Rehabilitation Methods for Unilateral Spatial Neglect in Stroke Patients
A Comparative Analysis of Methods for Rehabilitation of Unilateral Spatial Neglect (USN) in Stroke Patients: Conventional Therapy, Computerized Cognitive Training and Eye Movement Biofeedback Training
Federal Center of Cerebrovascular Pathology and Stroke, Russian Federation Ministry of Health
30 participants
Jan 9, 2025
INTERVENTIONAL
Conditions
Summary
Stroke remains one of the leading causes of mortality and disability worldwide. Between 30% and 40% of patients who have had an acute cerebral hemorrhage, develop unilateral spatial neglect syndrome (USN). USN is observed in 24% of patients with left-hemispheric stroke and 45% of patients with right-hemispheric lesions in the acute phase acute phase and in 20% of patients in the chronic phase. The presence of USN significantly complicates the rehabilitation process and negatively affects the functional outcomes. The complexity of USN correction is due to the heterogeneity of its manifestations and combination with other cognitive disorders. In 30-50% of patients with USN anosognosia is observed, in 60% - memory and attention disorders. Traditional methods of rehabilitation lead to significant improvement in 30-50% of patients with USN. The use of combined methods of treatment, including pharmacotherapy and non-medication methods, can improve efficacy by up to 70-80%. This indicates the need to develop and investigate new approaches to correct USN. Despite the growing number of studies in this area, there is still no unified approach to selecting the optimal method of USN correction for each individual patient. Different methods of rehabilitation may have different effects on neuroplasticity processes, which opens new perspectives for optimization of rehabilitation strategies.
Eligibility
Inclusion Criteria3
- Normal cognitive development in accordance with age and educational level;
- diagnosis with codes I63, I61 (ICD);
- presence of unilateral spatial neglect syndrome in the neuropsychological status.
Exclusion Criteria3
- presence of mental and somatic pathology of severe degree and in decompensation stage;
- the presence of gross oculomotor disorders;
- presence of a sensory visual defect of moderate to severe severity
Interventions
The methods of traditional neuropsychological rehabilitation used in the classes included: * attention tasks: proofreading tests, Schulte's Table; * spatial thinking tasks: copying, drawing, tasks using Nikitin cubes; * text reading tasks: texts from the Luria album. Each session began with oculomotor exercises. The correction programs differed by the type of feedback given to the patient in the course of correction. Feedback in this type of intervention is in the form of prompts from a specialist.
Rehabilitation in this group was carried out using an alternative communication device - oculograph C-Eye Pro (Assistech). The use of the device is characterized by a number of features: the presence of the eye movement biofeedback function (the patient and the specialist can see where the patient's gaze is directed by the movement of the red dot on the screen), the device needs to be pre-calibrated before the beginning of the session. To implement rehabilitation activities such tasks were used as: * Visual field training; * Word composing; * Vowel insertion; * Reading; * etc. The peculiarity of correction on the apparatus of alternative communication - oculograph - was the use of visual biological communication, visual biological communication, also in case of wrong answer a sound signal followed.
Rehabilitation of patients in the second experimental group was carried out on the RehaCom modular therapeutic system. The modular system includes a dedicated keyboard that has: numbers 1-9, 4 ok buttons, 4 arrow buttons, 2 pause/tip buttons and 2 exit/cancel buttons. Most of the tasks are performed using the keyboard, some of the tasks involved touch screen control. Tasks with stimulus images in the left screen space were used for rehabilitation activities: * "Saccades"; * "Attention and Concentration"; * "Planar Imagination"; * "General Presentation and Reading"; * "Shopping"; * "Daily routine". A feature of the correction on the modular therapy system was the involvement of a motor component, playing a sound cue or visual cue when an error occurred.
Locations(2)
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NCT06802159