Top-down strategy in rehabilitation of spatial neglect: how about age effect?

The aim of this work is to verify the effectiveness of our treatment in patients with spatial neglect in relation to their age and to the severity of neglect. Lots of studies on rehabilitation were proposed and, in some of them, treatments based upon visual-scanning abilities were described. Our rehabilitation training is aimed to induce patients to find by themselves an adequate strategy to solve spatial problems and, after that, try to let this searching strategy as automatized as possible. In this study, forty-six patients with right brain damage and left visuo-spatial neglect underwent to this specific cognitive treatment. A neuropsychological battery was administered before and after treatment. Repeated measure MANOVA on test performances showed significant main effects of treatments, age, and severity of neglect; an interaction effect between these three variables was found as well. Our results confirm an effectiveness of treatment, in particular for elderly patients. Actually, they seem to show a better recovery of neglect after cerebral stroke, even for those of them affected by a severe neglect. These data could be explained in accordance with recent neurophysiological models that claim compensatory responses to reduce brain plasticity even in terms of reorganization of cognitive functions such as visuo-spatial attention.