Prism Adaptation Treatment for Right-Sided and Left-Sided Spatial Neglect: A Retrospective Case-Matched Study

Abstract

Objective

To compare the effectiveness of prism adaptation treatment (PAT) between patients with right- and left-sided spatial neglect (SN).

Design

Retrospective case-matched design.

Setting

Inpatient rehabilitation hospitals and facilities.

Participants

A total of 118 participants were selected from a clinical dataset of 4256 patients from multiple facilities across the United States. Patients with right-sided SN (median age: 71.0 [63.5-78.5] years; 47.5% female; 84.8% stroke, 10.1% traumatic/nontraumatic brain injury) were matched 1:1 with patients with left-sided SN (median age: 70.0 [63.0-78.0] years; 49.2% female; 86.4% stroke, 11.8% traumatic/nontraumatic brain injury) based on age, neglect severity, overall functional ability at admission, and number of PAT sessions completed during their hospital stay.

Intervention

Prism adaptation treatment.

Main Outcome Measures

Primary outcomes were pre–post change on the Kessler Foundation Neglect Assessment Process (KF-NAP) and the Functional Independence Measure (FIM). Secondary outcomes were whether the minimal clinically important difference was achieved for pre–post change on the FIM.

Results

We found greater KF-NAP gain for patients with right-sided SN than those with left-sided SN (Z = 2.38, P=.018). We found no differences between patients with right-sided and left-sided SN for Total FIM gain (Z=–0.204, P=.838), Motor FIM gain (Z=–0.331, P=.741), or Cognitive FIM gain (Z=–0.191, P=.849).

Conclusions

Our findings suggest PAT is a viable treatment for patients with right-sided SN just as it is for patients with left-sided SN. Therefore, we suggest prioritizing PAT within the inpatient rehabilitation setting as a treatment to improve SN symptoms regardless of brain lesion side.