Spatial neglect is a syndrome that is most frequently associated with damage to the right hemisphere, although damage to the left hemisphere can also result in signs of spatial neglect. It is characterised by absent or deficient awareness of the contralesional side of space. The screening and diagnosis of spatial neglect lacks a universal gold standard, but is usually achieved by using various modes of assessment. Spatial neglect is also difficult to treat, although prism adaptation training (PAT) has in the past showed some promise. Study one aimed to first identify the spatial neglect assessments used the most by clinicians as a first step to reaching a universal consensus. This online survey attracted 454 responses from clinicians in 33 countries. In identifying and quantifying the selection of spatial neglect assessments (and reasons for their use), the survey found tentative signs of emerging consensus - in line with previous research. This survey also found that professionals worldwide express a desire for harmonisation, citing the varied range of assessments available to them. Study two was designed to ascertain whether PAT could enhance engagement in occupational therapy for stroke - an established intervention for stroke survivors. This study video-recorded patients (n=43) and therapists taking part in a visual search activity. These videos were later rated by an expert occupational therapist, finding that PAT did not significantly enhance engagement in occupational therapy by our operationalisation. This work highlights the need for a universal definition of engagement in therapy, and the potential need for interventions to enhance engagement and, by extension, outcomes after discharge. Study three aimed to uncover whether PAT has any efficacy (i.e. in the short term) in treating spatial neglect, specifically on cognitive and open-loop pointing outcomes. This aim was formulated following previous reviews of PAT effectiveness which were inconclusive (at best). This systematic-review and meta-analysis of eight eligible studies (N=216) found no evidence to suggest that PAT is efficacious in resolving the signs of spatial neglect within one month post-intervention. The use of PAT to treat spatial neglect lacks a clear evidence base, and more work is required to identify its mechanism(s) of action and how well it can resolve signs of spatial neglect. These studies highlight that the care of stroke and brain injury survivors with spatial neglect could be better-informed; the current literature provides a varied account of the assessment of, and interventions for, spatial neglect. There are promising signs of an appetite for harmonisation of assessment. For PAT, this thesis highlights that further work may be required to fully appreciate the limits of its usefulness in the clinical setting.
Date of Award | 31 Dec 2021 |
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Original language | English |
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Awarding Institution | - The University of Manchester
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Supervisor | Audrey Bowen (Supervisor) & Andy Vail (Supervisor) |
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- Clinical Practice
- Interventions
- Attention
- Diagnosis
- Screening
- Proof of Concept
- Consensus
- Prism Adaptation Training
- Occupational Therapy
- Inattention
- Neglect
- Stroke
- Systematic Review
Understanding the Assessment of Spatial Neglect and its Treatment Using Prism Adaptation Training
Checketts, M. (Author). 31 Dec 2021
Student thesis: Phd