Spatial neglect, pathologically asymmetric spatial behavior resulting from a brain injury (Heilman, 1979) and causing functional disability (Barrett and Burkholder, 2006) may occur in 20-50% of strokes, up to 350,000 Americans annually (Ringman et al., 2004; American Stroke Assoc., 2007). Difficulty eating, dressing, and navigating in complex environments occurs acutely in this disorder, but even if symptoms improve in chronic recovery, people with spatial neglect are more likely to lose functional independence (Katz et al., 1999). Current standard clinical approaches are not theory driven, and widely-employed therapies may be only marginally effective. In this proposal, we suggest two means by which scientific acute spatial neglect treatment can be implemented. In available studies, subject heterogeneity may have obscured treatment effects. Across methods, studies used single subject, case series, and group analytic designs, but did not attempt to reconcile the distinct advantages offered by individual versus group analytic approaches. Different treatments might affect different spatial cognitive recovery functions, but simple, global outcome measures may not reflect these changes. Modeling both subject-specific and group effects is also an extremely useful method of examining targeted treatment effects. We will collect spatial neglect treatment response data over four years, for two promising and feasible spatial neglect treatments: prism adaptation training and dopaminergic medication. With mechanism-specific outcome assessment and hierarchical linear modeling, we will examine whether treatments result in predictable response. We will also examine whether controlling for subject-specific predictors models group recovery trajectory. Lastly, we will examine current standard global outcome measures instruments which have not been fully psychometrically developed, and attempt to predict subject- and group-specific recovery profiles for these variables. We hope this research will improve our ability to design cognitive rehabilitation treatment studies. It may also, however, improve our ability to translate cognitive neuroscience models of action, spatial knowledge, and attention, to treatments to optimize adaptive movement in complex environments.
This study investigates novel methods of outcome analysis for comparing two treatments for hidden disabilities in functional vision after stroke. We hope this research will improve our ability to design cognitive rehabilitation treatment studies. It may also, however, improve our ability to bring basic brain science to the bedside, to optimize stroke survivors' adaptive movement and balanced visual-spatial function in complex environments. ? ? ? ? ? ? ?
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| Houston, Kevin E; Paschalis, Eleftherios I; Angueira, Danielle C et al. (2017) Restoration of Vision After Brain Injury Using Magnet Glasses. Am J Phys Med Rehabil 96:e70-e74 |
| Wagner, Daymond; Eslinger, Paul J; Barrett, A M (2016) Decreased leftward 'aiming' motor-intentional spatial cuing in traumatic brain injury. Neuropsychology 30:731-41 |
| Sacchetti, Daniela L; Goedert, Kelly M; Foundas, Anne L et al. (2015) Ipsilesional neglect: behavioral and anatomical correlates. Neuropsychology 29:183-90 |
| Chen, Peii; Goedert, Kelly M; Shah, Priyanka et al. (2014) Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment. Brain Imaging Behav 8:346-58 |
| Goedert, Kelly M; Chen, Peii; Boston, Raymond C et al. (2014) Presence of Motor-Intentional Aiming Deficit Predicts Functional Improvement of Spatial Neglect With Prism Adaptation. Neurorehabil Neural Repair 28:483-93 |
| Galletta, Elizabeth E; Campanelli, Luca; Maul, Kristen K et al. (2014) Assessment of neglect dyslexia with functional reading materials. Top Stroke Rehabil 21:75-86 |
| Bagherpour, Reza; Dykstra, Dennis D; Barrett, A M et al. (2014) A Comprehensive Neurorehabilitation Program Should be an Integral Part of a Comprehensive Stroke Center. Front Neurol 5:57 |
| Oh-Park, Mooyeon; Hung, Cynthia; Chen, Peii et al. (2014) Severity of spatial neglect during acute inpatient rehabilitation predicts community mobility after stroke. PM R 6:716-22 |
| Shah, Priyanka P; Spaldo, Nicole; Barrett, A M et al. (2013) Assessment and functional impact of allocentric neglect: a reminder from a case study. Clin Neuropsychol 27:840-63 |
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