Designing Rehabilitation Programs for Neglect: Could 2 Be More Than 1+1?

Abstract

Unilateral neglect is a multimodal neuropsychological disorder that has puzzled scientists for a long time. Many interventions have been developed, but only a handful has proven to be effective. This review examines whether applying different therapeutic techniques in combination will increase therapeutic benefits. Studies were reviewed where therapies are applied sequentially or in combination with other techniques. The results indicate that combining different interventions leads to increased general improvement compared with other noncombined designs, even when the number of treatment sessions is not constant. Practical and theoretical aspects of different treatments are discussed. The combined approach to treatment may have direct relevance to disorders other than neglect. This report introduces a new classification scheme for different interventions with the aim of facilitating more focused therapy. Finally, suggestions are made as to what the focus of future studies of neglect therapy should be and how therapeutic benefits might be maximized.

Key words:

• classification scheme
• sequential and combined designs
• therapeutic designs
• unilateral neglect

ACKNOWLEDGEMENTS

SS was supported with a grant from the German Academic Exchange Service and by a grant from the National Institute of Health to Prof. Christopher Rorden (R01-NS05426). ÁK was supported by a grant from the Research Fund of the University of Iceland and the Human Frontiers Science Program.

The authors would like to express their gratitude to Mrs. Stephanie Saskia Schneider for her assistance with data collection. Dr. Arthur MacNeill Horton, Jr., and five anonymous reviewers are thanked for helpful comments. Portions of this research were presented at the meeting of the Nordic-Baltic doctoral network in Helsinki, Finland, in August, 2009. UH and ÁK contributed equally to the study.

Notes

Note. Abbreviations for interventions: CVS = Caloric vestibular stimulation; EP = Eye patching; LAT = Limb activation training; NV = Neck vibration; OPKS = Optokinetic stimulation; PA = Prism adaptation; RHB = Right hemifield blinding; SAT = Sensory awareness training; SATG = Sustained attention training; TENS = Transcutaneous electrical nerve stimulation; VST = Visual scanning training.

Note. Abbreviations in the table: EP = Eye patching; LHB = Left hemifield blinding; NV = Neck vibration; PA = Prism adaptation; RHB = Right hemifield blinding; VST = Visual scanning training.

Note. Abbreviations in the table: ET = Exploration training; LAT = Limb activation training; LSS = Left-hand somatosensory stimulation; PA = Prism adaptation; RPMS = Repetitive peripheral magnetic stimulation; TENS = Transcutaneous electrical nerve stimulation; TR = Trunk rotation; VST = Visual scanning training; VT = Visual training.

Note. Abbreviations in the table: AT = Attention training; CAT = Computerized alertness training; IT = Imagination training; IVET = Interactive virtual imaging training; LAT = Limb activation training; NV = Neck vibration; OPKS = Optokinetic stimulation; OR = Oral reading; PA = Prism adaptation; rTMS = Repetitive transcranial magnetic stimulation; VFT = Visuomotor feedback training; VST = Visual scanning training.

Note. Abbreviations in the table: AS = Acoustical stimulation; AVP = Avoidance conditioning procedure; CS = Contralesional stimulation; CT = Copying training; EL = Errorless learning; FD = Figure description; GCI = General cognitive intervention; LAT = Limb activation training; NV = Neck vibration; OPKS = Optokinetic stimulation; PA = Prism adaptation; PCL = Perceptual anchoring training; RT = Reading training; SAT = Sensory awareness training; SATG = Sustained attention training; SOT = Spatial organization training; TENS = Transcutaneous electrical nerve stimulation; VCT = Visual compensatory training; VSMC = Visuospatial-motor cueing; VST = Visual scanning training.

¹At present, the low number of relevant studies prevents us from drawing strong conclusions about individual combinations of therapies and designs. Our aim is rather to highlight some trends in the findings—in particular that combinations of approaches hold the greatest promise—and to point the way forward in terms of research into different therapeutic designs.

²This scarcity of studies precludes a meta-analysis at this point.

³Note that the results of this pilot study by Keller et al. (2009) could, on the surface, be considered as speaking against the combined therapy approach that we advocate here. However, all of the other evidence that we present here points in the other direction.