Authors: Wenman R.¹; Bowen A.¹; Tallis R.C.¹; Gardener E.²; Cross S.²; Niven D.³

Source: Neuropsychological Rehabilitation, Volume 13, Number 4, September 2003 , pp. 441-459(19)

Publisher: Psychology Press, part of the Taylor & Francis Group

Abstract:

Unilateral spatial neglect is a disabling disorder, or set of disorders, that commonly occurs after stroke. Previous research suggests that tactile stimulation may reduce neglect, albeit temporarily. This study evaluated the effectiveness of a therapy package combining stimulation of the affected hand and the behavioural technique of self-instructional training. A randomised single case design, consisting of 12 phases (six treatment and six no treatment) administered in a random order, was used. Two research participants were assessed three times per phase using measures of impairment and activity. Analyses were by visual inspection, fitting linear regression lines to each phase and t test comparisons of these slopes in the treatment and no treatment phases. Visual inspection showed (1) marked variability within a phase, and (2) positive slopes were not more likely for treatment than no treatment for either participant. There was no significant difference on t test between the mean treatment and no treatment slopes on impairment or activity level measures. This study did not demonstrate evidence of effectiveness of the new therapy for neglect. Compliance by participants was poor indicating low acceptability of the therapy regime. Despite the results from these two participants, the study raises important methodological issues for practising clinicians and researchers. Clinical randomised single case designs have difficulties as well as advantages when used with a condition as variable as neglect. Despite this, these designs and the analysis of differential recovery rates warrant further investigation, and could be used to determine the effectiveness of therapy for other post-stroke cognitive impairments.

Document Type: Research article

DOI: http://dx.doi.org/10.1080/09602010343000048

Affiliations: 1: University of Manchester, UK 2: Salford Royal Hospitals NHS Trust, UK 3: University of Salford, UK

Publication date: 2003-09-01

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