Assessment of spatial neglect in clinical practice: A nationwide survey.

This study was part of a nationwide, anonymous, open Internet survey conducted amongst healthcare professionals in Denmark on the assessment and treatment of spatial neglect (SN). The objective was to describe knowledge and practices in the assessment of SN in current clinical practice across different healthcare sectors and professions. Data included the perceived prevalence, assessment methods and observations, subtypes and differential diagnostics of SN. A total of 525 professionals participated in the survey. The vast majority (81.5%) reported that assessment of SN was provided by their workplace. The median of perceived prevalence of SN was 35% (IQR 22-51) but major differences were found between professions. Occupational therapists and psychologists appeared to be most involved in assessment, whilst nursing staff and speech therapists were least involved. Subjective observations were the most common assessment method (90%). Conversely, systematic ADL observations, paper-and-pencil tests, confrontational tests and computerized tests were less common. The survey revealed large differences in the assessment methods and awareness of various aspects of SN symptoms (subtypes and differential diagnostics) between different healthcare professions. The results emphasize the need for international multidisciplinary clinical guidelines on how to assess SN and distinguish between different subtypes and differential diagnoses.

The computerized cognitive training alliance - A proposal for a therapeutic alliance model for home-based computerized cognitive training.

BACKGROUND: To increase the number of hours available for cognitive rehabilitation, it may be an option to use the spouse or paid assistants to assist with computerized home training. However, the delegation of training responsibilities may affect the normal roles of the therapist, the spouse and the training assistants. OBJECTIVE: This article suggests a new model for understanding the impact of computerized home training on the therapeutic alliance between the therapist, the patient and training assistants. Aspects of this knowledge are relevant also for the development and use of computerized training systems in clinical settings. METHOD: Qualitative Interpretative Phenomenological Analysis (IPA) of semi-structured interviews was used to analyse the experience gained during home-based computerized cognitive training. RESULTS: Home-based computerized training enforces the delegation of aspects of the therapeutic alliance established between the therapist and the patient. The perceived authority of assistants and computer training systems may differ from the authority established through the patient/therapist alliance. Information may be lost in transition impacting skills and expertise long-term. CONCLUSION: Roles and responsibilities between the therapist, the assistants and the computerized training system need to be clearly defined. A Cognitive Training Alliance model is being proposed which takes into consideration the challenges of delegating training responsibility to computer systems and non-professional assistants.

Treatment of spatial neglect in clinical practice: A nationwide survey.

OBJECTIVES: Clinical research has documented a range of evidence-based treatment approaches for spatial neglect (SN), but there is a lack of research on the implementation of treatment into clinical practice. The purpose of this study is to describe the current clinical practice of SN treatment across healthcare sectors including involved professions, methods, timing and sources of evidence. MATERIAL AND METHODS: This is the second part of a nationwide, anonymous, open Internet survey that was conducted among healthcare professionals in Denmark on assessment and treatment of SN. RESULTS: A total of 525 healthcare professionals participated in the survey of which 411 (78.3%) reported that SN treatment was provided at their workplace. Occupational and physiotherapist were most often involved in the treatment, most commonly characterized by training of activities of daily living (ADL), sensoric stimulation and cueing. Less frequently reported were evidence-based methods such as prism adaptation and visual scanning. The overall intensity of the SN treatment varied considerably across sectors and might consequently be inadequate. A minority of the participants consulted clinical research evidence in their choice of SN treatment approaches. CONCLUSIONS: There is a profound lack of dissemination and translation of clinical research into current clinical practice, which unarguably leads to an underuse of evidence-based treatment approaches in SN rehabilitation. The results call for international multidisciplinary clinical guidelines for the treatment of SN at different stages of rehabilitation and the tailoring of treatment approaches to the individual patient.

Simulated prism exposure in immersed virtual reality produces larger prismatic after-effects than standard prism exposure in healthy subjects.

Previous studies have shown that the size of the leftward bias after exposure to rightward prism-deviation (the prismatic after-effect) depends on the degree of rightward prism-deviation as well as the type of visual feedback receives during exposure to prism-deviation. In this study, we tested if it was possible to obtain a leftward bias in pointing precision using two different methods of creating diverted visual input by simulating a rightward prism diversion of visual input in immersive virtual reality. We compared the results to the leftward bias in pointing precision obtained after exposure to standard prism goggles deviating visual input 10 degrees to the right. Twenty healthy participants were subjected to one session of standard prism adaptation therapy under three different conditions of deviated visual input: 1) created by imitating a 10 degree leftward rotation of the head (VRR), 2) created by imitating a 2D leftward horizontal displacement of 10 degrees (VRS) and 3) a control condition using real right-deviating prisms (PCP). The study showed that the simulated prisms in the VRR and VRS conditions produced deviations in pointing precision of a similar size. However, exposure to the VRS and VRR conditions both produced larger prismatic after-effects than the exposure to real prism goggles. This research is important for the development and use of virtual reality systems in the rehabilitation of neglect after brain injury as it emphasizes that the adjustment to deviated visual input may be affected positively by the use of immersive virtual reality technology.

