EXAMINING THE EFFECTS OF A REPETITIVE TASK PRACTICE PROGRAM AMONG INDIVIDUALS WITH UNILATERAL SPATIAL NEGLECT

Unilateral spatial neglect (USN) is common after stroke and individuals with USN have greater disability than individuals without USN. Existing interventions for USN must be examined more closely and new interventions should be considered to identify interventions that show the most promise for reducing disability associated with USN. The focus of this dissertation was three-fold. First, we examined the state of the science related to interventions for USN after stroke, and articulated a scientific rationale for examining repetitive task practice. Second, we examined the association between USN and changes in impaired arm function over time. Third, we conducted a Phase II pilot clinical trial examining the feasibility, acceptability, and preliminary efficacy of repetitive task practice among adults with USN after stroke.\ud The findings highlight the complexities of impairments associated with USN (impaired arm use, impaired arm function, inattention). We proposed a new conceptual model that may be useful in conceptualizing and examining new intervention approaches to USN. We found that individuals with USN have greater impairments in arm function than individuals without USN at the onset of stroke rehabilitation, and that the trajectory of motor recovery is attenuated for individuals with USN in the next 6 months. We also determined that it is feasible to recruit and retain individuals with chronic USN and hemiparesis to participate in an intensive repetitive task practice program and that the intervention was tolerable for participants. Finally, we found that individuals with USN experience small, yet statistically reliable improvements in arm use, arm function, and attention after participating in a repetitive task practice program.\ud Future studies should prospectively examine variability in the trajectories of motor recovery, attention, and disability among individuals with USN from the onset of stroke through the first year or two after stroke to inform the refinement of sample selection criteria, intervention design and timing, as well as outcome assessment. These data may be used in future studies to explore additional interventions that address impaired arm use, impaired arm function, and inattention associated with USN. \ud \u