Neurobiomarker for Prism Adaptation Treatment Response

Study Overview
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Brief Summary
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Preliminary data will be collected about which individuals with spatial neglect from right hemisphere stroke (aiming vs perceptual neglect) improve with Prism Adaptation Training and if there is a particular pattern of damage in the brain that predicts both the type of neglect experienced and whether neglect is improved following Prism Adaptation Training

Detailed Description
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For preliminary data, twelve individuals with right hemisphere stroke and spatial neglect will participate. After pretesting for type of neglect and its severity, they will have an MRI with Diffusion Tensor Imaging (DTI). Then they will complete 10 sessions of Prism Adaptation Therapy and complete neglect post-testing. Response to Prism Adaptation Therapy will be assessed by comparing neglect scores pre- and post-training. Traditional lesion mapping, structural and functional lesion disconnectivity analyses, and tract-based spatial statistics of DTI measures will be used to examine whether any patterns of damage/dysfunction are related to a diagnosis of aiming neglect and response to Prism Adaptation Therapy.

Official Title
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Development of a Neuroimaging Biomarker to Identify Optimal Candidates for Prism Adaptation Treatment

Conditions
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Perceptual Disorders, Stroke, Biomarker

Intervention / Treatment
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* Behavioral: Prism Adaptation Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1) within 1 month of right hemisphere stroke 2) suspected of having unilateral spatial neglect 3) able to provide consent 4) likely to remain in rehabilitation for 10-12 days or willing to return to the University to complete 10 sessions of treatment and post-treatment testing 5) able to have an MRI 6) will be or has been admitted to the Craig H. Neilson Rehabilitation Hospital for rehabilitation or is able to come to the Craig H. Neilson Rehabilitation Hospital for prism adaptation therapy sessions. 7) age 18-90 years 8) able to sit in a wheelchair or other chair for 1 hour 9) able to point straight ahead and hold a pen with right hand Exclusion Criteria: 1) other neurologic, medical that would interfere with ability to complete the testing or training 2) no uncorrected visual or hearing problems, other than hemianopsia 3) contraindications to MRI 4) unable to provide consent due to significant aphasia or cognitive impairment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: a single group pre-post pilot study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Prism Adaptation Therapy<br>10 sessions (60 trials each) 1x/day of Prism Adaptation Therapy | Behavioral: Prism Adaptation Therapy<br>* Participants wear goggles with built-in prisms (a 20-diopter lens) that shift the visual scene to the right. While wearing the googles they reach to and cross out 60 lines/circles, requiring them to learn to reach more leftward than the visual targets appear. Participants can only see the end of their movements.<br>* Other names: PAT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Catherine Bergego Scale | asks the impact of neglect behavior on 20 everyday tasks using a 0-3 rating scale. Higher scores = more neglect impact. Total score is sum of item scores | baseline before prism adaptation therapy | 
| Catherine Bergego Scale | asks the impact of neglect behavior on 20 everyday tasks using a 0-3 rating scale. Higher scores = more neglect impact. Total score is sum of item scores | post-intervention immediately after prism adaptation therapy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Behavioral Attention Test conventional subtests | traditional neuropsychological subtests (line crossing, letter cancelation, star cancellation, figure and shape copying, line bisection, and representational drawing). Total score is the sum of scores on subtests with highest score being 146. A score of 129 or higher indicates neglect | baseline pre-prism adaptation therapy | 
| Behavioral Attention Test conventional subtests | traditional neuropsychological subtests (line crossing, letter cancelation, star cancellation, figure and shape copying, line bisection, and representational drawing). Total score is the sum of scores on subtests with highest score being 146. A score of 129 or higher indicates neglect | post-intervention immediately after prism adaptation therapy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stroke, Prism Adaptation Therapy, spatial neglect