Strategy Training for Hemispatial Neglect

Overseen By Emily Grattan, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Disqualifiers: Severe aphasia, Dementia, Major depression, others

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

Compensation: Varies

Number of Visits: Unknown

Duration: 3 weeks

38 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to assist individuals who have had a stroke and struggle with unilateral spatial neglect, a condition that impairs awareness of one side of the body or environment. The trial focuses on "strategy training," which aids participants in setting personal goals and finding ways to improve daily activities. Two groups participate: one receives strategy training, while the other reflects on their rehabilitation without specific strategies. Suitable candidates have experienced a stroke, are in inpatient rehab, and have difficulty noticing one side due to neglect. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could enhance rehabilitation strategies for stroke survivors.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this strategy training is safe for individuals with neglect?

Research shows that strategy training is generally easy for people to handle. Studies have examined its effects on individuals with hemispatial neglect, a condition where people struggle to notice one side of their environment after a stroke. One study found that while this training helped reduce the tendency to focus on one side, it did not significantly improve overall awareness. This indicates the training is safe, but more research is needed to fully understand its benefits. Since this training involves learning new ways to set goals and manage daily tasks, it does not carry the same risks as medications or surgeries. So far, there have been no major reports of negative effects from this treatment. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about strategy training for hemispatial neglect because it empowers individuals to set personalized goals and develop specific strategies to improve their daily activities. This method is distinct because it involves self-assessment and active participation, which can lead to more meaningful and sustainable improvements in daily living. Unlike conventional treatments that often rely solely on repetitive exercises, strategy training encourages participants to creatively overcome barriers, potentially leading to greater independence and quality of life.

What evidence suggests that strategy training could be an effective treatment for neglect?

This trial will compare Strategy Training with an Attention Control intervention. Research has shown that Strategy Training can help individuals with neglect pay more attention to the side they usually ignore, even if it doesn't enhance their overall ability to notice things. This may improve their focus on the neglected side of their surroundings. Studies also indicate that setting personal goals and evaluating progress can help participants overcome daily challenges. The training encourages the creation of strategies to improve everyday tasks, potentially reducing disabilities related to neglect. While more research is needed, early findings suggest it could be beneficial in improving awareness and function. ^{1 4 6 7 8}

Who Is on the Research Team?

Emily Grattan, PhD

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

This trial is for adults over 18 who've had a stroke and are now in rehab with unilateral spatial neglect, meaning they have trouble noticing one side of their body or environment. They must score below certain levels on specific tests that measure attention issues.

Inclusion Criteria

I have been diagnosed with a stroke.

I am admitted to a rehab facility.

Presence of neglect as determined by score of <18 on the Virtual Reality Lateralized Attention Test (VRLAT) or score below established cutoff for neglect on one of the six subtests of the Behavioral Inattention Test (BIT)

Exclusion Criteria

Boston Diagnostic Aphasia Examination (BDAE) Severity Scale score of 0 (severe global aphasia)

Anticipated length of stay <10 days

My medical records show I have major depression, bipolar, or a psychotic disorder.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive metacognitive strategy training to develop personalized goals and self-assess their performance of daily activities

3 weeks

Multiple sessions (in-person)

Follow-up

Participants are monitored for changes in self-awareness and satisfaction with the intervention

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Strategy Training

Trial Overview The study is testing 'strategy training' to see if it can help improve self-awareness, reduce disability, and address neglect by teaching patients how to better pay attention to the neglected side of their space.

How Is the Trial Designed?

Group I: Strategy Training Experimental Treatment 1 Intervention

The strategy training intervention teaches individuals to develop personalized goals, self-assess their performance of daily activities, and develop and evaluate strategies designed to overcome barriers and improve their performance of daily activities. Participants use a workbook to support their application of the strategy training.

Group II: Attention Control Active Control 1 Intervention

The attention control intervention controls for the non-specific effects of strategy training. The study team will administer the standardized and dose-matched protocol, using scripted open-ended questions to facilitate participants' reflections on their rehabilitation activities and experiences. Participants complete a daily journal, merely reviewing their rehabilitation activities.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

American Occupational Therapy Foundation

Collaborator

Trials

14

Recruited

380+

Published Research Related to This Trial

A pilot study involving 40 patients with left-sided neglect after right brain stroke demonstrated that a brief spatial exploration strategy training session reduced bias toward the neglected side, indicating potential efficacy in addressing spatial neglect symptoms.

Despite the treatment's effectiveness in reducing bias, it did not enhance overall detection performance or self-awareness of spatial difficulties, suggesting that treatment outcomes should not solely rely on patients' self-reports of their neglect symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Spatial exploration strategy training for spatial neglect: A pilot study. Toglia, J., Chen, P.[2023]

An adapted metacognitive strategy training protocol for 16 adults with mild to moderate aphasia was found to be feasible in an inpatient stroke rehabilitation setting, with therapists delivering the intervention effectively.

Participants showed significant improvement in disability, achieving a mean change of 21.8 on the Functional Independence Measure, comparable to results from previous trials involving individuals without aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Metacognitive Strategy Training Is Feasible for People With Aphasia. Kersey, J., Evans, WS., Mullen, K., et al.[2022]

In a study involving five patients with persistent left neglect after a right stroke, prism adaptation was linked to significant improvements in their condition, highlighting its potential as a therapeutic intervention.

The beneficial effects of prism adaptation were associated with increased activity in specific brain regions, including the right cerebellum and left thalamus, suggesting that the cerebellum plays a crucial role in processing visuomotor realignment and modulating areas involved in spatial cognition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional anatomy of the therapeutic effects of prism adaptation on left neglect. Luauté, J., Michel, C., Rode, G., et al.[2016]

In a study involving 15 chronic hemispatial neglect patients, visual scanning techniques significantly improved neglect test scores and self-care abilities compared to mental practice, indicating its effectiveness as a treatment.

