Prism Adaptation Therapy for Stroke-Related Perceptual Disorders

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Utah

Disqualifiers: Other neurologic, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 10

Duration: 2 weeks

12 Participants Needed

Trial Summary

What is the purpose of this trial?

Preliminary data will be collected about which individuals with spatial neglect from right hemisphere stroke (aiming vs perceptual neglect) improve with Prism Adaptation Training and if there is a particular pattern of damage in the brain that predicts both the type of neglect experienced and whether neglect is improved following Prism Adaptation Training

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Prism Adaptation Therapy for stroke-related perceptual disorders?

Research shows that Prism Adaptation Therapy (PAT) can help improve spatial and motor functions in stroke survivors, especially those with spatial neglect, a condition where patients have difficulty paying attention to one side of their environment. Studies found that patients who received PAT showed similar rehabilitation gains to those without spatial neglect, suggesting that PAT can enhance recovery in stroke patients. ^{1 2 3 4 5}

Is Prism Adaptation Therapy safe for humans?

Prism Adaptation Therapy (PAT) has been used safely in studies with both healthy individuals and stroke patients, with no reported safety concerns. It is a non-invasive treatment involving tasks with prism goggles, and has been applied to various conditions like spatial neglect and chronic pain. ^{1 2 3 5 6}

How is Prism Adaptation Therapy different from other treatments for stroke-related perceptual disorders?

Prism Adaptation Therapy (PAT) is unique because it uses prism goggles to shift the visual field, helping the brain adjust and improve spatial and motor functions. Unlike other treatments, PAT involves a visuo-motor task that reorganizes sensorimotor coordination, which can be particularly beneficial for stroke survivors with spatial neglect. ^{1 3 4 6 7}

Eligibility Criteria

This trial is for adults aged 18-90 who've had a right hemisphere stroke within the last month and are suspected of having spatial neglect. They must be able to consent, sit for an hour, point straight ahead, hold a pen with their right hand, and undergo MRI scans. They should not have other conditions affecting testing or training ability.

Inclusion Criteria

I will be or have been admitted to Craig H. Neilson Rehabilitation Hospital for therapy.

I can sit in a chair for at least an hour.

You are able to have a MRI scan.

Exclusion Criteria

You don't have uncorrected vision or hearing problems, except for hemianopsia.

You have a medical condition that makes it unsafe for you to have an MRI scan.

Unable to provide consent due to significant aphasia or cognitive impairment

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pretesting

Pretesting for type of neglect and its severity, followed by MRI with Diffusion Tensor Imaging (DTI)

1 week

Treatment

Participants complete 10 sessions of Prism Adaptation Therapy

2 weeks

10 sessions (in-person)

Post-testing

Neglect post-testing to assess response to Prism Adaptation Therapy

1 week

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Prism Adaptation Therapy

Trial Overview The study is looking at how effective Prism Adaptation Therapy is in treating spatial neglect caused by right hemisphere strokes. It aims to identify if brain damage patterns can predict the type of neglect and response to this therapy.

Participant Groups

Group I: Prism Adaptation Therapy Experimental Treatment 1 Intervention

10 sessions (60 trials each) 1x/day of Prism Adaptation Therapy

Prism Adaptation Therapy is already approved in United States for the following indications:

Approved in United States as Prism Adaptation Therapy for:

• Spatial neglect following right brain stroke
• Rehabilitation for stroke survivors with spatial neglect

Who Is Running the Clinical Trial?

University of Utah

Lead Sponsor

Trials

1,169

Recruited

1,623,000+

Findings from Research

Prism Adaptation Therapy (PAT) using a computer touchscreen can produce similar after-effects to traditional PAT methods, but only if participants receive direct visual feedback on their pointing accuracy during the exposure phase.

