Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect

Abstract

Hemispatial neglect is a severe cognitive condition frequently observed after a stroke, associated with unawareness of one side of space, disability and poor long-term outcome. Visuomotor feedback training (VFT) is a neglect rehabilitation technique that involves a simple, inexpensive and feasible training of grasping-to-lift rods at the centre. We compared the immediate and long-term effects of VFT vs. a control training when delivered in a home-based setting. Twenty participants were randomly allocated to an intervention (who received VFT) or a control group (n = 10 each). Training was delivered for two sessions by an experimenter and then patients self-administered it for 10 sessions over two weeks. Outcome measures included the Behavioural Inattention Test (BIT), line bisection, Balloons Test, Landmark task, room description task, subjective straight-ahead pointing task and the Stroke Impact Scale. The measures were obtained before, immediately after the training sessions and after four-months post-training. Significantly greater short and longterm improvements were obtained after VFT when compared to control training in line bisection, BIT and spatial bias in cancellation. VFT also produced improvements on activities of daily living. We conclude that VFT is a feasible, effective, homebased rehabilitation method for neglect patients that warrants further investigation with well-designed randomised controlled trials on a large sample of patients.

Functional outcomes following lesions in visual cortex: Implications for plasticity of high-level vision

“…However, he showed surprising visuomotor competence, as reflected by his ability to orient and shape his hand for reaching and grasping objects. The authors concluded that the preservation of the visuomotor sensitivity is mediated by the residual dorsal pathway (Goodale and Milner, 1992), consistent with findings that the magnocellular-dorsal pathway supports residual visual perception functions for action (although see Rossit et al, 2017, for some recent counter-evidence).…”

Therapeutic Intervention for Visuo-Spatial Neglect after Stroke: A Meta-Analysis of Randomized Controlled Trials

“…This study highlighted the effectiveness of VFT which has been neglected in the rehabilitation field [ 27 ]. However, it showed large effect sizes in both mental function and, activity and participation even though the selected study had only a 2 week intervention period.…”

Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke

“…All participants trialled a novel VR version of our home-based therapy for spatial neglect (Rossit et al, 2019) -computerized spatial inattention grasping home-based therapy (C-SIGHT - Figure 1A). During the focus group, the stroke survivors and carers also trialled three VirtualRehab 'exergames' (videogame-like exercise activities developed by Evolv Rehabilitation Technologies) including: 'Boxing' (sparring with a virtual boxing partner; Figure 1B), 'Bullseyes and Barriers' (hitting or avoiding targets; Figure 1C) and 'In the Kitchen' (search task in realistic kitchen layout; Figure 1D).…”

“…None of the stroke survivors received any form of spatial neglect rehabilitation at the time of this study. Prior to focus groups, spatial neglect was formally assessed in a separate session at the participant’s home, using paper-and-pencil tests including Behavioural Inattention Test (BIT; Wilson, Cockburn & Halligan, 1987), line bisection task (Rossit et al, 2019) and the paper version of the Broken hearts test (Oxford Cognitive Screening; Demeyere et al, 2015). Five stroke survivors were classified as having chronic neglect at the time of the study (N+) as they were impaired in at least one of the spatial neglect tests ( n = 3 left side neglect, n = 2 right side neglect).…”

“…VirtualRehab is a telerehabilitation tool for motor rehabilitation using non-immersive VR and a motion-tracking sensor. Computerized spatial inattention grasping home-based therapy (c-SIGHT) is a non-immersive VR version of our home-based therapy for spatial neglect (grasping-to-lift rods at the centre; Rossit et al, 2019) which uses a motion-tracking sensor to track performance. The performance of participant can be monitored by a therapist remotely (live or at a later stage after the therapy has been completed).…”