Article

Unilateral neglect due to parieto-temporo-frontal
lesions has a negative impact on the success of rehabilitation, and prism
adaptation (PA) enhances recovery from neglect. However, it is unclear if this
effect holds also in severely impaired patients and/or in the postacute phase of
rehabilitation. Moreover, it is not known whether PA affects all aspects of
neglect recovery or ego-centered spatial orientation only. METHODS: Sixteen
patients in a postacute stage (on average 36 days after a large right
cerebrovascular stroke) were entered into a series of single case design studies
with 4 measurements: 2 before and 2 after 1 week of PA treatment. All patients
had severe neglect (showing trunk, head, and eye deviation; canceling less than
20% of targets in a visual cancellation test). Lesions were transferred to a
standard brain to analyze size and location. RESULTS: Patients improved in cued
body orientation and in the cancellation task, that is, in ego-centered neglect.
However, none of the measures used to evaluate neglect of left side of objects
irrespective of their position on the right or left side of the patient
(allocentric neglect) showed an improvement. Treatment effects were not
influenced by total lesion size, but lesions including the postcentral cortex
were related to smaller recovery gains. CONCLUSION: PA is helpful in treating
severely impaired patients in the postacute phase, but the effect is restricted
to ego-centered neglect. Lesions in the postcentral cortex (middle
occipito-temporal, middle temporal, and posterior parietal areas) seem to limit
the effect of PA.

Langue : ANGLAIS