Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect

Abstract

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. Methods: 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. Results: 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). Interpretation: 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.

Anterior insula and inferior frontal gyrus: where ventral and dorsal visual attention systems meet

“…Indeed, it has been recognized early on that a punctual enhancement of alerting can trigger a transitory amelioration of hemispatial neglect symptoms ( Robertson et al , 1998 ). Consequently, several therapeutic approaches have been devised, aiming at ameliorating hemispatial neglect symptoms through an alerting enhancement ( Chandrakumar et al , 2019 ; Van Vleet et al , 2020 ), showing promising results on a group level. However, a great variability between individuals in treatment outcomes is a very common finding for neglect rehabilitation ( Bowen et al , 2013 ).…”

Cognitive decline in Huntington’s disease in the Digitalized Arithmetic Task (DAT)

“…This measure acknowledges that considering accuracy and response time separately may not capture the whole picture in patients’ cognitive decline. IES is widely used to measure cognition in healthy subjects as well as in patients with neurological injury [ 39 , 40 ] because it enhances the validity of cognitive measures reflecting “the average energy consumed by the system” [ 41 ]. When responding to a cognitive task, participants can be fast at the expense of accuracy or accurate at the expense of speed, yielding to a so-called “speed accuracy trade-off” [ 29 ].…”

Nedominuojančio pusrutulio insultas ir erdvinis neglektas. Ar žinomų pomėgių ir potraukių stimuliacija yra būdas padaryti reabilitaciją efektyvesnę?

“…In con trast to such patho log i cal crav ings, we look at mild crav ings as some thing that, via sa lience and meaningfulness of stim uli, helps pa tients sustain at ten tion through out re ha bil i ta tion and be come more vig i lant [45]. Sev eral stud ies have shown that en com passing is sues such as com puter games that trig ger re ward circuits in the mesolimbic do pa mine sys tem in re ha bil i ta tion lead to im prove ments in SN, both re lated to tonic and phasic alert ness [46,47]. It is, how ever, sur pris ing that var i ous com put er ized meth ods have not been cou pled with more per son al ized unique stim uli to help cap ture pa tients' at tention and im prove their re sponse time within the ne glected space.…”