Prism Adaptation and Optokinetic Stimulation Comparison in the Rehabilitation of Unilateral Spatial Neglect

Prism adaptation (PA) is one of the most effective treatments for the rehabilitation of unilateral spatial neglect. Optokinetic stimulation (OKS) has also been demonstrated to be effective in ameliorating symptoms of neglect. The aim of this study is to compare the effectiveness of these two methods in a group of neglect patients using a crossover design. A group of 13 post-acute brain-damaged patients with unilateral spatial neglect, who had never been rehabilitated, were treated using PA and OKS. Each treatment was applied for 10 sessions, twice a day, to all patients with both treatments in crossed order (i.e., PA followed by OKS or vice versa). Neuropsychological assessments were performed: before the first (T1), at the end of the first/beginning of the second (T2) and at the end of the second training sessions (T3), and two weeks after the end of treatment (T4). Both procedures produced a significant improvement in clinical tests at T2, independent of the type of training. The results suggest that either PA or OKS induces a significant amelioration of neglect in right brain-damaged patients, mainly in the first block of treatment. Since no differences between treatments were found, they could be applied in clinical practice, according to the requirements of the individual patient.

Pediatric unilateral spatial neglect: A systematic review

PURPOSE: Unilateral spatial neglect (USN), an inability to attend to one side of space or one’s body, is commonly reported in adult stroke survivors and is associated with poor outcomes. USN has been reported in pediatric survivors of stroke, but its impact is unclear. The purpose of this systematic review was to summarize and evaluate the literature regarding USN in pediatric stroke survivors. METHODS: PRISMA guidelines, Scopus, CINAHL, PubMed, and other relevant databases were searched with terms including “children”, “stroke”, and “unilateral neglect”, with the ages of participants limited from to birth to 18 years. Data were extracted from studies on the clinical presentation of pediatric USN, the assessment of this condition, treatment options, or USN recovery. RESULTS: A total of 18 articles met inclusion criteria. There were no current prevalence data available. USN presents similarly in children compared to adults. Several different USN assessments were used, however, there were little data regarding treatment options. Furthermore, the data suggest that not all children fully recover. CONCLUSION: This systematic review reveals a lack of quality research to inform the assessment and treatment of children with USN. Although the literature spans decades, there remain no guidelines for standardized assessment or treatment. Similar to adults, paper-and-pencil testing may be less able to identify USN than functional assessments. It is likely that there are children who struggle with undetected USN-related deficits years after their injuries. With a rise of pediatric stroke survivors, there is a pressing need for clinicians to be educated about USN in children, clinical presentations, assessments, and treatments.

Validity and reliability of standing balance control measurement on the left unilateral spatial neglect model

BACKGROUND: The present study developed a head-mounted display with the visual direction of a web camera modified to the right as a left unilateral spatial neglect (USN) model with respect to postural balance control. AIM: We aimed to estimate the validity and reliability of center of pressure (CoP) measurements in static standing balance (SSB) and dynamic standing balance (DSB) of healthy participants were using the USN model and to examine whether this model's use influenced postural balance control. METHOD: A portable CoP force plate was used to quantify postural balance control in 64 healthy participants as the model. The CoP displacement of the non-USN and USN models in the medial-lateral (ML) and anterior-posterior (AP) planes, CoP length, and bilateral load ratio in SSB and DSB to the right (R) and left (L) were evaluated. RESULTS: Regression analysis indicated that most CoP measurements have excellent concurrent validity. Bland–Altman plots showed good agreement between the non-USN and USN models in the CoP measurements. Test-retest reliability estimation between two times measurements varied in the frontal and sagittal planes. A Comparison of the results demonstrated that the CoP-AP and CoP length changed (-1.40% and 7.67%, respectively) significantly in SSB (P<0.05). Moreover, the CoP-AP changed very significantly in DSB-R and DSB-L (-1.50% and 1.86%, respectively) in opposite directions (P<0.01) when the subjects performed as the model. CONCLUSION: CoP measurements are valid and reliable to quantify standing balance control in both non-USN and USN models that appear to modulate changes in postural adaptation and adjustment.