Article

Spatial neglect (SN) is commonly associated with poor functional outcome.
Adaptation to a rightward optical deviation of vision has been shown to benefit
to SN rehabilitation. The neurophysiological foundations and the optimal
modalities of prism adaptation (PA) therapy however remain to be validated. This
study is aimed at exploring the long-term sensory-motor, cognitive and functional
effects produced by weekly PA sessions over a period of four weeks. A
double-blind, monocentric randomized and controlled trial (RCT) was carried out.
Twenty patients with left SN secondary to stroke were included, 10 in the "prism"
group and 10 in the "control" group. The sensory-motor effects of PA were
evaluated by measurement of manual and visual straight-ahead, and also by
precision of pointing without visual feedback before and after each PA session.
The functional independence measure (FIM) was evaluated before and at 1, 3 and 6
months after PA, while SN severity was assessed using the Behavioural Inattention
Test (BIT) before and 6 months after PA. Before the intervention, only manual
straight-ahead pointing constituted a reproducible sensory-motor measurement.
During prism exposure, a questionnaire showed that not a single patient were
aware of the direct effects of optical deviation on pointing movement
performance. The sensory-motor after-effects produced by the PA produced a more
rapid reduction of the rightward manual straight-ahead, which was secondarily
followed by visual straight-ahead. These sensory-motor effects helped to clarify
the action mechanisms of PA on SN. At the conclusion of the 6-month follow-up,
the two groups showed similar improvement, indicating that a weekly PA session
over 4 weeks was not sufficient to produce long-term functional benefit. This
improvement was correlated with the evolution of visual straight-ahead, which can
be proposed as a marker for patients outcome.
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