Scheffels Jannik Florian, Korabova Sona, Eling Paul, Kastrup Andreas, Hildebrandt Helmut
Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.
Department of Psychology, University of Oldenburg, Oldenburg, Germany.
Front Neurol. 2021 Nov 19;12:742727. doi: 10.3389/fneur.2021.742727. eCollection 2021.
Visuospatial neglect may interfere with activities of daily living (ADL). Prism adaptation (PA) is one treatment option and may involve two components: recalibration (more strategic) and realignment (more implicit). We examined whether recalibration or realignment is the driving force in neglect rehabilitation using PA. In a randomized controlled trial with two recruitment series and a cross-over design, 24 neglect patients were allocated to a continuous (PA-c) or intermittent (PA-i) PA procedure. During the PA-c condition, goggles were worn without doffing. In the PA-i condition, patients donned goggles twice (first series of patients) or three times (second series) during training to induce more recalibrations. Primary outcome parameters were performance (omissions) on the Apples Cancellation Test and ADL scores. To assess the efficacy of the PA treatment, we compared effect sizes of the current study with those from three groups from previous studies at the same rehabilitation unit: (1) a passive treatment with a similar intensity, (2) a placebo treatment with a similar intensity, and (3) a PA treatment with fewer therapy sessions. Treatment conditions did not significantly predict scores on primary and most secondary outcome parameters. However, the spontaneous ipsilesional body orientation improved only in patients receiving the PA-i condition and this improvement also appeared in patients showing a strong after-effect (irrespective of condition). Effect sizes for the Apples Cancellation Test and the Functional Independence Measure were larger for both PA treatment protocols than the historical control groups. We conclude that more recalibrations during an intermittent PA treatment may have a beneficial effect on spontaneous body orientation but not on other aspects of neglect or on ADL performance. German Clinical Trials Register, identifier: DRKS00018813, DRKS00021539.
视觉空间忽视可能会干扰日常生活活动（ADL）。棱镜适应（PA）是一种治疗选择，可能涉及两个组成部分：重新校准（更具策略性）和重新对齐（更含蓄）。我们研究了重新校准或重新对齐是否是使用PA进行忽视康复的驱动力。在一项具有两个招募系列和交叉设计的随机对照试验中，24名忽视患者被分配到连续（PA-c）或间歇（PA-i）PA程序。在PA-c条件下，佩戴护目镜不摘下。在PA-i条件下，患者在训练期间佩戴护目镜两次（第一组患者）或三次（第二组患者）以诱导更多的重新校准。主要结局参数是苹果取消测试的表现（遗漏）和ADL评分。为了评估PA治疗的疗效，我们将本研究的效应量与同一康复单元之前三项研究的三组效应量进行了比较：（1）强度相似的被动治疗，（2）强度相似的安慰剂治疗，以及（3）治疗次数较少的PA治疗。治疗条件并未显著预测主要和大多数次要结局参数的得分。然而，仅在接受PA-i条件的患者中，自发的同侧身体定向得到改善，并且这种改善也出现在显示出强烈后效应的患者中（无论条件如何）。两种PA治疗方案在苹果取消测试和功能独立性测量方面的效应量均大于历史对照组。我们得出结论，间歇性PA治疗期间更多的重新校准可能对自发身体定向有有益影响，但对忽视的其他方面或ADL表现没有影响。德国临床试验注册中心，标识符：DRKS00018813，DRKS00021539。
