Frontal lesions predict response to prism adaptation treatment in spatial neglect: A randomised controlled study

ABSTRACT

Spatial neglect commonly follows right hemisphere stroke. It is defined as impaired contralesional stimulus detection, response, or action, causing functional disability. While prism adaptation treatment is highly promising to promote functional recovery of spatial neglect, not all individuals respond. Consistent with a primary effect of prism adaptation on spatial movements, we previously demonstrated that functional improvement after prism adaptation treatment is linked to frontal lobe lesions. However, that study was a treatment-only study with no randomised control group. The current study randomised individuals with spatial neglect to receive 10 days of prism adaptation treatment or to receive only standard care (control group). Replicating our earlier results, we found that the presence of frontal lesions moderated response to prism adaptation treatment: among prism-treated patients, only those with frontal lesions demonstrated functional improvements in their neglect symptoms. Conversely, among individuals in the standard care control group, the presence of frontal lesions did not modify recovery. These results suggest that further research is needed on how frontal lesions may predict response to prism adaptation treatment. Additionally, the results help elucidate the neural network involved in spatial movement and could be used to aid decisions about treatment.

KEYWORDS:

• Spatial neglect
• Rehabilitation
• Lesion mapping
• Prism adaptation
• Stroke

Acknowledgements

The authors thank Dr James Danckert for prompting the analysis of the insula lesions. They also thank the participants for donating their time to take part in the study, Jenny Masmela for assistance with institutional reporting, data management, and staff supervision, and Meghan Caulfield for assistance with lesion mapping.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funded by The National Institute on Disability, Independent Living, and Rehabilitation Research [NIDILRR, 901F0037; PI: Barrett]; National Institutes of Health [R01 NS 055808 and K24 HD062647; PI: Barrett]; Wallerstein Foundation for Geriatric Life Improvement (PI: Barrett); Kessler Foundation (Chen and Barrett). The contents of this report do not necessarily represent the policy of NIDILRR, the US Administration for Community Living, or the US Department of Health and Human Services, and you should not assume endorsement by the Federal Government.