Prism Adaptation in Left Brain Stroke
Condition: Aphasia; Spatial Neglect; Stroke
MeSH terms: Stroke; Aphasia
Study type: Interventional

Summary: 
      Of the 15,000 Veterans who are hospitalized for stroke each year more than half experience
      spatial and motor impairments and pain. Spatial-motor-sensory problems limit functioning and
      independence, which is costly to Veterans, their families, and society. Currently,
      spatial-motor-sensory problems are targeted using different treatments. However, there is a
      treatment that has shown promise in simultaneously targeting spatial function, motor function
      and pain in right-brain stroke. The investigators propose to investigate the feasibility of
      using adapted spatial-motor sensory assessment and treatment procedures for Veterans with
      left-brain stroke who have language and cognitive impairment. The next step will be to
      conduct a large-scale study focused on this multi-target treatment for more efficient and
      effective stroke rehabilitation. The investigators expect this line of research to increase
      functioning, independence and quality of life in Veteran stroke survivors.
    

Detailed description: 
      The functional disability experienced by Veterans after stroke, and the limited
      rehabilitation resources available, highlight the importance of identifying feasible
      treatments acting on more than one recovery target. Currently, there are separate and
      modality-specific treatment pathways for cognitive and motor impairments. These
      modality-specific treatment pathways lead to fragmentation of care, and under-identification
      and under-treatment of invisible disabilities, such as spatial neglect, aphasia and pain. The
      result is longer hospital stays, greater risk of falls, and poor functional outcomes.
      Employing a treatment that simultaneously addresses multiple targets will ensure that the
      investigators provide the needed care for >50% of post-stroke Veterans who have both visible
      and invisible disabilities, during the critical post-acute period of recovery.

      Prism adaptation treatment (PAT) is a 10-day regimen reported to be inexpensive, replicable
      and effective for treatment of spatial neglect, and studies have demonstrated that it also
      enhances everyday activities and motor recovery and reduces chronic post-stroke pain in
      patients with right brain stroke. Additionally, brain mapping methods have shown that in
      patients with right brain stroke, those with frontal lesions respond optimally to PAT. No
      studies have investigated PAT in left-brain stroke patients with language and cognitive
      impairment. To address this research gap, the investigators will address the following aims:

      Aim 1: To demonstrate the feasibility of adapted PAT procedures in patients with aphasia and
      memory impairment. .

      Aim 2: To demonstrate the feasibility of adapted methods for assessing spatial and motor
      function and pain in patients with aphasia and memory impairment.

      Aim 3: To demonstrate the feasibility of using information about lesion location from the
      radiology report to classify frontal vs. nonfrontal lesions.
    

Intervention name(s): Prism Adaptation Treatment
Intervention type(s): Behavioral
Intervention description(s): Spatial retraining treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Multiple baseline, delayed treatment design
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: aphasia; spatial neglect; rehabilitation