appeared to show stronger functional recovery than those with intracranial hemorrhage or cortical infarction. Furthermore, patients with visual field deficits and those with more severe contralateral motor impairments had larger after-effect sizes but did not differ in treatment effects. In addition, patients with parietal lesions showed reduced recovery, whereas patients with lesions in the basal ganglia recovered better. We conclude that PAT (in its current form) is effective when fronto-subcortical areas are involved but it may not be the best choice when parietal regions are affected. Overall, the present work adds to the understanding on the effects of clinical characteristics on PAT.
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Affiliation(s)
- J F Scheffels
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - C Lipinsky
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - S Korabova
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - P Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - A Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - H Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
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Gillen RW, Harmon EY, Weil B, Fusco-Gessick B, Novak PP, Barrett AM. Prism Adaptation Treatment of Spatial Neglect: Feasibility During Inpatient Rehabilitation and Identification of Patients Most Likely to Benefit. Front Neurol 2022; 13:803312. [PMID: 35432163 PMCID: PMC9010528 DOI: 10.3389/fneur.2022.803312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSpatial Neglect is prevalent among stroke survivors, yet few treatments have evidence supporting efficacy. This study examines the feasibility of Prism Adaptation Treatment (PAT) within an inpatient rehabilitation facility and the degree by which PAT improves symptoms of spatial neglect and functional independence among sub-acute survivors of right hemispheric stroke.DesignIn this retrospective cohort study, 37 right hemispheric stroke patients were identified as having received at least 4 PAT sessions during their inpatient stay. Spatial neglect and functional independence levels of patients in the PAT cohort were compared to a matched active control group comprised of rehabilitation patients receiving alternative therapies to address neglect admitted during the same time period.ResultsMost patients received the full recommended 10 sessions of PAT (average sessions completed = 8.6). A higher percentage of severe neglect patients receiving PAT (69%) displayed clinically significant gains on FIM (≥22 points) compared to those receiving alternative treatments (6%). Patients with mild or moderate neglect in the PAT cohort did not exhibit greater benefit than controls.ConclusionProvision of PAT for treatment of spatial neglect in right hemispheric stroke patients was feasible during the inpatient rehabilitation admission. Patients with severe neglect showed the most benefit from PAT.Clinical Trial RegistrationThis study was registered as a retrospective observational study on Itab Clinical Trials.gov. NCT04977219.
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Affiliation(s)
- Robert W. Gillen
- Department of Neuropsychology, Sunnyview Rehabilitation Hospital, Schenectady, NY, United States
| | - Erin Y. Harmon
- Department of Neuropsychology, Sunnyview Rehabilitation Hospital, Schenectady, NY, United States
- *Correspondence: Erin Y. Harmon
| | - Brittany Weil
- Neurorehabilitation Institute, Sunnyview Rehabilitation Hospital, Schenectady, NY, United States
| | | | - Paul P. Novak
- Neurorehabilitation Institute, Sunnyview Rehabilitation Hospital, Schenectady, NY, United States
| | - A. M. Barrett
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health System, Atlanta, GA, United States
- Neurorehabilitation Division, Emory University School of Medicine, Atlanta, GA, United States
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Scheffels JF, Korabova S, Eling P, Kastrup A, Hildebrandt H. The Effects of Continuous vs. Intermittent Prism Adaptation Protocols for Treating Visuospatial Neglect: A Randomized Controlled Trial. Front Neurol 2021; 12:742727. [PMID: 34867725 PMCID: PMC8639507 DOI: 10.3389/fneur.2021.742727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Visuospatial neglect may interfere with activities of daily living (ADL). Prism adaptation (PA) is one treatment option and may involve two components: recalibration (more strategic) and realignment (more implicit). We examined whether recalibration or realignment is the driving force in neglect rehabilitation using PA. In a randomized controlled trial with two recruitment series and a cross-over design, 24 neglect patients were allocated to a continuous (PA-c) or intermittent (PA-i) PA procedure. During the PA-c condition, goggles were worn without doffing. In the PA-i condition, patients donned goggles twice (first series of patients) or three times (second series) during training to induce more recalibrations. Primary outcome parameters were performance (omissions) on the Apples Cancellation Test and ADL scores. To assess the efficacy of the PA treatment, we compared effect sizes of the current study with those from three groups from previous studies at the same rehabilitation unit: (1) a passive treatment with a similar intensity, (2) a placebo treatment with a similar intensity, and (3) a PA treatment with fewer therapy sessions. Treatment conditions did not significantly predict scores on primary and most secondary outcome parameters. However, the spontaneous ipsilesional body orientation improved only in patients receiving the PA-i condition and this improvement also appeared in patients showing a strong after-effect (irrespective of condition). Effect sizes for the Apples Cancellation Test and the Functional Independence Measure were larger for both PA treatment protocols than the historical control groups. We conclude that more recalibrations during an intermittent PA treatment may have a beneficial effect on spontaneous body orientation but not on other aspects of neglect or on ADL performance. Clinical Trial Registration: German Clinical Trials Register, identifier: DRKS00018813, DRKS00021539.
