Spatial exploration strategy training for spatial neglect: A pilot study

ABSTRACT

Spatial neglect is a syndrome due to impaired neural networks critical for spatial attention and related cognitive and motor functions. Affected individuals also have impaired self-awareness of their own neglect symptoms. The present randomized controlled study was the first proof-of-concept pilot examining the multi-context treatment approach using a protocol of spatial exploration strategy training in one brief session (20–30 minutes). The therapist provided supportive feedback and semi-structured guidance to promote strategy learning and self-discovery of omission errors. 40 patients with left-sided neglect after right brain stroke were included. The results showed that the treatment reduced lateralized bias toward the ipsilesional side of space but did not improve overall detection performance. Impaired general self-awareness of daily-life spatial difficulties was found independent of treatment outcome. This implies that judgment regarding responsiveness to treatment should not be made based on an awareness interview or the severity of neglect symptoms. Lastly, the treatment showed the potential of improving online contextual self-awareness of spatial abilities. A collaborative and interactive approach that focuses on helping the patient self-discover, monitor and self-manage their errors, appears to have a potential for decreasing neglect symptoms. Future studies are required to examine additional aspects of the multi-context treatment approach.

KEYWORDS:

• Stroke rehabilitation
• Brain injury
• Occupational therapy
• Cognitive rehabilitation
• Anosognosia

Acknowledgements

We thank occupational therapists and participating patients in the Rusk Institute of New York University Medical Center, Burke Rehabilitation Hospital, Helen Hayes Hospital, New York Presbyterian Hospital, and Kings Harbor Multicare Center.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was partially supported by an Extramural Research Development Award (Eunice Kennedy Shriver National Institute of Child Health and Human Development), National Institutes of Health No. 2G11HD035965, Pilot grant awarded to Joan Toglia, through award received by Mercy College, Dobbs Ferry, NY.