Comparison of 3 Intervention Approaches into the Rehabilitation of Hemispatial Neglect: An Evaluation of Short and Long Term Recovery

We describe the outcome of a single-blinded randomized comparison of 3 different interventions in sub-acute right hemisphere lesioned stroke patients, suffering from hemispatial neglect. We compared 2 established intervention techniques (Visual Scanning Training (VST) and Optokinetic Stimulation (OKS)) to Visuomotor Feedback Training (VFT). VFT is a relatively unexplored cognitive rehabilitation technique that involves a simple procedure of grasping-to-lift rods at the centre. We evaluated the effectiveness of the 3 approaches in terms of decreased visual neglect symptoms, and possible improvements in activities of daily living, awareness and depression/anxiety, immediately after the training and at a 3 month follow up. Sixty patients were randomised into the 3 groups (VST, N=22; OKS, N=18; VFT, N=22) and each intervention consisted of 10 training sessions conducted over 10 consecutive days, lasting an average of 30 minutes. We found that patients in all 3 groups demonstrated a significant reduction of their neglect symptoms accompanied by transfer effects showing significant increases in activities of daily living and awareness as well as reduction in anxiety extending to the 3 months follow up. Although we failed to find significant differences between the 3 interventions, we demonstrate for the first time, that the relatively unexplored intervention of VFT is as effective as the more established rehabilitation approaches of VST and OKS. Moreover, we found further subtle (non-significant) differences between the techniques: For VFT improvements occurred immediately after testing and remained constant at follow up, for OKS greatest improvements seemed to occur between the end of training and follow up, whereas for VST the biggest effects were found straight after training. These are most promising results that can guide future large scale interventions