Die Kombination von Prismen-Adaptation und visueller Suche zur Behandlung des Neglekts in der Phase B der neurologischen Rehabilitation

Background and objective: Visuospatial neglect after right hemispherical damage not only causes neuropsychological impairments, but it also has serious consequences for performing activities of daily life (ADL). Prism adaptation (PA) is one treatment option. Nevertheless, evidence for its effectiveness in the post-acute and most severe stage of the disease is inconsistent. A possible explanation for the inconsistency in the research literature could be the monotony of the typical PA protocol (reaching movements toward spatially moving targets). Therefore, the present study implemented a combined intervention consisting of PA and visual search tasks, in order to prevent patient burden and motivational issues that interfere with treatment success. Methods: Eight patients from an early rehabilitation unit suffering from left visual neglect were treated during 15 therapy sessions (distributed over 3 weeks). Additionally, we used data from a control group (n = 14) which received neuropsychological therapy at the same frequency, but without targeting visuospatial aspects. Neglect severity was evaluated in both groups twice prior to treatment (T1, T2) and once afterward (T3) using neuropsychological instruments and ADL questionnaires. Results: After our specific PA treatment, the intervention group significantly improved on the Apples cancellation and line bisection tests as well as on spontaneous and cued sitting position tests. For the Early Rehabilitation Barthel Index and functional independence measure (improvement in both groups), the intervention group only showed greater improvement in terms of absolute values. Conclusion: This study showed that a relatively short and combined treatment consisting of PA and visual search tasks significantly reduces neglect symptoms in post-acute patients. We suggest that – besides effects due to the prisms themselves – the reasons may be the adjustments which are playful and are tailored to patients’ needs, for instance, by taking motivational issues into account.