Harnessing Motivation to Alleviate Neglect

Abstract

The syndrome of spatial neglect results from the combination of a number of deficits in attention, with patients demonstrating both spatially lateralized and non-lateralized impairments. Previous reports have hinted that there may be a motivational component to neglect and that modulating this might alleviate some of the debilitating symptoms. Additionally, recent work on the effects of reward on attention in healthy participants has revealed improvements across a number of paradigms. As the primary deficit in neglect has been associated with attention, this evidence for reward’s effects is potentially important. However, until very recently there have been few empirical studies addressing this potential therapeutic avenue. Here we review the growing body of evidence that attentional impairments in neglect can be reduced by motivation, for example in the form of preferred music or anticipated monetary reward, and discuss the implications of this for treatments for these patients. Crucially these effects of positive motivation are not observed in all patients with neglect, suggesting that the consequences of motivation may relate to individual lesion anatomy. Given the key role of dopaminergic systems in motivational processes, we suggest that motivational stimulation might act as a surrogate for dopaminergic stimulation. In addition, we consider the relationship between clinical post stroke apathy and lack of response to motivation.

Improving left spatial neglect through music scale playing

“…We also sought to control for any effect of the keyboard in itself in modulating patients' performance. The possibility may be entertained that the keyboard per se could act as a particularly interesting and motivating object, as compared, for example, with a standard cancellation task, resulting in a better exploration performance (see Russell, Li, & Malhotra, , for a review on the role of motivational factors in modulating spatial unilateral neglect). To this aim, on a separate day, participants were tested in a newly developed cancellation task (‘modified H cancellation task’), designed with a rationale similar to the letter cancellation task of Diller and Weinberg ().…”

Recent theoretical, neural, and clinical advances in sustained attention research

“…Additionally, motivational deficits, which make neglect patients extremely difficult to rehabilitate, may also play key roles in patients’ sustained attention deficits. Recent intervention work has highlighted how reward contingencies and playing rewarding music can improve both spatial and nonspatial symptoms of neglect . Current research is focused on elucidating the mechanisms of these sustained attention deficits and how they exacerbate spatial biases and impede recovery.…”

“…Recent intervention work has highlighted how reward contingencies and playing rewarding music can improve both spatial and nonspatial symptoms of neglect. 158,159 Current research is focused on elucidating the mechanisms of these sustained attention deficits and how they exacerbate spatial biases and impede recovery.…”

Spatial neglect

“…A less obvious line of research has aimed to improve neglect by enhancing motivation. 76 Anecdotally, task performance has been shown to improve with the incorporation of a monetary goal 77 and standard contemporary therapy also involves clearly-defined goals. However, there are now empirical studies showing improvement of neglect using motivational and rewarding stimuli in different forms, including anticipated monetary gain, 78 altering task instruction, 79 passively listening to pleasant music 80 and playing a musical sequence.…”