Rehabilitation by limb activation training reduces left-sided motor impairment in unilateral neglect patients: A single-blind randomised control trial

Abstract

Limb activation treatment for unilateral neglect has been shown to be effective in several single case studies (Robertson, Hogg, & McMillan, 1998a; Robertson, North, & Geggie, 1992). Limb Activation Treatment (LAT) is based on the theoretical model that links different aspects of spatial representation in the brain. Specifically, proprioceptive representations are strongly linked to external visual representations, such as activation of one may have influences on the other. LAT is implemented using an automatic device—the limb activation device (LAD). This device encourages patients with left unilateral neglect to make small movements with the partly paralysed left side of their body. Thirty-nine patients with right brain damage following cerebrovascular accident (CVA) who showed left unilateral neglect, were randomly allocated to perceptual training plus LAT or to perceptual training alone. Both groups received training of 12 sessions of 45 min duration over a 12 week period; 36 of the 39 patients were successfully followed up blind at 3 months, a total of 32 were followed up blind at 6 months and 26 at 18–24 months. Outcome was assessed using a variety of standardised functional outcome and neuropsychological measures. LAT treatment was associated with significantly improved left-sided motor function, with effects lasting up to 18–24 months. The limb activation device can be used in the context of existing therapy with no additional therapy time. This study shows that LAT can produce enduring improvements in left-sided motor impairment in CVA patients suffering left unilateral neglect.