In a study involving 81 healthy subjects and 7 brain-injured patients, indirect feedback methods (like icons on a screen) were ineffective, highlighting the importance of direct feedback for successful rehabilitation of visuospatial disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Indirect versus direct feedback in computer-based Prism Adaptation Therapy. Wilms, I., Malá, H.[2010]

In a follow-up study of nine participants with spatial neglect after stroke, 60% of those who received Prism Adaptation Treatment (PAT) still showed symptoms, indicating that while PAT may help, some individuals continue to experience neglect.

The study found that participants in the PAT group performed significantly better on the line bisection test compared to the standard care group, suggesting that PAT may have a beneficial effect on certain aspects of spatial neglect.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A One-Year Follow-Up Study on Community Dwelling Multiple Stroke Survivors with Spatial Neglect. Hreha, K., Rich, T., Wong, J.[2020]

Prism adaptation treatment (PAT) is feasible for stroke survivors with multiple strokes and significantly improves spatial neglect compared to standard care, as shown by greater improvements in specific spatial function tests.

While both treatment and comparison groups improved in motor function, the treatment group's improvement was not statistically significant compared to the comparison group, indicating that PAT may be more effective for spatial than motor outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The feasibility and effectiveness of using prism adaptation to treat motor and spatial dysfunction in stroke survivors with multiple incidents of stroke. Hreha, K., Gillen, G., Noce, N., et al.[2018]

In a study of 355 stroke patients, 23.7% were found to have spatial neglect (SN), which negatively impacted their functional recovery and independence, regardless of whether they received prism adaptation treatment (PAT).

However, patients with SN who underwent PAT showed similar rehabilitation gains as those without SN, suggesting that integrating PAT into intensive rehabilitation can help mitigate the adverse effects of SN on recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prism Adaptation Treatment Predicts Improved Rehabilitation Responses in Stroke Patients with Spatial Neglect. Vilimovsky, T., Chen, P., Hoidekrova, K., et al.[2022]

Prism adaptation treatment (PAT) was found to be more effective in improving neglect symptoms, as measured by the Kessler Foundation Neglect Assessment Process (KF-NAP), in patients with right-sided spatial neglect compared to those with left-sided neglect.

Despite the differences in neglect symptom improvement, both groups showed similar outcomes in overall functional independence, indicating that PAT is beneficial for patients with spatial neglect regardless of the side of the brain lesion.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prism Adaptation Treatment for Right-Sided and Left-Sided Spatial Neglect: A Retrospective Case-Matched Study. Rich, TJ., Pylarinos, M., Parrott, D., et al.[2023]

Prism adaptation (PA) is a non-invasive technique that may help in rehabilitating neglect symptoms after right-hemisphere lesions, but its effectiveness in treating complex regional pain syndrome (CRPS) is still unclear due to insufficient data.

There is no consensus on whether CRPS patients exhibit neglect-like symptoms, and further research is needed to explore the relationship between PA and pain modulation, as well as to refine the assessment of neglect in various types of chronic pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prisms for pain. Can visuo-motor rehabilitation strategies alleviate chronic pain? Torta, DM., Legrain, V., Rossetti, Y., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Indirect versus direct feedback in computer-based Prism Adaptation Therapy. [2010]

2. England pubmed.ncbi.nlm.nih.gov

A One-Year Follow-Up Study on Community Dwelling Multiple Stroke Survivors with Spatial Neglect. [2020]

3. England pubmed.ncbi.nlm.nih.gov

The feasibility and effectiveness of using prism adaptation to treat motor and spatial dysfunction in stroke survivors with multiple incidents of stroke. [2018]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Prism Adaptation Treatment Predicts Improved Rehabilitation Responses in Stroke Patients with Spatial Neglect. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Prism Adaptation Treatment for Right-Sided and Left-Sided Spatial Neglect: A Retrospective Case-Matched Study. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Prisms for pain. Can visuo-motor rehabilitation strategies alleviate chronic pain? [2022]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Aftereffect induced by prisms of different power in the rehabilitation of neglect: A multiple single case report. [2013]