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Affiliation(s)
- Jannik Florian Scheffels
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Sona Korabova
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Helmut Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
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10
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Bourgeois A, Schmid A, Turri F, Schnider A, Ptak R. Visual but Not Auditory-Verbal Feedback Induces Aftereffects Following Adaptation to Virtual Prisms. Front Neurosci 2021; 15:658353. [PMID: 34764847 PMCID: PMC8575682 DOI: 10.3389/fnins.2021.658353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Visuo-motor adaptation with optical prisms that displace the visual scene (prism adaptation, PA) has been widely used to study visuo-motor plasticity in healthy individuals and to decrease the lateralized bias of brain-damaged patients suffering from spatial neglect. Several factors may influence PA aftereffects, such as the degree of optical deviation (generally measured in dioptres of wedge prisms) or the direction of the prismatic shift (leftward vs. rightward). However, the mechanisms through which aftereffects of adaptation in healthy individuals and in neglect affect performance in tasks probing spatial cognition remain controversial. For example, some studies have reported positive effects of PA on auditory neglect, while other studies failed to obtain any changes of performance even in the visual modality. We here tested a new adaptation method in virtual reality to evaluate how sensory parameters influence PA aftereffects. Visual vs. auditory-verbal feedback of optical deviations were contrasted to assess whether rightward deviations influence manual and perceptual judgments in healthy individuals. Our results revealed that altered visual, but not altered auditory-verbal feedback induces aftereffects following adaptation to virtual prisms after 30-degrees of deviation. These findings refine current models of the mechanisms underlying the cognitive effects of virtual PA in emphasizing the importance of visual vs. auditory-verbal feedback during the adaptation phase on visuospatial judgments. Our study also specifies parameters which influence virtual PA and its aftereffect, such as the sensory modality used for the feedback.
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Affiliation(s)
- Alexia Bourgeois
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Audrey Schmid
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Francesco Turri
- Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Armin Schnider
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Radek Ptak
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
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11
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Boukrina O, Chen P. Neural Mechanisms of Prism Adaptation in Healthy Adults and Individuals with Spatial Neglect after Unilateral Stroke: A Review of fMRI Studies. Brain Sci 2021; 11:1468. [PMID: 34827467 PMCID: PMC8615640 DOI: 10.3390/brainsci11111468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
Functional disability due to spatial neglect hinders recovery in up to 30% of stroke survivors. Prism adaptation treatment (PAT) may alleviate the disabling consequences of spatial neglect, but we do not yet know why some individuals show much better outcomes following PAT than others. The goal of this scoping review and meta-analysis was to investigate the neural mechanisms underlying prism adaptation (PA). We conducted both quantitative and qualitative analyses across fMRI studies investigating brain activity before, during, and after PA, in healthy individuals and patients with right or left brain damage (RBD or LBD) due to stroke. In healthy adults, PA was linked with activity in posterior parietal and cerebellar clusters, reduced bilateral parieto-frontal connectivity, and increased fronto-limbic and sensorimotor network connectivity. In contrast, RBD individuals with spatial neglect relied on different circuits, including an activity cluster in the intact left occipital cortex. This finding is consistent with a shift in hemispheric dominance in spatial processing to the left hemisphere. However, more studies are needed to clarify the contribution of lesion location and load on the circuits involved in PA after unilateral brain damage. Future studies are also needed to clarify the relationship of decreasing resting state functional connectivity (rsFC) to visuomotor function.
