Stroke researchers report improvement in spatial neglect with prism adaptation therapy
Benefits shown in subset of patients with spatial neglect following right brain stroke. Findings support behavioral classification and early intervention
West Orange, NJ. December 27, 2013. Stroke rehabilitation researchers report improvement in spatial neglect with prism adaptation therapy. This new study supports behavioral classification of patients with spatial neglect as a valuable tool for assigning targeted, effective early rehabilitation. Results of the study, “Presence of motor-intentional aiming deficit predicts functional improvement of spatial neglect with prism adaptation” DOI: 10.1177/1545968313516872 were published ahead of print in Neurorehabilitation and Neural Repair on December 27, 2013.
The article is authored by Kelly M. Goedert, PhD, of Seton Hall University, Peii Chen, PhD, of Kessler Foundation, Raymond C. Boston, PhD, of the University of Pennsylvania, Anne L. Foundas, MD, of the University of Missouri, and A.M. Barrett, MD, director of Stroke Rehabilitation Research at Kessler Foundation, and chief of Neurorehabilitation Program Innovation at Kessler Institute for Rehabilitation. Drs. Barrett and Chen have faculty appointments at Rutgers New Jersey Medical School.
Spatial neglect, an under-recognized but disabling disorder, often complicates recovery from right brain stroke,” noted Dr. Barrett. “Our study suggests we need to know what kind of neglect patients have in order to assign treatment.” The research team tested the hypothesis that classifying patients by their spatial neglect profile, i.e., by Where (perceptional-intentional) versus Aiming (motor-intentional) symptoms, would predict response to prism adaptation therapy. Moreover, they hypothesized that patients with Aiming bias would have better response to prism adaptation recovery than those with isolated Where bias.
The study involved 24 patients with right brain stroke who completed 2 weeks of prism adaptation treatment. Participants also completed the Behavioral Inattention Test and Catherine Bergego Scale (CBS) tests of neglect recovery weekly for 6 weeks. Results showed that those with only Aiming deficits improved on the CBS, whereas those with only Where deficits did not improve. Participants with both types of deficits demonstrated intermediate improvement. “These findings suggest that patients with spatial neglect and Aiming deficits may benefit the most from early intervention with prism adaptataion therapy,” said Dr. Barrett. “More broadly, classifying spatial deficits using modality-specific measures should be an important consideration of any stroke trial intending to obtain the most valid, applicable, and valuable results for recovery after right brain stroke.”
Study supported by Kessler Foundation, the National Institutes of Health and the National Institute of Disability and Rehabilitation Research (K02 NS 047099, R01 NS 055808, K24 HD062647, H133 G120203 PI: Barrett).
About Stroke Rehabilitation Research at Kessler Foundation
Research studies span all domains of post-stroke cognitive dysfunction, but emphasize hidden disabilities after stroke, including hidden disabilities of functional vision (spatial bias and spatial neglect). Students, resident physicians, and post-doctoral trainees are mentored in translational neuroscience of rehabilitation. Dr. Barrett and her colleagues work closely with the clinical staff at Kessler Institute for Rehabilitation. Among their collaborative efforts are the founding of the Network for Spatial Neglect and development of the Kessler Foundation Neglect Assessment Process (KF-NAPTM). Stroke Research receives funding from the Department of Education/NIDRR; the National Institutes of Health/NICHD/NCMRR; Kessler Foundation; the Healthcare Foundation of New Jersey; and the Wallerstein Foundation for Geriatric Improvement. Scientists have faculty appointments at Rutgers New Jersey Medical School.
About A.M. Barrett, MD
A.M. Barrett, MD, a cognitive neurologist and clinical researcher, studies brain-behavior relationships from the perspectives of cognitive neurology, cognitive neuroscience, and cognitive neurorehabilitation. Dr. Barrett is an expert in hidden cognitive disabilities after stroke, which contribute to safety problems & rehospitalization, increased caregiver burden, & poor hospital-to-home transition. She is a founder of the Network for Spatial Neglect, which promotes multidisciplinary research for this underdiagnosed hidden disability. Dr. Barrett is also professor of physical medicine & rehabilitation at Rutgers New Jersey Medical School and adjunct professor of neurology at Columbia University School of Medicine. She is a former president of the American Society for Neurorehabilitation.
Dr. Barrett is author of the reference article Spatial Neglect on emedicine.com. A recent publication is Barrett AM. Picturing the body in spatial neglect: descending a staircase. Neurology. 2013 Oct 8;81(15):1280-1.
About Kessler Foundation
Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.