title: Smooth Pursuit "Bedside" Training Reduces Disability and Unawareness During the Activities of Daily Living in Neglect: A Randomized Controlled Trial.
abstract: Background Neglect is associated with disability, unawareness, poor long-term outcome, and dependence from caregivers. No randomized trial has evaluated the effects of smooth pursuit eye movement training (SPT) and visual scanning training (VST) at the bedside on these variables. Objective To compare the effects of SPT and VST in postacute stroke at 1 month with left neglect.
  
  
  METHODS
  We carried out an assessor-blinded, randomized controlled trial. The 24 participants were randomly allocated to either SPT or VST (n = 12 each). They received 20 treatment sessions lasting 30 minutes each at the bedside over 4 weeks. Outcome measures included the Functional Neglect Index (FNI) based on 4 tasks: find objects on a tray, stick bisection, picture search, and gaze orientation. In addition, the Unawareness and Behavioral Neglect Index (UBNI) with 6 items about unawareness and 4 about neglect in activities of daily living, the Help index (required assistance in 10 functional activities), the Barthel Index, and the rehabilitation phase were rated by treatment-blinded assessors. Outcome measures were obtained before and immediately after the end of the interventions and at a 2-week follow-up. Results Significantly greater improvements were obtained after SPT versus VST treatment in the FNI and UBNI, and there were continued improvements selectively in the SPT group 2 weeks later. Conclusions SPT accelerates recovery from functional neglect and reduces unawareness significantly. Bedside neglect treatment using SPT is effective and feasible early after stroke.
authors.affiliation: Saar Universität, Saarbruecken, Germany kerkhoff@mx.uni-saarland.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Kerkhoff
authors.affiliation: Saar Universität, Saarbruecken, Germany.
authors.forename: Leandra
authors.initials: L
authors.lastname: Bucher
authors.affiliation: Ambulantes Neurologisches Rehazentrum, Hildesheim, Germany Asklepios Klinik Schildautal, Seesen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Brasse
authors.affiliation: Saar Universität, Saarbruecken, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Leonhart
authors.affiliation: Asklepios Klinik Schildautal, Seesen, Germany.
authors.forename: Manfed
authors.initials: M
authors.lastname: Holzgraefe
authors.affiliation: Helios Klinik, Hattingen, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Völzke
authors.affiliation: Schön Klinik, Bad Aibling, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Keller
authors.affiliation: Saar Universität, Saarbruecken, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Reinhart
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006423:Hemianopsia / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010468:Perceptual Disorders / Q000209:etiology / Q000628:therapy*; D011698:Pursuit, Smooth / Q000502:physiology*; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods*; D014796:Visual Perception / Q000502:physiology*
keywords: anosognosia; hemianopsia; hemineglect; stroke rehabilitation; visual scanning; visual smooth pursuit