In patients with stroke, unilateral neglect is a predictor for poor independency and quality of life. Current therapies are lacking a progression based on clear criteria. We developed a criterion based system with an assessment and intervention package, in which we are matching interventions to specific neglect related deficits and behaviours.
Participants were assessed with the Catherine Bergego Scale to identify whether problems are mainly in the personal space, e.g. problems with shaving, in the peripersonal space, e.g. not eating food on the neglected side of the plate, or in the extra personal space, e.g. not reacting to persons standing on the neglected side.
Visual or tactile scanning in the personal space:
For this intervention a vest is firmly attached to the patient’s body to assure that the training is conducted in the personal space. A thick red line is visible and sensible on the left lateral border of the vest. Velcro straps are placed horizontally on the vest. Objects with different textures and shapes are arranged on the vest.
Visual or tactile scanning and trunk rotation in the peripersonal space:
Patients are sitting or standing in front of a custom-made training table with objects within reaching distance. In addition to the scanning training the patients are encourage to use trunk rotation to the left side to find the anchor point.
Visual scanning and trunk rotation in the extrapersonal space:
Patients are sitting or standing in front of a 2 x 3 m screen that is outside the reaching distance. A laser pointer is attached to the patient’s chest. At the start the patients have to move the pointer to the anchor line on the left side. This is accomplished by a trunk rotation between 15 and 35°.
We tested the intervention during two years in a rehabilitation clinic with a feasibility study. Based on this feasibility study the assessment and intervention package could be improved and its efficacy can now be tested in a larger randomised controlled trial.