Rode G, Lacour S, Jacquin-Courtois S, Pisella L, Michel C, Revol P, Alahyane N, Luauté J, Gallagher S, Halligan P, Pélisson D, Rossetti Y
Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France; Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France; Plate-forme « Mouvement et Handicap », hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France.
Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France.
Ann Phys Rehabil Med. 2015 Apr;58(2):40-53. doi: 10.1016/j.rehab.2014.10.004. Epub 2014 Oct 30.
Spatial neglect (SN) is commonly associated with poor functional outcome. Adaptation to a rightward optical deviation of vision has been shown to benefit to SN rehabilitation. The neurophysiological foundations and the optimal modalities of prism adaptation (PA) therapy however remain to be validated. This study is aimed at exploring the long-term sensory-motor, cognitive and functional effects produced by weekly PA sessions over a period of four weeks. A double-blind, monocentric randomized and controlled trial (RCT) was carried out. Twenty patients with left SN secondary to stroke were included, 10 in the "prism" group and 10 in the "control" group. The sensory-motor effects of PA were evaluated by measurement of manual and visual straight-ahead, and also by precision of pointing without visual feedback before and after each PA session. The functional independence measure (FIM) was evaluated before and at 1, 3 and 6 months after PA, while SN severity was assessed using the Behavioural Inattention Test (BIT) before and 6 months after PA. Before the intervention, only manual straight-ahead pointing constituted a reproducible sensory-motor measurement. During prism exposure, a questionnaire showed that not a single patient were aware of the direct effects of optical deviation on pointing movement performance. The sensory-motor after-effects produced by the PA produced a more rapid reduction of the rightward manual straight-ahead, which was secondarily followed by visual straight-ahead. These sensory-motor effects helped to clarify the action mechanisms of PA on SN. At the conclusion of the 6-month follow-up, the two groups showed similar improvement, indicating that a weekly PA session over 4 weeks was not sufficient to produce long-term functional benefit. This improvement was correlated with the evolution of visual straight-ahead, which can be proposed as a marker for patients outcome.
空间忽视（SN）通常与不良的功能预后相关。已证明适应视觉向右光学偏差有益于SN康复。然而，棱镜适应（PA）治疗的神经生理学基础和最佳方式仍有待验证。本研究旨在探索为期四周、每周进行PA治疗所产生的长期感觉运动、认知和功能影响。开展了一项双盲、单中心随机对照试验（RCT）。纳入了20例因中风导致左侧SN的患者，“棱镜”组10例，“对照组”10例。通过测量手动和视觉直视方向，以及在每次PA治疗前后无视觉反馈时的指向精度来评估PA的感觉运动效果。在PA治疗前以及治疗后1、3和6个月评估功能独立性测量（FIM），同时在PA治疗前和治疗后6个月使用行为疏忽测试（BIT）评估SN严重程度。在干预前，只有手动直视方向的指向构成可重复的感觉运动测量。在使用棱镜期间，一份问卷显示没有患者意识到光学偏差对指向运动表现的直接影响。PA产生的感觉运动后效应使向右的手动直视方向更快减少，其次是视觉直视方向。这些感觉运动效应有助于阐明PA对SN的作用机制。在6个月随访结束时，两组显示出相似的改善，表明为期四周、每周一次的PA治疗不足以产生长期功能益处。这种改善与视觉直视方向的变化相关，视觉直视方向可被提议作为患者预后的一个指标。
