Combined effects of sensory cueing and limb activation on unilateral neglect in subacute left hemiplegic stroke patients: a randomized controlled pilot study.

OBJECTIVE: To compare the effects of contralesional sensory cueing and limb activation with that of sham control in the treatment of unilateral neglect after stroke. DESIGN: A randomized, single-blinded, sham-controlled pilot study. SETTING: Two rehabilitation hospitals. SUBJECTS: Forty subacute left hemiplegic stroke inpatients with unilateral neglect. INTERVENTIONS: Participants were assigned randomly to 1 of 2 groups. The experimental group wore a wristwatch cueing device over the hemiplegic arm for three hours a day, five days per week, for three weeks, and also underwent conventional rehabilitation. Patients were encouraged to move their hemiplegic arm five consecutive times after each prompt. The sham group underwent the same rehabilitation process, except they wore a sham device. MAIN MEASURES: Neglect, arm motor performance, and overall functioning were assessed pre- and posttraining, and at follow-up. RESULTS: There were no significant differences between groups in outcome measures except the neglect drawing tasks (p = 0.034) (the mean gain score from baseline to follow-up assessment was 5.2 (3.7) in the experimental group and 1.9 (3.5) in the sham group), across three time intervals. The experimental group showed greater improvement in arm motor performance than did the sham group. CONCLUSION: The results did not confirm that sensory cueing and limb activation treatment is effective when compared with those receiving placebo to reduce unilateral neglect, but it might be useful for promoting hemiplegic arm performance in stroke patients.

Measuring processing speed after traumatic brain injury in the outpatient clinic.

OBJECTIVES: To evaluate processing speed performance in outpatients with moderate-to-severe traumatic brain injury (TBI). DESIGN: Prospective cross-sectional observational study. PARTICIPANTS: Twenty outpatients with traumatic brain injury (TBI) were compared with 20 matched healthy subjects. MEASURE: Measurement by six instruments in the domains of simple reaction time (SRT), movement time (MT), and mental processing speed at a single time occasion. RESULTS: Significant differences were found in speed but not accuracy of work between outpatients with TBI and healthy subjects. Simple reaction time was sensitive to predicting patients with moderate-to-severe TBI as opposed to healthy counterparts. CONCLUSION: Outpatient clinics should consider measuring SRT.

The effect of voluntary trunk rotation and half-field eye-patching for patients with unilateral neglect in stroke: a randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of voluntary trunk rotation and half-field eye-patching to treat patients with unilateral neglect in stroke. DESIGN: Pre-post, day 60 follow-up, single-blinded randomized controlled trial. SETTING: Single-centre inpatient rehabilitation hospital. SUBJECTS: Sixty subacute patients with right hemisphere stroke having unilateral neglect within eight weeks post stroke consented to participate between November 2003 and July 2005. They were randomly assigned to three comparison groups. INTERVENTIONS: Nineteen patients received daily experimental training in voluntary trunk rotation (TR) for 1 hour five times a week for 30 days. Twenty patients received the same kind of treatment together with half-field eye-patching (TR + EP). Fifteen patients in the control group received conventional training with the same contact time. MAIN OUTCOME MEASURES: Patients were assessed on days 0, 30 and 60 using the Behavioural Inattention Test, the Clock Drawing Test, and the Functional Independence Measure. RESULTS: No significant differences between voluntary trunk rotation (TR), voluntary trunk rotation and half-field eye-patching (TR + EP) and controls were found in functional performance and neglect measures at day 30 (P = 0.042-0.994) and follow-up (P = 0.052-0.911) at P = 0.005 using Bonferroni correction. CONCLUSIONS: The results of this study do not support the use of voluntary trunk rotation alone or with half-field eye-patching to improve functional performance or reduce unilateral neglect in subacute patients with stroke.