Search

Supplemental material, sj-docx-4-cre-10.1177_02692155221134060 for A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial by Verity Longley, Kate Woodward-Nutt, Ailie J. Turton, Katie Stocking, Matthew Checketts, Ann Bamford, Emma Douglass, Julie Taylor, Julie Woodley, Pam Moule, Andy Vail and Audrey Bowen in Clinical Rehabilitation

Supplemental material, sj-docx-2-cre-10.1177_02692155221134060 for A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial by Verity Longley, Kate Woodward-Nutt, Ailie J. Turton, Katie Stocking, Matthew Checketts, Ann Bamford, Emma Douglass, Julie Taylor, Julie Woodley, Pam Moule, Andy Vail and Audrey Bowen in Clinical Rehabilitation

Supplemental material, sj-docx-3-cre-10.1177_02692155221134060 for A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial by Verity Longley, Kate Woodward-Nutt, Ailie J. Turton, Katie Stocking, Matthew Checketts, Ann Bamford, Emma Douglass, Julie Taylor, Julie Woodley, Pam Moule, Andy Vail and Audrey Bowen in Clinical Rehabilitation

Supplemental material, sj-doc-1-cre-10.1177_02692155221134060 for A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial by Verity Longley, Kate Woodward-Nutt, Ailie J. Turton, Katie Stocking, Matthew Checketts, Ann Bamford, Emma Douglass, Julie Taylor, Julie Woodley, Pam Moule, Andy Vail and Audrey Bowen in Clinical Rehabilitation

Several recent studies have reported non-linear effects of transcranial direct current stimulation (tDCS), which has been attributed to an interaction between the stimulation parameters (e.g., current strength, duration) and the neural state of the cortex being stimulated (e.g., indexed by baseline performance ability, age) (see Fertonani and Miniussi, 2016). We have recently described one such non-linear interaction between current strength and baseline performance on a visuospatial attention (landmark) task (Benwell et al., 2015). In this previous study, we induced a small overall rightward shift of spatial attention across 38 participants using bi-hemispheric tDCS applied for 20 min (concurrent left posterior parietal (P5) anode and right posterior parietal (P6) cathode) relative to a sham protocol. Importantly, this shift in bias was driven by a state-dependent interaction between current intensity and the discrimination sensitivity of the participant at baseline (pre-stimulation) for the landmark task. Individuals with high discrimination sensitivity (HDS) shifted rightward in response to low- (1 mA) but not high-intensity (2 mA) tDCS, whereas individuals with low discrimination sensitivity (LDS) shifted rightward with high- but not low-intensity stimulation. However, in Benwell et al. (2015) current strength was applied as a between-groups factor, where half of the participants received 1 mA and half received 2 mA tDCS, thus we were unable to compare high and low-intensity tDCS directly within each individual. Here we aimed to replicate these findings using a within-group design. Thirty young adults received 15 min of 1 and 2 mA tDCS, and a sham protocol, each on different days, to test the concept of an interaction between baseline performance and current strength. We found no overall rightward shift of spatial attention with either current strength, and no interaction between performance and current strength. These results provide further evidence of low replicability of non-invasive brain stimulation protocols, and the need for further attempts to replicate the key experimental findings within this field.

IntroductionUnilateral spatial neglect (inattention of contralesional space) is a disabling syndrome that often follows stroke. Identifying neglect is an important step for clinicians before formulating a clinical care plan. There is no universally-agreed standard for diagnosis and no universally-agreed operational definition of neglect for guidance. As a first step to achieving consensus we began with an international survey of stroke cliniciansu2019 current use of neglect assessments.MethodUsing an online survey, we targeted international clinicians with current experience in screening/diagnosing neglect. We distributed the survey via professional bodies and networks representing various specialities. We asked respondents to indicate their use of neglect assessments categorised as cognitive, functional, and neurological, whether these choices were guided by professional choice or institutional policy, and also invited further suggestions and comments. ResultsThe survey attracted 454 responses from 12 professional groups across 33 countries, predominantly occupational therapy (179), psychology (84), medicine (70) and physiotherapy (55) with most respondents from the UK (172), USA (99) and Italy (76). Respondents had a median of 120 months experience, typically worked exclusively in in-patient settings (50%) and saw more than one patient with neglect every two months (67%). Data cleaning is complete: quality is good with very little missing data. We are finalising analyses to examine the most frequently used assessments and explore potential differences in clinical practice e.g. between professions and countries. ConclusionResults from this inter-professional, international survey will form a useful starting point for consensus discussions regarding screening and diagnosing neglect.

Background and purpose Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time-limited clinical environments. Methods Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations. Results A total of 512 articles were screened, and 42 were included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copying, reading/writing, and behavioral. Cancellation tasks were most frequently used (97.6% of studies), followed by bisection, copying, behavioral, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying, and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, the literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible. Conclusions This study provides consensus recommendations for rapid bedside detection of neglect in real-world, clinical environments.