Prism Adaptation in Rehabilitation? No Additional Effects of Prism Adaptation on Neglect Recovery in the Subacute Phase Poststroke: A Randomized Controlled Trial
Prism Adaptation in Rehabilitation? No Additional Effects of Prism Adaptation on Neglect Recovery in the Subacute Phase Poststroke: A Randomized Controlled Trial
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DOI：
10.1177/1545968317744277
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发表时间：
2017-12-01
影响因子：
4.2
通讯作者：
Nijboer, Tanja C. W.
中科院分区：
文献类型：
--
作者：
Ten Brink, Antonia F.;Visser-Meily, Johanna M. A.;Nijboer, Tanja C. W.
背景忽视患者忽视或反应较慢，对病灶的刺激。神经性痴呆对日常生活活动（ADL）的独立性有负面影响。棱镜适应（PA）是最常研究的治疗方法之一，但很少有证据表明对ADL中的忽视行为有积极影响。Objective.评估在不同复杂程度的情况下，亚急性期的PA是否改善忽视。方法.共有70名住院脑卒中康复的忽视患者接受了为期2周的PA或假适应（SA），并完全接受标准治疗。有7个时间依赖性测量值（基线和治疗开始后1-4、6和14周）。主要结果是在Catherine Bergego量表（CBS）的基础ADL期间观察到的忽视变化。次要结局是动态多任务（即，移动性评估课程[MAC]）和静态纸笔任务（即，形状取消任务[SC]）的性能变化。结果共34例患者接受PA和35例SA。通过CBS、MAC和SC测量，表现有显著的时间依赖性改善（所有F > 15.57; P <0.001）。两组CBS、MAC和SC的改善程度无显著差异（均F < 2.54; P > 0.113）。结论.在卒中后亚急性期，PA与SA相比没有观察到有益的影响，这在不同复杂性的情况下是相当的。并对证候的异质性、发病时间、治疗内容等进行了讨论。关于亚型和恢复模式的基本知识将有助于制定有针对性的治疗。
Background. Patients with neglect ignore or respond slower to contralesional stimuli. Neglect negatively influences independence in activities of daily living (ADL). Prism adaptation (PA) is one of the most frequently studied treatments, yet there is little evidence regarding positive effects on neglect behavior in ADL. Objective. To assess whether PA in the subacute phase ameliorates neglect in situations of varying complexity. Methods. A total of 70 neglect patients admitted for inpatient stroke rehabilitation received either PA or sham adaptation (SA) for 2 weeks, with full access to standard treatment. There were 7 time-dependent measurements (baseline and 1-4, 6, and 14 weeks after start of treatment). The primary outcome was change of neglect as observed during basic ADL with the Catherine Bergego Scale (CBS). Secondary outcomes were changes in performance on a dynamic multitask (ie, the Mobility Assessment Course [MAC]) and a static paper-and-pencil task (ie, a shape cancellation task [SC]). Results. In all, 34 patients received PA and 35 SA. There were significant time-dependent improvements in performance as measured with the CBS, MAC, and SC (all F > 15.57; P < .001). There was no significant difference in magnitude of improvement between groups on the CBS, MAC, and SC (all F < 2.54; P > .113]. Conclusions. No beneficial effects of PA over SA in the subacute phase poststroke were observed, which was comparable for situations of varying complexity. Heterogeneity of the syndrome, time post-stroke onset, and the content of treatment as usual are discussed. Basic knowledge on subtypes and recovery patterns would aid the development of tailored treatment.