The benefits of visual scanning were not only immediate but also partially maintained three months after the intervention, suggesting lasting positive effects on daily functioning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is visual scanning better than mental practice in hemispatial neglect? Results from a pilot study. Ferreira, HP., Leite Lopes, MA., Luiz, RR., et al.[2019]

In a study involving 29 subacute right hemisphere stroke patients, both experimental and control groups showed significant improvements in neglect tests after 30 training sessions over 6 weeks, indicating that visual scanning training can be beneficial for these patients.

However, adding a dual task component to the training did not yield additional benefits compared to the standard training, suggesting that while visual scanning training is effective, the integration of dual tasks may need further refinement to enhance outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visual Scanning Training for Neglect after Stroke with and without a Computerized Lane Tracking Dual Task. van Kessel, ME., Geurts, AC., Brouwer, WH., et al.[2021]

In a study involving 12 patients with hemispatial neglect after stroke, left arm activation training alone led to significant improvements in visual neglect, which were maintained for up to 6 months after rehabilitation.

While traditional visual scanning training also showed benefits, the arm activation training proved effective on its own, suggesting it could be a viable alternative or complement in rehabilitation programs for neglect.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rehabilitation of hemispatial neglect: A randomized study using either arm activation or visual scanning training. Luukkainen-Markkula, R., Tarkka, IM., Pitkänen, K., et al.[2013]

Long-term prism adaptation training showed positive effects on visuo-spatial processing in a patient with chronic neglect, improving tasks like cancellation and grasping, with benefits lasting up to 1 year post-training.

While immediate performance improvements decreased over time, the training led to better performance when tested shortly after sessions, indicating that prolonged training can help realign visuo-motor mappings and alleviate some neglect symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term effects of prism adaptation in chronic visual neglect: A single case study. Humphreys, GW., Watelet, A., Riddoch, MJ.[2022]

Visuomotor feedback training (VFT) significantly improved cognitive function and spatial awareness in stroke patients with hemispatial neglect, showing greater short and long-term benefits compared to a control training group.

The study involved 20 participants who underwent VFT over two weeks, and results indicated that VFT not only enhanced performance on various cognitive tasks but also improved daily living activities, suggesting it is a practical rehabilitation method for neglect patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect. Rossit, S., Benwell, CSY., Szymanek, L., et al.[2022]

Prism adaptation training, involving five 10-minute sessions over 12 to 17 days, led to immediate improvements in tasks related to hemispatial neglect, such as subjective straight ahead pointing and line cancellation, in four stroke patients.

The training also showed potential benefits in functional tasks, like obstacle avoidance while walking, suggesting it could be a valuable addition to current treatments for hemispatial neglect, although further research is needed due to the small sample size and lack of a control group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of fresnel prism glasses to treat stroke patients with hemispatial neglect. Keane, S., Turner, C., Sherrington, C., et al.[2007]

Prism adaptation training (PAT) is effective for patients with unilateral neglect, particularly when fronto-subcortical areas of the brain are involved, as shown in a re-analysis of data from a randomized controlled trial with 23 participants.

Patients with subarachnoid bleeding demonstrated stronger functional recovery compared to those with other types of brain injuries, while those with parietal lesions showed reduced recovery, indicating that the efficacy of PAT may depend on the type and location of brain damage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The influence of clinical characteristics on prism adaptation training in visuospatial neglect: A post-hoc analysis of a randomized controlled trial. Scheffels, JF., Lipinsky, C., Korabova, S., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7855016/

Spatial Exploration Strategy Training for Spatial Neglect The results showed that the treatment reduced lateralized bias toward the ipsilesional side of space but did not improve overall detection performance. Impaired ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10157074/

Feasibility of hemispatial neglect rehabilitation with virtual ... Therefore, we conducted a feasibility study to assess the effectiveness of VR-VET in managing HSN in patients with stroke. We assessed the ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S1877065716305322

Rehabilitation of unilateral neglect: Evidence-based ... The purpose of this study was to provide an overview of the evidence on the effectiveness of rehabilitation procedures for unilateral neglect.

4. pubs.asha.org pubs.asha.org/doi/10.1044/2023_JSLHR-23-00285

Identifying Spatial Neglect in Chronic Right Hemisphere ... Spatial exploration strategy training for spatial neglect: A pilot study. Neuropsychological Rehabilitation, 32(5), 792–813. Go to Citation. Crossref · PubMed.

5. researchgate.net researchgate.net/publication/343082886_Spatial_exploration_strategy_training_for_spatial_neglect_A_pilot_study

Spatial exploration strategy training for spatial neglect The results showed that the treatment reduced lateralized bias toward the ipsilesional side of space but did not improve overall detection performance. Impaired ...

6. withpower.com withpower.com/trial/phase-perceptual-disorders-6-2024-e4d7b

Strategy Training for Hemispatial Neglect Trial Overview The study is testing 'strategy training' to see if it can help improve self-awareness, reduce disability, and address neglect by teaching ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3039433/

Recent trends in rehabilitation interventions for visual neglect ... The results suggest that visual scanning training showed a positive but modest improvement on neglect symptoms, whereas OKS with pursuit eye movements led to ...

8. medbridge.com medbridge.com/blog/four-basic-strategies-to-improve-hemispatial-neglect

Four Basic Strategies to Improve Hemispatial Neglect Dr. Martha Burns explains some strategies that can be taught to a person to help compensate for deficits in hemispatial neglect and improve daily function.