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

Trial Summary

What is the purpose of this trial?

It is common for individuals after stroke to have a cognitive perceptual impairment called unilateral spatial neglect (neglect). Individuals with neglect have difficulty paying attention to one side of their body or one side of the environment and therefore experience difficulty performing daily activities. There are a lack of effective treatments for neglect and new interventions are needed to help reduce disability for these individuals. Metacognitive strategy training (strategy training) is an intervention that has the potential to reduce neglect-related disability and improve individuals' awareness of their neglect. This study seeks to examine the effects of strategy training on self-awareness, disability, and neglect.

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 data supports the effectiveness of the treatment Strategy Training, Metacognitive Strategy Training for hemispatial neglect?

Research on similar treatments, like visuomotor feedback training and spatial exploration strategy training, shows they can help improve spatial awareness and daily activities in patients with hemispatial neglect. These treatments focus on helping patients become more aware of their spatial errors and learn strategies to manage them, suggesting that Strategy Training and Metacognitive Strategy Training might also be effective. ^{1 2 3 4 5}

Is strategy training safe for humans?

The studies reviewed do not report any safety concerns related to strategy training, suggesting it is generally safe for humans. ^{2 5 6 7 8}

How does Strategy Training for Hemispatial Neglect differ from other treatments?

Strategy Training for Hemispatial Neglect is unique because it focuses on helping patients become aware of their own neglect symptoms and learn to manage them through self-discovery and monitoring. Unlike other treatments that may use tools like prism glasses or visual scanning tasks, this approach emphasizes a collaborative and interactive process to improve self-awareness and reduce neglect symptoms. ^{2 5 6 9 10}

Research Team

Emily Grattan, PhD

Principal Investigator

University of Pittsburgh

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

References

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

Functional anatomy of the therapeutic effects of prism adaptation on left neglect. [2016]

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

Long-term effects of prism adaptation in chronic visual neglect: A single case study. [2022]

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

Is visual scanning better than mental practice in hemispatial neglect? Results from a pilot study. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Spatial exploration strategy training for spatial neglect: A pilot study. [2023]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Visual Scanning Training for Neglect after Stroke with and without a Computerized Lane Tracking Dual Task. [2021]

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

Rehabilitation of hemispatial neglect: A randomized study using either arm activation or visual scanning training. [2013]

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

Metacognitive Strategy Training Is Feasible for People With Aphasia. [2022]

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

Use of fresnel prism glasses to treat stroke patients with hemispatial neglect. [2007]

10. United States 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. [2022]