title: Effects of contralesional robot-assisted hand training in patients with unilateral spatial neglect following stroke: a case series study.
abstract: BACKGROUND
  A reduction of hemispatial neglect due to stroke has been associated with activation of the contralesional hand in the contralesional hemispace. Robot-assisted upper limb training was found to effectively improve paretic arm function in stroke patients. To date no proof of concept of robot-assisted hemispatial neglect therapy has been reported in literature. This study aimed to determine whether robot-assisted left (contralesional) hand activation alone could lead to an improvement in hemispatial neglect following stroke.
  
  
  METHODS
  Three stroke patients with right brain injury underwent a 2-week training program of robotic left hand activation with the Gloreha® hand rehabilitation glove, which provides repetitive, passive mobilization of the fingers. Outcomes were assessed using the Line Crossing test, the Bells test, the Sentence Reading test, the Saccadic Training, the Sustained Attention to Response Task, and the Purdue Pegboard test.
  
  
  RESULTS
  Changes were observed after treatment as follows. Line Crossing test: all patients showed improved performance (6.7%, 89.5% and 80% increase in lines crossed) with two patients reaching normal performance levels. Bells test: one patient improved performance (50% increase), while one patient showed no change and one patient declined (-10.3% change); no patient reached normal performance levels. Sentence Reading test: all patients showed improved performance (800%, 57.1% and 42.9% increase in number of sentences read) with no patient reaching normal performance level. Saccadic Training: all patients showed improved performance (-62.8%, -15.5% and -9.7% change of the left hemifield reaction time). Sustained Attention to Response Task: all patients showed improved performance (-20.5%, -5.8% and -10% change of the reaction time) with two patients reducing incorrect responses (-42.9% and -73.3%) and one patient increasing them (9.1%). Purdue Pegboard test: all patients showed improved performance (100%, 27.3% and 75% change in the left + right + both hands sub-item score).
  
  
  CONCLUSIONS
  Some caution is warranted when interpreting our results, as the responses to the intervention were variable and might have been due to a placebo effect or fluctuating clinical conditions. However, robot-assisted hemispatial neglect therapy might be useful in stroke patients. Larger-scale investigations are needed to confirm our preliminary findings.
authors.forename: Valentina
authors.initials: V
authors.lastname: Varalta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Fonte
authors.forename: Giulia
authors.initials: G
authors.lastname: Montemezzi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: La Marchina
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Italy, P,le L,A, Scuro, 10, Verona 37134, Italy. nicola.smania@univr.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D000368:Aged; D005260:Female; D006225:Hand / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D010468:Perceptual Disorders / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D012371:Robotics / Q000379:methods*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation