Please select the eligibility criteria that correspond to the clinical trial below.
Title: Virtual Reality Attention Training in Stroke Patients
Brief Summary: Hemispatial neglect is a post-stroke condition in which patients fail to detect stimuli presented on the side of space opposite to the damaged brain hemisphere (contralesional space). To date, there is no established effective treatment for this condition. A virtual reality (VR) behavioral training for the attention deficits characteristic of patients with hemispatial neglect was developed. Patients are stimulated in the visual and auditory modality to orient towards the contralesional side and are rewarded for detecting targets on this side in this training. In the current study the researchers aim to answer two main questions: 1) how feasible is a VR game-based intervention in stroke patients? and 2) what is the efficacy of the virtual reality game-based intervention in reducing the attention deficits characteristic of hemispatial neglect? To answer these questions a randomized partially double-blind placebo-controlled crossover study will be conducted. Two within-subject conditions will be compared: in the active condition patients will play a VR game in which multisensory stimulation is progressively presented in the neglected region (the location where previously presented targets were missed by the patient) and in the placebo condition patients will play a VR game in which the stimulation is presented in the center of of the VR environment. Neglect symptoms will be measured on a two-daily basis to establish the trend of symptom recovery through time. The hypothesis states that symptoms will recover more quickly when patients receive the active version of the VR intervention compared to the placebo version of the VR intervention.


Options:
A: Inclusion Criteria:

* Ischemic or hemorrhagic stroke 3 months post stroke.
* Fugl-Meyer Upper Extremity (FMA-Upper Extremity) score between 20-56/60
* Inducible motor evoked potential (MEP) of the abductor pollicis brevis (APB) on the paretic stimulation (TMS)
* Demonstrate the presence of unilateral neglect (Virtual Reality Lateralized Attention Test score \<18)

Exclusion Criteria:

* History of cortical hemorrhagic stroke
* Presence of any MRI, TMS, tDCS risk factors including:

  * history of seizures
  * history of brain tumor
  * hardware in skull or spine (e.g. coils, clips)
  * implantable medical device (e.g. pacemaker)
  * metal in body (not compatible with MRI)
  * pregnancy
* Severe spasticity (Modified Ashworth Scale score 3)
* Severe aphasia or cognitive impairment limiting participants' comprehension (National Institutes of Health Stroke Scale Level of Consciousness Commands Item score 1 or Best Language Item score 2)
* Unable to travel to UE Motor Function Laboratory at the Center for Rehabilitation Research in Neurological Conditions (a collaborative, MOU approved, research center Ralph H. Johnson VA Medical Center and the Medical University of South Carolina) for the study
B: Inclusion Criteria:

* They are above 18 years.
* They have had a stroke.

Exclusion Criteria:

* They or their legal representative are unable to provide informed consent.
* They have a severe comorbid psychiatric (E.g. psychotic symptoms) disorder.
* They have a premorbid neurodegenerative disease (E.g. Alzheimer's dementia, vascular dementia).
* They have severe written language comprehension deficits.
* They have a medical implant, such as a cochlear implant or a pacemaker.
* They have a severe visual or auditory impairment that cannot be corrected for by wearing glasses or a hearing aid while wearing the Oculus Rift headset.
* They are unable to concentrate on a task for more than 15 minutes or are unable to complete a task according to simple task instructions.
* They have a history of epileptic seizures.
* They do not show signs of a spatial asymmetry in performance on a battery of screening tasks.
* The expected discharge of patients is in a period shorter than 7 weeks.
C: Inclusion Criteria:

* 18 years old or older
* demonstrated visual/spatial neglect, as demonstrated by NIH Stroke Scale (NIHSS) and deficits in assessing tactile extinction and visuospatial neglect done on admission.

Exclusion Criteria:

* severe pain or skin disease at the posterior neck
* severe atherosclerosis of carotid arteries by an ultrasonic evaluation
D: Inclusion Criteria:

* The subject is 18 to 100 years of age, inclusive.
* The subject has had a stroke on the right side of the brain.
* The subject is able to give Informed consent.
* The subject has a spatial neglect (if known).
* The subject is able and willing to comply with the study protocol, including availability for all scheduled clinic visits.

Exclusion Criteria:

* The subject has or had a serious brain condition other than stroke.

Answer: B