Group treatment of spatial neglect in patients with right brain injury

Abstract

This study examined the efficacy of a group treatment for remediation of unilateral spatial neglect in chronic, right brain injured stroke patients. Treatment procedures combined established intervention strategies with novel ones designed to optimize patients' awareness of the left hemispace and reliance on internalized adaptations rather than external cues. Treatment procedures were administered in a group format and within a structure that promoted dynamic interactions among patients, clinician and the treatment environment.;Nine male patients received treatment in groups of three, rotating among roles of Instructor, Student and Critical Observer. Treatment was conducted over twenty one-hour sessions and was alternated with a control period of comparable duration consisting of sessions of group discussion and eye movement exercises. A crossover design was employed to enable direct comparison of the effects of the experimental treatment against potential benefits derived from the regular interactions with a clinician and other patients during the control intervention.;Analyses of variance of neuropsychological test results, obtained prior to entry into study and following control and experimental treatment periods, yielded significant interaction effects that were supportive of treatment efficacy on measures of simple visual search and reading, and generalization to measures of complex visual attention, visual organization, visual constructional ability (untimed), visual recall and visual spatial reasoning. A measure of auditory spatial attention and select verbally bound measures yielded significant results that were largely attributable to a decline in scores when the control intervention was administered first. Behavioral improvements were noted in all instances and repeat EEG records for certain subjects were blindly judged by a neurologist as clinically less pathological, relative to baseline recordings, following treatment. It was also observed that the occurrence and relative severity of symptoms of spatial neglect were dissociated along visual, auditory and haptic dimensions. The theoretical and practical implications of these findings are discussed.