Prism Adaptation Therapy for Stroke Rehabilitation

Recruiting at 2 trial locations

Overseen By Anna M Barrett, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Multiple sclerosis, Alzheimer, left brain stroke, 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: 12

Duration: 2 weeks

244 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial focuses on helping Veterans who have experienced a right brain stroke and now struggle with spatial neglect, which causes difficulty in noticing things on their left side. Researchers are testing Prism Adaptation Therapy (PAT), a treatment using special glasses to improve movement and awareness on the left side. The goal is to develop a brain scan test to identify those who will benefit most from PAT, potentially enhancing their independence in daily activities. This trial suits individuals who had a right brain stroke 1-4 months ago, can sit up, see well enough to point at objects, and are free of other serious brain disorders. As an unphased trial, it offers a unique opportunity to contribute to innovative research that could enhance treatment options for future patients.

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's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that Prism Adaptation Therapy is safe for stroke rehabilitation?

Research has shown that Prism Adaptation Therapy (PAT) is a well-researched treatment for spatial neglect, a condition often occurring after a stroke. Patients who received PAT improved in performing daily tasks and thinking more clearly, indicating that PAT is both effective and safe.

Studies have found that patients easily handle PAT, with no serious side effects reported. Stroke rehabilitation guidelines even recommend it for treating spatial neglect. This treatment involves wearing special glasses with prisms during training, which helps improve awareness of the left side.

Overall, past research supports the safety of PAT for those recovering from a stroke. For those considering joining a trial using PAT, existing evidence suggests it is a safe option. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Prism Adaptation Therapy for stroke rehabilitation because it offers a unique approach for addressing spatial neglect, a common post-stroke condition. Unlike traditional therapies that often focus on repetitive exercises to improve motor skills, this therapy uses special glasses with prism lenses to shift visual perception, helping the brain recalibrate its spatial awareness. This method directly targets the brain's ability to process spatial information, potentially offering quicker and more effective symptom reduction. By focusing on the underlying brain processes rather than just physical symptoms, Prism Adaptation Therapy could revolutionize how we approach rehabilitation for stroke patients with spatial neglect.

What evidence suggests that Prism Adaptation Therapy is effective for spatial neglect?

Research has shown that Prism Adaptation Therapy (PAT), which participants with spatial neglect in this trial will receive, can help treat spatial neglect after a stroke. One study found that patients who received PAT improved in performing daily activities. Another study noted that more PAT sessions can lead to better recovery. However, some research presents mixed results regarding its effectiveness. Despite this, many experts believe PAT can help reduce symptoms of spatial neglect, especially for those who have trouble aiming. ^{2 4 6 7 8}

Who Is on the Research Team?

Anna M. Barrett, MD

Principal Investigator

VA Central Western Massachusetts Healthcare System, Leeds, MA

Are You a Good Fit for This Trial?

This trial is for Veterans over 18 who've had their first right brain stroke within the last 1-4 months. They must be able to sit up, have vision better than 20/50 in both eyes, and give informed consent. It's not for those with other neurological disorders like Alzheimer's, previous left brain strokes or significant prior strokes visible on scans.

Inclusion Criteria

I can sit up, see clearly with both eyes, and point to objects.

Can give informed consent to participate

I was diagnosed with a right brain stroke 1-4 months ago.

Exclusion Criteria

You have poor vision, seeing less clearly than most people.

I have a chronic neurological condition like MS or Alzheimer's.

I have had a stroke on the left side of my brain or scans show I've had strokes.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 10 days of visuomotor training while wearing optical prisms (PAT) to treat spatial neglect

2 weeks

10 visits (in-person)

Follow-up

Participants are monitored for improvements in functional independence and spatial neglect severity

5 weeks

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Prism Adaptation Therapy

Trial Overview

The study tests Prism Adaptation Therapy (PAT) as a rehabilitation method for spatial neglect after a right brain stroke. The therapy involves visuomotor training while wearing optical prisms over a period of ten days. Researchers aim to develop a brain scan test to identify candidates for PAT.

How Is the Trial Designed?

Group I: No spatial neglect Active Control 1 Intervention

People without spatial neglect symptoms will not receive an intervention for spatial neglect.

Group II: Prism adaptation Therapy Active Control 1 Intervention

People with spatial neglect will receive this effective treatment to reduce symptoms, which the investigators' previous work indicated may be particularly effective for Aiming SN symptoms.

