“The future’s so bright, I gotta wear shades” boasted American indie rock band Timbuk3 in 1986. And a new study backs up the link between funky eyewear and a brighter future for patients suffering from spatial neglect on one side of the body. The study paired Prism Adaptation therapy, which uses prismatic goggles, with Ritalin to achieve lasting benefits. If you’re a stroke patient suffering from neglect, you should talk to your therapy team about deploying this one-two punch.
Neglect is a condition in which stroke patients have problems processing sensory information from one side of the body. Essentially, patients are short an eye and an ear and usually not aware of how much they’re missing. This leaves them vulnerable to hazards coming from the affected side. Neglect has few proven treatments and a strongly negative impact on patient independence.
A Franco-Swiss research team working at multiple institutions analyzed a pool of 21 patients randomly divided into two groups. One group of 13 patients received Ritalin along with Prism Adaptation (PA) therapy. The other group of eight patients received a placebo along with PA therapy. Patients had four sessions of PA therapy on consecutive days and continued taking Ritalin or placebo until the end of therapy.
PA therapy begins with an unaided visual task, usually pointing at a target. The patients then put on prismatic glasses that displace the visual field (in this study, 10 degrees right). The patients then perform more pointing tasks while wearing the glasses. Finally, patients remove the glasses and continue the pointing activities for a brief time. The idea is to stimulate the brain into reintegrating the neglected sensory data. Patients were tested before therapy, at the end of therapy, and then 30 days after the end.
Prism therapy has been around for a few years, as this video shows.
Ritalin group patients had much better long-term neglect improvement than placebo group patients. Researchers believe that is because the combination of therapies addresses all or most of the patients’ neglect issues simultaneously. PA therapy helps the patients’ visual neglect, while Ritalin helps with non-visual neglect and increases patient focus.
While this topic requires further research, this combined approach shows a lot of promise. And patients reported no serious side effects. Strengths of the study include the use of placebos, random patient assignment, and cross-institution data collection and analysis. One weakness of the study is the relatively small sample size. Note that the study also doesn’t try to discern how much benefit was due to either of the therapies.
The first author of the original article was Jacques Luauté, MD, PhD, Integrative, Multisensory, Perception, Action and Cognition Team, Lyon Neuroscience Research Center, Université de Lyon, France.