Department of Research and Development, Posit Science Inc, San Francisco, CA, USA.
Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA.
Ann Neurol. 2020 Oct;88(4):747-758. doi: 10.1002/ana.25862. Epub 2020 Sep 4.
We conducted a multisite, randomized, double-blinded, controlled trial to examine the effectiveness of a digital health intervention targeting the intrinsic regulation of goal-directed alertness in patients with chronic hemispatial neglect.
Forty-nine participants with hemispatial neglect, who demonstrated significant spatially biased attention after acquired brain injury, were randomly assigned to the experimental attention remediation treatment or the active control group. The participants engaged with the remotely administered interventions for 12 weeks. The primary outcome was spatial bias on the Posner cueing task (response time difference: left minus right target trials). Secondary outcomes included functional abilities (measured via the Catherine Bergego scale and Barthel index), spatial cognition, executive function, quality of life, and sleep. Assessments were conducted before and immediately after participation in the experimental intervention or control condition, and again after a 3-month no-contact period.
Compared with the active control group, the intervention group exhibited a significant improvement in the primary outcome, a reduction in spatially biased attention on the Posner cueing task (p = 0.010, Cohen's d = 0.96), in addition to significant improvements in functional abilities as measured on the Catherine Bergego and Barthel indices (p = 0.027, Cohen's d = 0.24).
Our results demonstrate that our attention training program was effective in improving the debilitating attention deficits common to hemispatial neglect. This benefit generalized to improvements in real-world functional abilities. This safe, highly scalable, and self-administered treatment for hemispatial neglect might serve as a useful addition to the existing standard of care. ANN NEUROL 2020;88:747-758.
我们开展了一项多中心、随机、双盲、对照试验，以检验针对慢性偏侧空间忽略患者目标导向警觉性内在调节的数字健康干预措施的有效性。
49 名有偏侧空间忽略的参与者，这些参与者在获得性脑损伤后表现出明显的空间偏向注意，他们被随机分配到实验组注意力矫正治疗或主动对照组。参与者接受远程管理的干预措施 12 周。主要结局指标是正性线索任务中的空间偏倚（反应时差异：左减去右目标试验）。次要结局指标包括功能能力（通过 Catherine Bergego 量表和 Barthel 指数测量）、空间认知、执行功能、生活质量和睡眠。在参与实验干预或对照条件之前和之后立即进行评估，并且在 3 个月无接触期后再次进行评估。
与主动对照组相比，干预组在主要结局指标上表现出显著改善，正性线索任务中的空间偏向注意减少（p=0.010，Cohen's d=0.96），Catherine Bergego 和 Barthel 指数测量的功能能力也显著提高（p=0.027，Cohen's d=0.24）。
我们的研究结果表明，我们的注意力训练方案在改善偏侧空间忽略常见的注意力缺陷方面是有效的。这种益处泛化到现实生活中功能能力的提高。这种针对偏侧空间忽略的安全、高度可扩展和自我管理的治疗方法可能是现有护理标准的有益补充。
