Active Cue-Training in Neglect

The presented study investigates standardized visual cueing in reading and visual spatial task as a treatment method for spatial neglect. In a randomized controlled design patients receive either cued reading and visual spatial tasks (intervention) or treatment which is unspecific to neglect (control). In the intervention condition, patients with left-sided neglect receive intense training, including reading and visual spatial task with standardized and adapted visual cueing by the therapist. Improvements in reading and visual spatial tasks lead to a reduction of cues by the therapist. Accordingly, the patient has to apply self-cueing over time in order to solve the task. For the control condition, all patients receive unspecific treatment without any standardized adapted cueing implemented by the therapist. To enhance the effectivity of cueing in reading and visual spatial tasks, the investigators additionally conduct parietal transcranial direct current stimulation (tDCS) in those patients without tDCS exclusion criteria (see exclusion criteria below). It is hypothesised that systematic and adaptive therapeutic cueing leads to a significant reduction of omissions of word and word parts in reading. UPDATE: No Add-on tDCS was performed since it was not applicable for our severly impaired patients due to the strict exclusion criteria of tDCS.

adaptive, therapeutic cueing during reading tasks adaptive, therapeutic cueing during visuo spatial tasks

the patient has to read a standardized text of 55 words and a word list of 13 words. Omissions of the complete word and/or of a word part are counted.

Primary Outcome Measure is assessed two times in the first week (3 days in between), after week 4, after week 7, after week 8

A blinded neurologist evaluates spontaneous and cued body posture (head, eyes, trunk) for ipsilesional, moderate ipsilesional or no deviation.

Secondary Outcome Measure is assessed two times in the first week (3 days in between), after week 4, after week 7, after week 8

Secondary Outcome Measure is assessed two times in the first week (3 days in between), after week 4, after week 7, after week 8

The blinded hospital staff evaluates activities of daily living by using the Catherine Bergego scale with specified scoring criteria

Inclusion Criteria: Left sided neglect Capacity of at least 30 minutes Ability to read in German language Mobilization of 80% Exclusion Criteria: Previous known dementia Normal pressure hydrocephalus Exclusion Criteria for tDCS Add-on (not exclusion of the intervention): Shunt Craniectomy Epilepsy Other metal implants