Adaptive Cueing Treatment of Neglect in Stroke Patients Leads to Improvements in Activities of Daily Living: A Randomized Controlled, Crossover Trial

Background. Visuospatial neglect is a disabling syndrome with serious consequences for activities in daily life. This study investigated the effect of adaptive cueing during a reading task as a possible treatment for neglect by including (1) a task relevant for the patient’s daily life, (2) a fading out procedure to stimulate independent orientation to the left by self-cueing, and (3) a clear definition of neglect severity for the adaptive treatment protocol. Methods. A randomized controlled crossover design was used, including 26 patients from an early rehabilitation unit with left-sided visuospatial neglect after stroke or hemorrhage. They were examined twice at baseline (T1, T2), after 15 daily sessions in 1 condition (T3), and again after 15 daily sessions in the other condition (T4). The intervention condition included a daily reading task combined with endogenous and exogenous cues provided by a therapist, which were continuously reduced after a patient had reached a defined level of performance. The control condition consisted of a neuropsychological treatment of the same length, not targeting visuospatial attention. Results. Significant improvements were shown after intervention on scores for reading (word and text reading), daily life activities (Catherine Bergego Scale), Line Bisection, and the Clock Drawing Task. Conclusion. This study shows that adaptive cueing in a reading task can improve neglect symptoms by using an intensive intervention lasting 3 weeks.