Developmental Clinical Studies - Does Repeated Vestibular Stimulation Induce Lasting Recovery From Hemi-Spatial Neglect?

这项研究将为半空间忽视提供一种新的治疗方法。这是一种注意力障碍，通常在中风后出现，导致患者表现得好像他们的视觉世界的一半消失了。症状包括撞到物体，把食物留在盘子的一边，以及没有注意到受影响一侧的人。除了这些使人衰弱的影响外，这种情况还强烈预测了个体从中风的其他症状中恢复的速度。许多在入院时表现出半侧空间忽视的人在多年后仍然在日常生活中挣扎。目前的治疗几乎没有缓解。我们的新方法包括通过耳朵后面的头皮部分传递微小的电流。电流太小，不会引起不适，但会刺激从内耳到大脑受损部位的神经通路。与目前需要专业人员和空间的治疗不同，刺激可以由没有技术专长的护士在床边施加，并且可以在任何时间对患者方便。更重要的是，该设备可以便宜地安装在家中供个人使用，减少住院时间并节省前往诊所的需要。我们治疗的一个主要缺点是，一旦停止刺激，有益的效果就会消失。我们需要找到一种方法来触发持续更长时间的效果。其他种类的神经刺激在5-10天内重复应用时最有效，可诱导中风幸存者持续数周的收益。我们自己的试验数据，尽管非常初步，表明同样的模式适用于这里描述的新技术。现在需要一个更大的、适当控制的研究来证实这一观察结果。令人信服的是，其他类型的神经残疾，包括痴呆症的方面，也在前庭刺激过程中消退，所以如果持久的恢复在这里显示，那么其他类型的患者也可能受益。我们计划从东肯特神经康复服务中心招募60名患有半侧空间忽视的患者，接受10天的刺激，然后在几周后进行几次随访。这些随访将告诉我们是否发生了持久的改善，使我们能够确定该技术是否可能与康复实践有关。如果是这样的话，那么我们将开始进一步的试验与微型设备，目前正在进行验证的下游医药合作者。

The research will pilot a new treatment for hemi-spatial neglect. This is an attentional disorder that commonly arises after stroke, causing sufferers to act as if one half of their visual world is missing. Symptoms include bumping into objects, leaving food on one side of the plate, and failing to notice people on the affected side. Aside from these debilitating effects, the condition strongly predicts the rate at which individuals recover from the other symptoms of stroke. Many individuals who show hemi-spatial neglect at hospital admission still struggle with daily routine years later. The current treatment provides little relief. Our new approach involves passing tiny electrical currents through the part of the scalp that lies just behind the ears. The currents are too small to cause discomfort, but stimulate nerve pathways that project from the inner ear to those parts of the brain that are damaged. Unlike the current treatment which requires specialist staff and space, stimulation can be applied by a nurse at bedside with no technical expertise and at whatever time is convenient for the patient. More so, the apparatus can be cheaply miniaturised for personal use at home, reducing hospital stay and saving on the need to travel to clinic. A major drawback of our treatment is that the beneficial effects disappear as soon as stimulation is stopped. We need to find a way of triggering effects that last for much longer. Other kinds of neuro-stimulation are most effective when repeatedly applied across 5-10 days, inducing gains in stroke survivors that last for many weeks. Our own pilot data, albeit very preliminary, suggests that the same pattern holds for the new technique described here. A larger, properly controlled study is now needed to confirm this observation. Compellingly, other types of neuro-disability including aspects of dementia also recede during vestibular stimulation, so if lasting recovery is shown here then other types of patient might also be expected to benefit. We plan to recruit 60 individuals with hemi-spatial neglect from the East Kent Neuro-Rehabilitation Service to receive both 10 days of stimulation and then several follow-up sessions a few weeks later. These follow-ups will tell us whether lasting improvement has occurred, enabling us to determine if the technique might be relevant to rehabilitative practice. If so, then we will begin further trials with a miniature device that is currently undergoing validation by a downstream commerical collaborator.