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Affiliation(s)
- Olga Boukrina
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
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Chen P, Diaz-Segarra N, Hreha K, Kaplan E, Barrett AM. Prism Adaptation Treatment Improves Inpatient Rehabilitation Outcome in Individuals With Spatial Neglect: A Retrospective Matched Control Study. Arch Rehabil Res Clin Transl 2021; 3:100130. [PMID: 34589681 PMCID: PMC8463461 DOI: 10.1016/j.arrct.2021.100130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To determine whether prism adaptation treatment (PAT) integrated into the standard of care improves rehabilitation outcome in patients with spatial neglect (SN). Design Retrospective matched control study based on information extracted from June 2017-September 2019. Setting Inpatient rehabilitation. Participants Patients from 14 rehabilitation hospitals scoring >0 on the Catherine Bergego Scale (N=312). The median age was 69.5 years, including 152 (49%) female patients and 275 (88%) patients with stroke. Interventions Patients were matched 1:1 by age (±5 years), FIM score at admission (±2 points), and SN severity using the Catherine Bergego Scale (±2 points) and classified into 2 groups: treated (8-12 daily sessions of PAT) vs untreated (no PAT). Main Outcome Measures FIM and its minimal clinically important difference (MCID) were the primary outcome variables. Secondary outcome was home discharge. Results Analysis included the 312 matched patients (156 per group). FIM scores at discharge were analyzed using repeated-measures analyses of variance. The treated group showed reliably higher scores than the untreated group in Total FIM, F=5.57, P=.020, partial η2=0.035, and Cognitive FIM, F=19.20, P<.001, partial η2=0.110, but not Motor FIM, F=0.35, P=.553, partial η2=0.002. We used conditional logistic regression to examine the odds ratio of reaching MCID in each FIM score and of returning home after discharge. No reliable difference was found between groups in reaching MCID or home discharge. Conclusions Patients with SN receiving PAT had better functional and cognitive outcomes, suggesting that integrating PAT into the standard of care is beneficial. However, receiving PAT may not determine home discharge.
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Key Words
- Brain injury
- CBS, Catherine Bergego Scale
- CMS, Centers for Medicare and Medicaid Services
- IRB, institutional review board
- KF-NAP, Kessler Foundation Neglect Assessment Process
- KF-PAT, Kessler Foundation Prism Adaptation Treatment
- LOS, length of stay
- List of abbreviations: ANOVA, analysis of variance
- MCID, minimal clinically important difference
- Neurorehabilitation
- OR, odds ratio
- OT, occupational therapist
- Outcome
- PAT, prism adaptation treatment
- RCT, randomized controlled trial
- Rehabilitation
- SN, spatial neglect
- Stroke rehabilitation
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Affiliation(s)
- Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ
| | - Nicole Diaz-Segarra
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ.,Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, West Orange, NJ
| | - Kimberly Hreha
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Emma Kaplan
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - A M Barrett
- Department of Neurology, Emory University School of Medicine, Atlanta, GA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, US Department of Veterans Affairs, Decatur, GA
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Longley V, Hazelton C, Heal C, Pollock A, Woodward-Nutt K, Mitchell C, Pobric G, Vail A, Bowen A. Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury. Cochrane Database Syst Rev 2021; 7:CD003586. [PMID: 34196963 PMCID: PMC8247630 DOI: 10.1002/14651858.cd003586.pub4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with spatial neglect after stroke or other brain injury have difficulty attending to one side of space. Various rehabilitation interventions have been used, but evidence of their benefit is unclear. OBJECTIVES The main objective was to determine the effects of non-pharmacological interventions for people with spatial neglect after stroke and other adult-acquired non-progressive brain injury. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; last searched October 2020), MEDLINE (1966 to October 2020), Embase (1980 to October 2020), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1983 to October 2020), and PsycINFO (1974 to October 2020). We also searched ongoing trials registers and screened reference lists. SELECTION CRITERIA We included randomised controlled trials (RCTs) of any non-pharmacological intervention specifically aimed at spatial neglect. We excluded studies of general rehabilitation and studies with mixed participant groups, unless separate neglect data were available. