title: Prism adaptation improves ego-centered but not allocentric neglect in early rehabilitation patients.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Klinikum Bremen-Ost, Bremen, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Gossmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Kastrup
authors.forename: Georg
authors.initials: G
authors.lastname: Kerkhoff
authors.forename: Carmen
authors.initials: C
authors.lastname: López-Herrero
authors.forename: Helmut
authors.initials: H
authors.lastname: Hildebrandt
mesh_terms: D000221:Adaptation, Ocular / Q000502:physiology*; D000368:Aged; D001930:Brain Injuries / Q000150:complications; D002540:Cerebral Cortex / Q000473:pathology; D004532:Ego; D005260:Female; D006801:Humans; D007909:Lenses; D008297:Male; D008875:Middle Aged; D009949:Orientation; D010468:Perceptual Disorders / Q000209:etiology / Q000534:rehabilitation*; D013028:Space Perception / Q000502:physiology*; D018709:Statistics, Nonparametric; D013997:Time Factors
keywords: ego-centered versus allocentric neglect; neglect; prism adaptation; rehabilitation