Date Presented 3/31/2017
Stroke survivors can have spatial neglect and movement deficits. Few studies examine effects of spatial treatments on motor function or recruit people with multiple strokes. This study concluded that prism adaptation treatment is feasible and effective in improving spatial neglect and arm movement.
Primary Author and Speaker: Kimberly Hreha
Contributing Authors: Glen Gillen
PURPOSE: A stroke resulting in cognitive and motor problems can be debilitating and prolong recovery. For 40% of first-time stroke survivors, a second stroke occurs within 5 yr. Frequently, a second stroke increases and worsens deficits such as spatial and motor disorders. Spatial treatments improving functions of spatial and motor systems may produce better outcomes. Prism adaptation treatment (PAT) has not been studied with a cohort with multiple stroke incidents, nor has change been measured using specific motor outcomes. This study sought to determine (1) the feasibility of using PAT to treat stroke survivors with multiple strokes, (2) if PAT in addition to standard care is more effective in improving motor (FIM®) and spatial function (Catherine Bergego Scale via Kessler Foundation Neglect Assessment Process [KF–NAP] and two subtests of the Behavior Inattention Test [BIT]) in stroke survivors with multiple strokes, and (3) if PAT in addition to standard care improves motor outcomes (Wolf Motor Function Test, Motor Activity Log, and accelerometer output).
DESIGN: The study involved a prospective intervention with retrospective comparison. Thirteen participants from an inpatient rehabilitation facility (IRF) were the treatment group; 13 others who received only standard inpatient rehabilitation care were the comparison group. The total cohort consisted of nine men and 17 women with ages ranging from 60–94 yr (M = 78.3, SD = 8.7). The treatment group was on average 8 yr younger than the comparison group (p = .014); otherwise, the groups were not different in sex ratio, time poststroke, discharge disposition, length of stay, or outcome measures at baseline. Motor and spatial outcomes were measured before and after 10 days of intervention. Only the treatment group was assessed with all motor outcomes and wore an accelerometer for 24 hr pre- and posttreatment. Statistical analyses used, depending on normality, included analysis of variance, t test, and Mann–Whitney U test.
RESULTS: Thirteen participants successfully completed the PAT protocol. Both groups improved in functional measures of spatial neglect (KF–NAP) over time (p < .001), but the treatment group showed greater improvement on the star cancellation (p = .001) and line bisection tests (p = .002). Similarly, both groups improved in motor function (p < .001), although the treatment group’s improvement was not superior. The treatment group’s accelerometer data for abstract arm movement and position of arm during dinner showed a significant change (p < .001) with large effects (d = 6.24 and d = 3.29, respectively).
CONCLUSION: The study suggests that PAT is a feasible treatment for stroke survivors with multiple strokes. PAT did not seem more effective than standard care in improving spatial activity function or motor function; however, it did improve spatial neglect as measured by the BIT. Future studies with a controlled design and larger samples are necessary to better understand PAT’s effectiveness on motor and spatial functions for individuals with multiple strokes. This study is important because this cohort is routinely in IRFs nationwide; thus, occupational therapists need to better understand treatment options that work for these patients. This study directly impacts the profession of occupational therapy.
