Mechanisms underlying neglect recovery after prism adaptation.

Prism adaptation (PA) has been demonstrated to be effective in improving hemispatial neglect. However not all patients seem to benefit from this procedure. Thus, the objective of the present work is to provide behavioural and neuroanatomical predictors of recovery by exploring the reorganization of low-order visuo-motor behaviour and high-order visuo-spatial representation induced by PA. To this end, 16 neglect patients (experimental group) were submitted to a PA treatment for 10 daily sessions. Neglect and oculo-motor responses were assessed before the treatment, 1 week, 1 and 3 months after the treatment. Eight control patients, who received general cognitive stimulation, were submitted to the same tests at the same time interval. The results showed that experimental patients obtained, as a consequence of PA, a long lasting neglect recovery, a reorganization of low-order visuo-motor behaviour during and after prism exposure (error reduction and after-effect, respectively) and a leftward deviation of oculo-motor responses. Importantly, the level of error reduction obtained in the first week of treatment was predictive of neglect recovery and the amelioration of oculo-motor responses, and the degree of eye movement deviation was positively related to neglect amelioration. Finally, the study of patients' neuroanatomical data showed that severe occipital lesions were associated with a lack of error reduction, poor neglect recovery and reduced oculo-motor system amelioration. In conclusion, the present results suggest that low-order visuo-motor reorganization induced by PA promotes a resetting of the oculo-motor system leading to an improvement in high-order visuo-spatial representation able to ameliorate neglect.