title: Long-term sensorimotor and therapeutical effects of a mild regime of prism adaptation in spatial neglect. A double-blind RCT essay.
abstract: Spatial neglect (SN) is commonly associated with poor functional outcome. Adaptation to a rightward optical deviation of vision has been shown to benefit to SN rehabilitation. The neurophysiological foundations and the optimal modalities of prism adaptation (PA) therapy however remain to be validated. This study is aimed at exploring the long-term sensory-motor, cognitive and functional effects produced by weekly PA sessions over a period of four weeks. A double-blind, monocentric randomized and controlled trial (RCT) was carried out. Twenty patients with left SN secondary to stroke were included, 10 in the "prism" group and 10 in the "control" group. The sensory-motor effects of PA were evaluated by measurement of manual and visual straight-ahead, and also by precision of pointing without visual feedback before and after each PA session. The functional independence measure (FIM) was evaluated before and at 1, 3 and 6 months after PA, while SN severity was assessed using the Behavioural Inattention Test (BIT) before and 6 months after PA. Before the intervention, only manual straight-ahead pointing constituted a reproducible sensory-motor measurement. During prism exposure, a questionnaire showed that not a single patient were aware of the direct effects of optical deviation on pointing movement performance. The sensory-motor after-effects produced by the PA produced a more rapid reduction of the rightward manual straight-ahead, which was secondarily followed by visual straight-ahead. These sensory-motor effects helped to clarify the action mechanisms of PA on SN. At the conclusion of the 6-month follow-up, the two groups showed similar improvement, indicating that a weekly PA session over 4 weeks was not sufficient to produce long-term functional benefit. This improvement was correlated with the evolution of visual straight-ahead, which can be proposed as a marker for patients outcome.
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France; Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France; Plate-forme « Mouvement et Handicap », hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France. Electronic address: gilles.rode@chu-lyon.fr.
authors.forename: G
authors.initials: G
authors.lastname: Rode
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France.
authors.forename: S
authors.initials: S
authors.lastname: Lacour
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France; Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France; Plate-forme « Mouvement et Handicap », hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France.
authors.forename: S
authors.initials: S
authors.lastname: Jacquin-Courtois
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France.
authors.forename: L
authors.initials: L
authors.lastname: Pisella
authors.affiliation: Laboratoire Inserm U1093, faculté des sciences du sport (UFR Staps), université de Bourgogne, 21078 Dijon, France.
authors.forename: C
authors.initials: C
authors.lastname: Michel
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France; Plate-forme « Mouvement et Handicap », hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France.
authors.forename: P
authors.initials: P
authors.lastname: Revol
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France.
authors.forename: N
authors.initials: N
authors.lastname: Alahyane
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France; Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France; Plate-forme « Mouvement et Handicap », hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France.
authors.forename: J
authors.initials: J
authors.lastname: Luauté
authors.affiliation: Department of philosophy, university of Memphis, Memphis, TN 38152, United States of America.
authors.forename: S
authors.initials: S
authors.lastname: Gallagher
authors.affiliation: School of psychology, Cardiff University, Tower Building 70, Park Place Cardiff, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Halligan
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France.
authors.forename: D
authors.initials: D
authors.lastname: Pélisson
authors.affiliation: Inserm UMR-S 1028, CNRS UMR 5292, impact, centre de recherche en neurosciences de Lyon, université Lyon 1, 16, avenue Lépine, 69676 Bron, France; Plate-forme « Mouvement et Handicap », hôpital Henry-Gabrielle, Hospices Civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Rossetti
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology; D004311:Double-Blind Method; D056228:Feedback, Sensory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D011597:Psychomotor Performance; D013028:Space Perception; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome; D014796:Visual Perception
keywords: Bottom-up; Egocentric reference; Hemineglect; Prism adaptation; RCT; Rehabilitation; Spatial neglect