Fordell Helena, Bodin Kenneth, Eklund Anders, Malm Jan
a Department of Pharmacology and Clinical Neuroscience , Umeå University , Sweden.
b Department of Computing Science (HPC2N and UMIT) , Umeå University , Sweden.
Top Stroke Rehabil. 2016 Jun;23(3):191-9. doi: 10.1080/10749357.2016.1138670. Epub 2016 Mar 8.
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.
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.
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.
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.
目前对于偏侧空间忽视症缺乏有效的治疗方法。我们开发了一种新的训练方法，即RehAtt™。本研究的目的是确定RehAtt™是否能改善中风后慢性偏侧空间忽视症患者的空间注意力。
RehAtt™由一台配有显示器的计算机、3D眼镜和一个力反馈接口（机器人笔）组成，该接口可对患侧手臂进行感觉运动激活。该软件在3D虚拟现实（VR）游戏环境中将视觉扫描训练与多感官刺激相结合。15名患有慢性偏侧空间忽视症（病程>6个月）的中风患者进行了多次基线评估，以确认症状的稳定性。所有测试均未发现重测效应。此后，所有患者在RehAtt™中训练15小时（5周，每周3次，每次1小时）。使用一套偏侧空间忽视测试和凯瑟琳·贝热戈量表（CBS）来评估干预后的行为结果。在6个月的随访中也使用了CBS。
通过重复测量分析发现，训练后在星形删除测试（p = 0.006）、烤盘任务（p < 0.001）和消去测试（p = 0.05）中有所改善。在波斯纳任务中，漏靶情况减少（p = 0.024）。CBS显示训练后日常生活活动立即有所改善（p < 0.01）。6个月后，患者仍报告CBS有所改善。
RehAtt™是一种治疗偏侧空间忽视症的新概念。采用VR方法进行训练可改善空间注意力，并在慢性偏侧空间忽视症患者的日常生活活动中表现出对空间注意力改善的迁移作用。我们的结果很有前景，值得进一步研究。
