Spatial neglect treatment: The brain's spatial-motor Aiming systems.
A M Barrett, Kelly M Goedert, Alexandre R Carter and 1 others
PMID 33941021WHAT IT FOUND
Patients with 'Aiming' spatial neglect (movement initiation deficits) improved on functional tasks with bromocriptine or prism adaptation.
Those with 'Where' deficits (perceptual/attentional) did not. Standard paper-and-pencil tests miss this distinction, potentially hiding treatment responders.
Key findings
01Stroke survivors with Aiming spatial neglect showed significant functional improvement on the Catherine Bergego Scale after 7 weeks of bromocriptine, while those with Where deficits did not.
02Patients with frontal lobe lesions and Aiming spatial neglect responded better to prism adaptation therapy than those without these features.
03Standard paper-and-pencil assessments like the Behavioral Inattention Test often fail to detect Aiming spatial neglect, which requires motor-intentional measures or functional scales like the Catherine Bergego Scale.
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 preliminary study had only 10 participants, making the results highly unstable and not generalizable. There was no control group or placebo in the bromocriptine study, so spontaneous recovery cannot be ruled out. The study did not adjust for confounders like depression, age, or other medications. The review relies heavily on the authors' own prior work, which may introduce bias. The distinction between 'Where' and 'Aiming' neglect is not yet standard in clinical guidelines, so implementation requires new assessment protocols.
Declared interests
The authors report no relevant scientific or financial conflicts of interest.
The easy way to misread this
Do not prescribe bromocriptine or assume all neglect patients will respond to prism adaptation. The bromocriptine results are from a tiny, uncontrolled study of 10 people and are not clinical evidence. Additionally, standard paper-and-pencil tests may miss Aiming neglect, so a 'normal' score does not rule out motor-intentional deficits that need different treatment.