Treating perceptual organization deficits in nonneglecting RBD stroke patients

Abstract

Thirty-five right brain-damaged (RBD) stroke patients, enrolled in active rehabilitation programs, participated in this study. Patients were selected on the basis of their evidenced deficits in performing complex visuo-cognitive tasks and the absence of overt evidence of unilateral visual-spatial neglect. Seventeen of the 35 patients were randomly chosen to receive a training program (lasting approximately 1 month) designed to establish a systematic strategy of organizing complex visual material. The remaining 18 patients were re-examined after 1 month, and served as controls. The design of the treatment program was based on the hypothesis that nonneglected RBD patients fail to appreciate and synthesize elements of complex visual material due to a breakdown in compensation for a persistent lateral bias in visual-spatial attention. Upon posttesting, it was found that those patients who received training exhibited significantly improved performance, as compared to controls, on a subgroup of visuo-cognitive tasks. These results are discussed in terms of: (1) offering indirect support for the argument that pathological asymmetries in attention play a significant role in the failure of RBD patients on many visuo-cognitive tasks; and, (2) offering a basis for extending the treatment of perceptual problems in RBD patients.

A comparison of two approaches in the treatment of perceptual problems after stroke

“…In contrast, the results of the current study did not support other randomised controlled studies, which found the transfer of training approach to perceptual treatment to be more effective than conventional therapy (Diller et al, 1974;Weinberg et al, 1979;Weinberg et al, 1982;Young et al, 1983;Gordon et al, 1985;Soderback and Normell, 1986;Ladavas et al, 1994).…”

“…However, both of these studies by Weinberg et al only included left hemiplegic patients, either with unilateral neglect and spatial problems (Weinberg et al, 1979) or without neglect (Weinberg et al, 1982). Both studies randomly assigned patients to the two treatment groups but there may have been some bias in the selection of patients for these studies.…”

“…Group studies (not all were RCTs) have found significant differences between control groups of conventional rehabilitation and experimental groups receiving specialised perceptual treatment of various kinds, suggesting that their treatment techniques were of value in the remediation of perceptual problems (Diller et al, 1974;Weinberg et al, 1979;Weinberg et al, 1982;Young et al, 1983;Gordon et al, 1985). Diller et al (1974) in one of a series of studies involving both right and left hemiplegic stroke patients, investigated the effect of perceptual treatment following the transfer of training approach.…”

“…The studies which claimed that they randomly allocated patients to the different group lacked details of how the groups were actually randomised (Diller et aI., 1974;Weinberg et al, 1979;Weinberg et al, 1982;Robertson et al, 1990;Taylor et al, 1971;Lincoln et al, 1985;Hajek et al, 1993). Both of these studies Gouvier et al, 1984) report the association between visual scanning training and wheelchair navigation but this was in male patients only.…”

“…A further study by Weinberg et al (1982) included 35 left hemiplegic patients with visuo-cognitive problems but without unilateral visual neglect, who were randomly assigned to two groups. The experimental group consisted of 17 patients, with a mean age of 64.2 years and mean of 13.5 weeks post stroke.…”