RehAtt – scanning training for neglect enhanced by multi-sensory stimulation in Virtual Reality

Abstract

Background: There is a lack of effective treatment for neglect. We have developed a new training method, RehAtt™. The objective of this study was to determine whether RehAtt™ improves spatial attention in chronic neglect after stroke. Methods: RehAtt™ consists of a computer with monitor, 3D glasses, and a force feedback interface (Robotic pen) giving sensory motor activation to the contra-lesional arm. The software combines visual scanning training with multi-sensory stimulation in 3D virtual reality (VR) game environment. Fifteen stroke patients with chronic neglect (duration > 6 month) had repeated baseline evaluations to confirm stability of symptoms. There were no test–retest effects for any of the tests. Thereafter, all patients trained 15 h in RehAtt™ (3 × 1 h for 5 weeks). A neglect test battery and Catherine Bergego Scale, CBS, were used to assess behavioral outcome after intervention. CBS was also used at a 6-month follow-up. Results: Using repeated measurement analysis improvements due to the training were found for Star cancellation test (p = 0.006), Baking tray task (p < 0.001), and Extinction test (p = 0.05). In the Posner task improvements were seen fewer missed targets (p = 0.024). CBS showed improvements in activities of daily life immediately after training (p < 0.01). After 6 months the patients still reported improvement in CBS. Conclusion: RehAtt™ is a new concept for rehabilitation of neglect. Training with the VR-method improved spatial attention and showed transfer to improved spatial attention in activities of daily living in chronic neglect. Our results are promising and merit further studies.

Keywords:

• Spatial neglect
• Cognitive rehabilitation
• Attention, treatment, virtual reality, stroke

Funding

The study has been financed by the Swedish Stroke Association, Neuro Sweden Association, EU Founding Objective One, Umeå University; ALF, Neuro foundation, and Stroke foundation.

Disclosures

Helena Fordell is the founder of a startup company to assign the intellectual property of RehAtt, registered by Umeå University Innovation office, Uminova. Kenneth Bodin, Anders Eklund, and Jan Malm do not report any disclosure.