Active Cue-Training in Neglect

Study Overview
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Brief Summary
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The presented study investigates standardized visual cueing in reading and visual spatial task as a treatment method for spatial neglect. In a randomized controlled design patients receive either cued reading and visual spatial tasks (intervention) or treatment which is unspecific to neglect (control). In the intervention condition, patients with left-sided neglect receive intense training, including reading and visual spatial task with standardized and adapted visual cueing by the therapist. Improvements in reading and visual spatial tasks lead to a reduction of cues by the therapist. Accordingly, the patient has to apply self-cueing over time in order to solve the task. For the control condition, all patients receive unspecific treatment without any standardized adapted cueing implemented by the therapist. To enhance the effectivity of cueing in reading and visual spatial tasks, the investigators additionally conduct parietal transcranial direct current stimulation (tDCS) in those patients without tDCS exclusion criteria (see exclusion criteria below). It is hypothesised that systematic and adaptive therapeutic cueing leads to a significant reduction of omissions of word and word parts in reading. UPDATE: No Add-on tDCS was performed since it was not applicable for our severly impaired patients due to the strict exclusion criteria of tDCS.

Official Title
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Active Cue-Training in Neglect

Conditions
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Hemispatial Neglect

Intervention / Treatment
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* Behavioral: Cueing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Left sided neglect Capacity of at least 30 minutes Ability to read in German language Mobilization of 80% Exclusion Criteria: Previous known dementia Normal pressure hydrocephalus Exclusion Criteria for tDCS Add-on (not exclusion of the intervention): Shunt Craniectomy Epilepsy Other metal implants
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
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>adaptive, therapeutic cueing during reading tasks adaptive, therapeutic cueing during visuo spatial tasks | Behavioral: Cueing<br> <br> |
| No Intervention: Control<br>- unspecific neglect treatment | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in word and word-part omissions in standardized reading of text and word list | the patient has to read a standardized text of 55 words and a word list of 13 words. Omissions of the complete word and/or of a word part are counted. | Primary Outcome Measure is assessed two times in the first week (3 days in between), after week 4, after week 7, after week 8 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in standardized evaluation of the body posture | A blinded neurologist evaluates spontaneous and cued body posture (head, eyes, trunk) for ipsilesional, moderate ipsilesional or no deviation. | Secondary Outcome Measure is assessed two times in the first week (3 days in between), after week 4, after week 7, after week 8 | 
| Change in Apples Cancellation Task | a standardized measurement for the evaluation of egocentric and allocentric neglect symptoms | Secondary Outcome Measure is assessed two times in the first week (3 days in between), after week 4, after week 7, after week 8 | 
| Change in activities of daily living using the Catherine Bergego Scale | The blinded hospital staff evaluates activities of daily living by using the Catherine Bergego scale with specified scoring criteria | Secondary Outcome Measure is assessed after week 1, after week 4, after week 7, after week 8 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hemispatial Neglect, cueing, egocentric-allocentric, early rehabilitation, parietal tDCS