Stroke. 2014 August
Reviewed by Lindsay Wettergreen, OD; Southern College of Optometry
Spatial neglect is a common consequence for patients who have experienced a stroke in the right hemisphere. Some cases of spatial neglect resolve spontaneously within days, while other cases can last much longer. This study evaluated the effects of hemifield eye patching (HEP) and repetitive optokinetic stimulation (OKS) on the degree and speed of resolution of spatial neglect in acute stroke victims.
Subjects consisted of twenty-one patients who were admitted to the stroke unit at University Hospital Schleswig-Holstein, Lubeck, Germany following acute (<14 days) right hemisphere stroke. They were evaluated bedside for neglect by the following tests: Line bisection, Star cancellation, Text reading, Bells cancellation and Ogden figure copying task. They had to show pathological performance on two of the tests in order to be considered for the study. Patients were then divided into a treatment group and a control group. Control patients received usual stroke care provided by the hospital while the treatment group received HEP and OKS treatment in addition to usual stroke care. HEP was initiated by applying dark non-translucent tape to the right half of a non-corrective lenses. Patients were instructed to wear the glasses all-day for one week and only remove them for the OKS treatment sessions. The OKS therapy consisted of an 18.4” notebook monitor that contained seventy colored geometric objects moving right to left at varying speeds from 8-12 degrees/second. Sessions were performed bedside daily for 15 minutes each. Assessments were performed at baseline (day 1), post treatment (day 8) and follow-up (day 30). Patients were evaluated on mean performance (accuracy) in the neuropsychological tests and on neglect-related functional disability measured by the Catherine Bergego Scale.
Results showed that both the treatment (P<0.001) and control (P<0.05) group improved similarly between baseline and post treatment (day 8). There was additional improvement from post treatment (day 8) and follow-up (day 30) in the treatment group (P<0.01) and stable effects in the control group (P>0.05). Functional disability measures from the Catherin Bergego Scale showed an equal decrease from post treatment to follow-up for both the treatment (P<0.01) and control (P<0.01) group. Separate primary outcome analyses of each individual patient were performed and showed that there was significant improvement in individual patients, despite their allocated group.
Overall this study showed that patients in both groups made improvements in neuropsychological test performance and neglect related functional disability over the 30-day period. Therefore, early intervention of combined HEP & OKS therapy has no additive effect to the spontaneous remission of spatial neglect secondary to right hemisphere stroke. It is important to remember that all patients in this study received customary acute stroke care provided by the hospital including physio-, speech and occupational therapy. These therapies should continue to be initiated early in post-stroke care without the need for additional neglect-specific therapy. The results of this study should not be generalized to chronic neglect patients who may show beneficial effects from neglect-specific therapeutic activities.