Nys G M S, de Haan E H F, Kunneman A, de Kort P L M, Dijkerman H C
Laboratory for Neuropsychology, Department of Neurology, Ghent University, Belgium.
Restor Neurol Neurosci. 2008;26(1):1-12.
At present, prism adaptation is probably the most promising rehabilitation procedure for hemi-neglect. However, randomised controlled trials are lacking and no data are available on the effectiveness of prism adaptation in the treatment of acute neglect.
We followed sixteen neglect patients using a randomised controlled design in which six patients received four-day-in-a-row placebo treatment (CG) and ten patients received four-day-in-a row experimental treatment with 10 degrees rightward deviating prisms (EG) during their stay on the stroke unit. We examined whether patients in the EG improved faster than the CG by administering three neglect tasks (Schenkenberg Line Bisection, Letter Cancellation, Gainotti Scene Copying) immediately before and after each treatment. Second, we examined whether patients in the EG demonstrated a better long-term outcome at one month post-treatment (Behavioural Inattention Test).
Patients in the EG improved faster on spatial tasks (line bisection, cancellation) than the CG but not on visuo-construction. Patients in the EG showed no differences with the CG in neglect outcome at one month post-treatment.
Four consecutive prism sessions produced beneficial effects in patients with acute neglect. However, prism effects were either short-term, or placebo treatment with repeated pointing and/or repeated neglect testing was more helpful than we anticipated. Our results emphasize the importance of a placebo condition and a follow-up in rehabilitation studies.
目前，棱镜适应可能是针对半侧空间忽视最有前景的康复方法。然而，缺乏随机对照试验，且尚无关于棱镜适应治疗急性忽视有效性的数据。
我们采用随机对照设计对16名忽视患者进行跟踪研究，其中6名患者在卒中单元住院期间接受连续四天的安慰剂治疗（对照组），10名患者接受连续四天使用10度向右偏斜棱镜的实验性治疗（实验组）。我们通过在每次治疗前后进行三项忽视任务（申肯伯格线段二等分、字母划消、加诺蒂场景临摹）来检查实验组患者的改善是否比对照组更快。其次，我们检查实验组患者在治疗后一个月是否表现出更好的长期预后（行为疏忽测试）。
实验组患者在空间任务（线段二等分、划消）上的改善比对照组更快，但在视觉构建任务上并非如此。实验组患者与对照组在治疗后一个月的忽视预后方面没有差异。
连续四次棱镜治疗对急性忽视患者产生了有益效果。然而，棱镜效果要么是短期的，要么是重复指向和/或重复忽视测试的安慰剂治疗比我们预期的更有帮助。我们的结果强调了康复研究中安慰剂对照条件和随访的重要性。
