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Top Stroke Rehabil. 2018 May;25(4):305-311. doi: 10.1080/10749357.2018.1437937. Epub 2018 Feb 19.

The feasibility and effectiveness of using prism adaptation to treat motor and spatial dysfunction in stroke survivors with multiple incidents of stroke.

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a Rehabilitation Medicine , University of Washington , Seattle , WA , USA.
c Movement Science , Teachers College, Columbia University , New York City , USA.
d Occupational Therapy , Kessler Institute for Rehabilitation , West Orange , USA.
b Occupational Therapy , Columbia University , New York City , USA.


Background Strokes resulting in cognitive and motor problems can be debilitating and prolong recovery. Risk of a second stroke occurs for 40% of all first-time stroke survivors within five years. Prism adaptation treatment (PAT) may simultaneously improve functions of both spatial and motor systems. This has not been studied with a cohort comprised of multiple strokes nor measured change using specific motor outcomes. Objectives To determine the feasibility and effectiveness of using PAT to improve spatial and motor functions in stroke survivors with multiple strokes. Method A prospective intervention with retrospective comparison. Thirteen participants from an inpatient rehabilitation facility (IRF) comprised the treatment group; 13 others who only received standard care comprised the comparison group. Treatment group tested on: 4 motor and 3 spatial outcome measures before and after the 10 PAT sessions. The comparison group tested on: 1 motor and 3 spatial measures before and after standard care. Results Thirteen participants successfully completed the PAT. Both groups improved on measures of spatial neglect over time (p < .001), but the treatment group showed greater improvement on two subtests of spatial function (Behavior inattention test) (p = .001 & p = .002). Similarly, both groups improved in motor function (Functional independence measure) (p < .001), although the treatment group's improvement was not statistically significant against the comparison group (p = .853). Conclusion PAT is a feasible treatment for stroke survivors with multiple strokes. PAT did improve spatial neglect function more than standard care, only at one level of analysis of standard paper and pencil measures. Further research is necessary.


Stroke; motor outcomes; prism adaptation treatment; spatial neglect; upper extremity

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