Frontal lesions predict response to prism adaptation treatment in spatial neglect: A randomised controlled study.
Kelly M Goedert, Peii Chen, Anne L Foundas and 1 others
PMID 29558241WHAT IT FOUND
Prism adaptation improved daily functional neglect only in stroke patients with frontal lesions.
Those without frontal lesions saw no benefit over standard care. Paper-and-pencil tests missed this difference entirely. Use functional observation to guide treatment selection.
Key findings
01Patients with frontal lesions who received prism adaptation showed significant improvement in functional neglect scores, whereas those without frontal lesions did not improve beyond standard care.
02The improvement in functional neglect for patients with frontal lesions was driven by the treatment itself, as control patients with frontal lesions recovered similarly to untreated patients without frontal lesions.
03Paper-and-pencil neglect measures showed overall improvement over time but failed to detect any difference between the prism and control groups or between lesion types.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was very small, with only 17 participants analysed, making the results fragile and susceptible to individual outliers. The control group received standard care rather than a placebo, so it is unclear if the prism effect is due to the lenses themselves or the additional attention and time spent with a therapist. The benefit was seen on functional tasks but not on standard paper-and-pencil tests, raising questions about how to best measure success in clinical practice. Drop-out rates prevented analysis of long-term follow-up beyond six weeks, so it is unknown if the gains persist. The apparent benefit in the control group without frontal lesions disappeared when a single outlier was removed, suggesting no true spontaneous recovery advantage in that subgroup.
Declared interests
Authors Chen and Barrett are employees of the Kessler Foundation and report scientific funding. Other authors report no conflicts.
The easy way to misread this
Do not assume prism adaptation works for all neglect patients. The benefit was restricted to those with frontal lesions, and the study was small enough that a single patient skewed the control group results. Also, standard paper-and-pencil tests failed to detect the functional gains seen in the treatment group, so do not use them alone to judge whether the treatment is working.