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Prism adaptation for spatial neglect after stroke: translational practice gaps

Nature Reviews Neurology volume 8, pages 567–577 (2012)Cite this article

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Abstract

Spatial neglect increases hospital morbidity and costs in around 50% of the 795,000 people per year in the USA who survive stroke, and an urgent need exists to reduce the care burden of this condition. However, effective acute treatment for neglect has been elusive. In this article, we review 48 studies of a treatment of intense neuroscience interest: prism adaptation training. Due to its effects on spatial motor 'aiming', prism adaptation training may act to reduce neglect-related disability. However, research failed, first, to suggest methods to identify the 50–75% of patients who respond to treatment; second, to measure short-term and long-term outcomes in both mechanism-specific and functionally valid ways; third, to confirm treatment utility during the critical first 8 weeks poststroke; and last, to base treatment protocols on systematic dose–response data. Thus, considerable investment in prism adaptation research has not yet touched the fundamentals needed for clinical implementation. We suggest improved standards and better spatial motor models for further research, so as to clarify when, how and for whom prism adaptation should be applied.

Key Points

  • Spatial neglect is a major predictor of stroke disability; survivors with this condition are at high risk of adverse outcomes during acute stroke care

  • Stroke survivors with spatial neglect can demonstrate different symptoms: some have primarily 'where' spatial perceptual unawareness, whereas others have primarily 'aiming' spatial motor-exploratory dysfunction

  • Prism adaptation treatment is a potentially efficient and hospital-feasible therapy approach, with strong basic science support

  • We may need to target survivors with spatial 'aiming' neglect for prism adaptation training, as these individuals may demonstrate the best treatment response

  • Before we can use prism adaptation in the clinical setting, we need to define treatment candidacy, demonstrate in-hospital efficacy and short-term and long-term benefits, and optimize treatment procedures and dosing

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Acknowledgements

The authors thank medical student Rong (Tina) Chen, University of Medicine & Dentistry of New Jersey, New Jersey Medical School (references, organizational assistance), the Kessler Foundation and NIH/National Institute of Neurological Disorders and Stroke (manuscript support; K02 NS 047099, R01 NS 055808, K24HD062647, Principal Investigator A. M. Barrett), and Jenny R. Masmela (ideas central to the manuscript discussion). The authors are also grateful for the helpful suggestions of three anonymous reviewers, who read the manuscript in previous draft form.

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Authors and Affiliations

  1. Stroke Rehabilitation Research Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, 07052, NJ, USA

    A. M. Barrett

  2. Department of Psychology, Seton Hall University, 400 South Orange Avenue, South Orange, 07079, NJ, USA

    Kelly M. Goedert

  3. Behavioral & Neural Sciences Graduate Program, Center for Molecular and Behavioral Neuroscience, Rutgers University, 197 University Avenue, Newark, 07102, NJ, USA

    Julia C. Basso

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A. M. Barrett and J. C. Basso researched data for the article. All three authors contributed to writing the article. A. M. Barrett and K. M. Goedert made substantial contributions to discussion of the content, and reviewed and edited the manuscript before submission.

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Correspondence to A. M. Barrett.

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Further reading and reviews on spatial cognitive neuroscience and prism adaptation (DOC 43 kb)

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Barrett, A., Goedert, K. & Basso, J. Prism adaptation for spatial neglect after stroke: translational practice gaps. Nat Rev Neurol 8, 567–577 (2012). https://doi.org/10.1038/nrneurol.2012.170

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