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Review authors categorised the interventions into eight broad types deemed to be applicable to clinical practice through iterative discussion: visual interventions, prism adaptation, body awareness interventions, mental function interventions, movement interventions, non-invasive brain stimulation, electrical stimulation, and acupuncture. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS We included 65 RCTs with 1951 participants, all of which included people with spatial neglect following stroke. Most studies measured outcomes using standardised neglect assessments. Fifty-one studies measured effects on ADL immediately after completion of the intervention period; only 16 reported persisting effects on ADL (our primary outcome). One study (30 participants) reported discharge destination, and one (24 participants) reported depression. No studies reported falls, balance, or quality of life. Only two studies were judged to be entirely at low risk of bias, and all were small, with fewer than 50 participants per group. We found no definitive (phase 3) clinical trials. None of the studies reported any patient or public involvement. Visual interventions versus any control: evidence is very uncertain about the effects of visual interventions for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 55 participants) (standardised mean difference (SMD) -0.04, 95% confidence interval (CI) -0.57 to 0.49); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Prism adaptation versus any control: evidence is very uncertain about the effects of prism adaptation for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 39 participants) (SMD -0.29, 95% CI -0.93 to 0.35); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Body awareness interventions versus any control: evidence is very uncertain about the effects of body awareness interventions for spatial neglect based on measures of persisting functional ability in ADL (5 studies, 125 participants) (SMD 0.61, 95% CI 0.24 to 0.97); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Mental function interventions versus any control: we found no trials of mental function interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of mental function interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Movement interventions versus any control: we found no trials of movement interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of body awareness interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Non-invasive brain stimulation (NIBS) versus any control: evidence is very uncertain about the effects of NIBS on spatial neglect based on measures of persisting functional ability in ADL (3 studies, 92 participants) (SMD 0.35, 95% CI -0.08 to 0.77); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Electrical stimulation versus any control: we found no trials of electrical stimulation for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of electrical stimulation on spatial neglect based on immediate neglect assessments. Acupuncture versus any control: we found no trials of acupuncture for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of acupuncture on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. AUTHORS' CONCLUSIONS The effectiveness of non-pharmacological interventions for spatial neglect in improving functional ability in ADL and increasing independence remains unproven. Many strategies have been proposed to aid rehabilitation of spatial neglect, but none has yet been sufficiently researched through high-quality fully powered randomised trials to establish potential or adverse effects. As a consequence, no rehabilitation approach can be supported or refuted based on current evidence from RCTs. As recommended by a number of national clinical guidelines, clinicians should continue to provide rehabilitation for neglect that enables people to meet their rehabilitation goals. Clinicians and stroke survivors should have the opportunity, and are strongly encouraged, to participate in research. Future studies need to have appropriate high-quality methodological design, delivery, and reporting to enable appraisal and interpretation of results. Future studies also must evaluate outcomes of importance to patients, such as persisting functional ability in ADL. One way to improve the quality of research is to involve people with experience with the condition in designing and running trials.
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Affiliation(s)
- Verity Longley
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Calvin Heal
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Claire Mitchell
- Division of Human Communication, Development & Hearing, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Gorana Pobric
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Andy Vail
- Centre For Biostatistics, Manchester Academic Health Science Centre, Manchester, UK, University of Manchester, Manchester, UK
| | - Audrey Bowen
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK
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