Normative perceptual estimates for 91 healthy subjects age 60-75: impact of age, education, employment, physical exercise, alcohol, and video gaming.

Visual perception serves as the basis for much of the higher level cognitive processing as well as human activity in general. Here we present normative estimates for the following components of visual perception: the visual perceptual threshold, the visual short-term memory (VSTM) capacity and the visual perceptual encoding/decoding speed (processing speed) of VSTM based on an assessment of 91 healthy subjects aged 60-75. The estimates were modeled from input from a whole-report assessment based on a theory of visual attention. In addition to the estimates themselves, we present correlational data, and multiple regression analyses between the estimates and self-reported demographic data and lifestyle variables. The regression statistics suggest that education level, video gaming activity, and employment status may significantly impact the encoding/decoding speed of VTSM but not the capacity of VSTM nor the visual perceptual threshold. The estimates will be useful for future studies into the effects of various types of intervention and training on cognition in general and visual attention in particular.

Intensive video gaming improves encoding speed to visual short-term memory in young male adults.

The purpose of this study was to measure the effect of action video gaming on central elements of visual attention using Bundesen's (1990) Theory of Visual Attention. To examine the cognitive impact of action video gaming, we tested basic functions of visual attention in 42 young male adults. Participants were divided into three groups depending on the amount of time spent playing action video games: non-players (<2h/month, N=12), casual players (4-8h/month, N=10), and experienced players (>15h/month, N=20). All participants were tested in three tasks which tap central functions of visual attention and short-term memory: a test based on the Theory of Visual Attention (TVA), an enumeration test and finally the Attentional Network Test (ANT). The results show that action video gaming does not seem to impact the capacity of visual short-term memory. However, playing action video games does seem to improve the encoding speed of visual information into visual short-term memory and the improvement does seem to depend on the time devoted to gaming. This suggests that intense action video gaming improves basic attentional functioning and that this improvement generalizes into other activities. The implications of these findings for cognitive rehabilitation training are discussed.

Dissimilar outcomes of apparently similar procedures as a challenge to clinical neurorehabilitation and basic research: when the same is not the same.

In the study of the brain and how it adapts to changes or injury, researchers sometimes come across situations where apparently similar types of tests or training do not achieve similar outcome results. This is true, in particular, within the field of computer-based rehabilitation where paper-and-pencil tests and training is converted to computer. This paper raises the attention to the fact that supposedly similar settings may not, in fact, elicit similar results and caution therapists and researchers who work with rehabilitation of brain injury. The paper suggests that the underlying mechanisms behind this may be illuminated by using the REF (Reorganization of Elementary Functions) model and suggests that further research into the use of advanced technologies such as computer-generated virtual reality is required.

Indirect versus direct feedback in computer-based Prism Adaptation Therapy.

Prism Adaptation Therapy (PAT) is an intervention method in the treatment of the attention disorder neglect (Frassinetti, Angeli, Meneghello, Avanzi, & Ladavas, 2002; Rossetti et al., 1998). The aim of this study was to investigate whether one session of PAT using a computer-attached touchscreen would produce similar after-effects to the conventional box normally used in PAT. In four experiments, 81 healthy subjects and 7 brain-injured patients diagnosed with neglect were subjected to a single session of PAT under two conditions: (1) using the original box, and (2) using a computer-based implementation of PAT. The session of PAT included a pre-exposure step involving pointing at 30 targets without feedback; an exposure step involving pointing at 90 targets with prism goggles and feedback; and a post-exposure step involving pointing at 60 targets, with no goggles and no feedback. The results indicate that the expected similarity in the after-effect produced by the two conditions seems to occur only if subjects receive feedback on pointing precision by seeing their fingertip during the exposure step. Attempts to provide feedback indirectly via icons on the computer screen failed to produce the expected size in the after-effect. The findings have direct implications for computer-based treatment of visuospatial disorders in the future and computer-assisted rehabilitation in general.