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?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

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]

In a study of 520 patients receiving prism adaptation treatment (PAT) for spatial neglect (SN), more sessions of PAT were associated with greater improvement in SN, particularly in those with moderate-to-severe neglect.

The frequency of PAT sessions also positively influenced rehabilitation outcomes, with patients completing 8 or more sessions showing better SN improvement, highlighting the importance of treatment dosage in rehabilitation settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impacts of Prism Adaptation Treatment on Spatial Neglect and Rehabilitation Outcome: Dosage Matters. Chen, P., Hreha, K., Gonzalez-Snyder, C., et al.[2022]

In a study involving 29 stroke patients with left visual neglect, prismatic lenses that only deviated the visual field by 5 degrees did not show any significant therapeutic effect compared to placebo lenses.

The observed improvements in both groups were likely due to the pointing exercises rather than the prismatic lenses, suggesting that effective treatment may require stronger lenses (at least 20 prism diopters) to create a meaningful impact on neglect rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical application of prismatic lenses in the rehabilitation of neglect patients. A randomized controlled trial. Mancuso, M., Pacini, M., Gemignani, P., et al.[2016]

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 therapy, which uses prismatic goggles to help patients point to visual targets, has shown significant improvements in treating visuo-spatial disorders like unilateral neglect, suggesting a shift from traditional rehabilitation methods that focus on patients' deficits.

This ascending approach to rehabilitation emphasizes the importance of visuo-manual adaptation and has the potential to enhance not only visual and motor skills but also higher cognitive functions, indicating a need for a theoretical reevaluation of neurorehabilitation strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prism adaptation in the rehabilitation of patients with visuo-spatial cognitive disorders. Pisella, L., Rode, G., Farnè, A., et al.[2013]

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]

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]

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]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8463461/

Prism Adaptation Treatment Improves Inpatient ...

Patients with SN receiving PAT had better functional and cognitive outcomes, suggesting that integrating PAT into the standard of care is beneficial.

2.

sciencedirect.com

sciencedirect.com/science/article/pii/S2590109523000101

Prism Adaptation Treatment for Right-Sided and Left- ...

Objective. To compare the effectiveness of prism adaptation treatment (PAT) between patients with right- and left-sided spatial neglect (SN).

3.

kesslerfoundation.org

kesslerfoundation.org/press-release/dosage-inpatient-prism-adaptation-treatment-spatial-neglect-predicts-outcomes-stroke

Dosage of inpatient prism adaptation treatment for spatial ...

Number and frequency of prism adaptation treatment sessions correlate with improvement in spatial neglect and rehabilitation outcome.

4.

frontiersin.org

frontiersin.org/journals/rehabilitation-sciences/articles/10.3389/fresc.2025.1539887/full

Does prism adaptation treatment reduce spatial neglect ...

The potential of using prism adaptation for treating spatial neglect (SN) was questioned when recent meta-analyses found inconsistent evidence.

5.

kesslerfoundation.org

kesslerfoundation.org/researchcenter-stroke-rehabilitation-research/guide-spatial-neglect-healthcare-professionals

Guide to Spatial Neglect For Healthcare Professionals

This guide for healthcare professionals discusses spatial neglect disorder caused by brain damage, with stroke as a common cause.

6.

stoeltingco.com

stoeltingco.com/Psychological-Testing/Kessler-Foundation-Prism-Adaptation-Treatment-KF-PAT-for-Spatial-Neglect~10544

Kessler Foundation Prism Adaptation Treatment (KF-PAT) ...

Kessler Foundation Prism Adaptation Therapy - A complete course of treatment for spatial neglect, a common complication of stroke that hinders recovery.

7.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC9010528/

Prism Adaptation Treatment of Spatial Neglect

This study examines the feasibility of Prism Adaptation Treatment (PAT) within an inpatient rehabilitation facility and the degree by which PAT improves ...

8.

stoeltingco.com

stoeltingco.com/Psychological/media/KF-PAT_Manual_Sample.pdf

Kessler Foundation Prism Adaptation Treatment KF-PAT® ...

Evidence-based treatment. Prism adaptation treatment is recommended for spatial neglect in the stroke rehabilitation practice guidelines published in 2016 by ...