| Author: | Feng, Danling |
| Title: | Effects of prism adaptation on left and right unilateral neglect in patients with subacute stroke : a randomized controlled trial |
| Advisors: | Fong, Kenneth (RS) |
| Degree: | DHSc |
| Year: | 2023 |
| Subject: | Cerebrovascular disease -- Patients -- Rehabilitation Motor ability Hong Kong Polytechnic University -- Dissertations |
| Department: | Faculty of Health and Social Sciences |
| Pages: | 125 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Previous studies have been conducted to explore the effect of prism adaptation (PA) on unilateral neglect (UN) after stroke. According to the evidence, PA has been proved to be the most effective intervention for improving left lateralized UN (LUN) after right-hemispheric stroke. Probably because of the lower manifestations of right lateralized UN (RUN) compared to LUN, the effect of PA on RUN was not well investigated. Objective: To investigate the effects of PA, using left or right visual shift prism, on improving LUN or RUN in patients after subacute stroke. Methods: This is a subject-blinded, multi-centered, randomized controlled trial. Stroke patients with either LUN or RUN were randomly assigned to one of the two groups – PA and sham PA. Both groups implemented three steps of pointing movements: the pre-exposure baseline measurement of pointing, the exposure to prismatic displacement to elicit sensorimotor adaptation, and the post-exposure after-effect measurement. The only difference between groups was the glasses in the exposure stage; patients in the PA group wore a pair of prisms that induced a 10° optical shift to the right or left, while the patients in the sham PA group wore plain glasses. The training lasted for 20-30 minutes per session, 10 sessions in 2 weeks. The outcome measurements included the Conventional Behavioral Inattention Test (BIT-C), the Catherine Bergego Scale (CBS), and the modified Barthel index (MBI), which were rated at four timepoints, i.e., baseline (T0), after the intervention (T1), 2nd week after intervention (T2), and 4th week after the intervention (T3). Results: We screened 1,100 stroke patients for eligibility. Of these, 289 patients were assessed, and 48 patients with UN were recruited (25 in the PA group, 23 in the Sham group; 34 LUN, 14 RUN). Five participants (three in the PA group and two in the Sham group) dropped out. The results showed that both groups had significant improvement over time, and the gain scores of CBS, MBI, and BIT-C (compare with T0) in the PA group were significantly higher than the Sham group at T1, T2, and T3. Subgroup analyses divided the sample into four subgroups based on the side of neglect and treatment protocols -PA-LUN, PA-RUN, Sham-LUN, and Sham-RUN. The results demonstrated that the gain scores of CBS, MBI, BIT-C in PA-LUN and PA-RUN groups were significantly higher than Sham-LUN and Sham-RUN groups, respectively, at T1, T2, and T3. The gain scores of three cancellation subtests in the BIT-C (line crossing, letter cancellation, and star cancellation) showed significant improvement in all groups, and significant differences between groups were found in the three comparisons (PA vs. Sham, PA-LUN vs. Sham-LUN, PA-RUN vs. Sham-RUN), except for the analysis of line crossing gain scores in the comparison between PA-RUN and Sham-RUN. Conclusion: PA is effective for poststroke UN recovery and performs better than sham adaptation in amelioration of neglect symptom (particularly on visual search tasks), and activities of daily living in patients with LUN and RUN. Both LUN and RUN patients performs better than sham adaptation. PA has equal advantage in improving neglect over LUN and RUN patients but the difference in proportion of the mean gain shows that patients with LUN benefit more from the effects of PA than patients with RUN. |
| Rights: | All rights reserved |
| Access: | restricted access |
Files in This Item:
| File | Description | Size | Format | |
|---|---|---|---|---|
| 7287.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 2.15 MB | Adobe PDF | View/Open |
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