Thomas Van Vleet1, Paolo Bonato2,3, Eric Fabara3, Sawsan Dabit1, Sarah-Jane Kim1, Christopher Chiu4, Antonio Luigi Bisogno5, Michael Merzenich1,6, Maurizio Corbetta5,7,8, Joseph DeGutis9,10. 1. Department of Research and Development, Posit Science Inc, San Francisco, CA, USA. 2. Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA. 3. Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA. 4. Department of Psychology, University of Massachusetts, Boston, MA, USA. 5. Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC), University of Padova, Italy. 6. School of Medicine, University of California, San Francisco, CA, USA. 7. Department of Neurology, Radiology, Neuroscience Washington University School of Medicine, St. Louis, MO, USA. 8. Venetian Institute of Molecular Medicine, VIMM, Padova, Italy. 9. Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, USA. 10. Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Abstract
OBJECTIVE: We conducted a multisite, randomized, double-blinded, controlled trial to examine the effectiveness of a digital health intervention targeting the intrinsic regulation of goal-directed alertness in patients with chronic hemispatial neglect. METHODS:Forty-nine participants with hemispatial neglect, who demonstrated significant spatially biased attention after acquired brain injury, were randomly assigned to the experimental attention remediation treatment or the active control group. The participants engaged with the remotely administered interventions for 12 weeks. The primary outcome was spatial bias on the Posner cueing task (response time difference: left minus right target trials). Secondary outcomes included functional abilities (measured via the Catherine Bergego scale and Barthel index), spatial cognition, executive function, quality of life, and sleep. Assessments were conducted before and immediately after participation in the experimental intervention or control condition, and again after a 3-month no-contact period. RESULTS: Compared with the active control group, the intervention group exhibited a significant improvement in the primary outcome, a reduction in spatially biased attention on the Posner cueing task (p = 0.010, Cohen's d = 0.96), in addition to significant improvements in functional abilities as measured on the Catherine Bergego and Barthel indices (p = 0.027, Cohen's d = 0.24). INTERPRETATION: Our results demonstrate that our attention training program was effective in improving the debilitating attention deficits common to hemispatial neglect. This benefit generalized to improvements in real-world functional abilities. This safe, highly scalable, and self-administered treatment for hemispatial neglect might serve as a useful addition to the existing standard of care. ANN NEUROL 2020;88:747-758.
RCT Entities:
OBJECTIVE: We conducted a multisite, randomized, double-blinded, controlled trial to examine the effectiveness of a digital health intervention targeting the intrinsic regulation of goal-directed alertness in patients with chronic hemispatial neglect. METHODS: Forty-nine participants with hemispatial neglect, who demonstrated significant spatially biased attention after acquired brain injury, were randomly assigned to the experimental attention remediation treatment or the active control group. The participants engaged with the remotely administered interventions for 12 weeks. The primary outcome was spatial bias on the Posner cueing task (response time difference: left minus right target trials). Secondary outcomes included functional abilities (measured via the Catherine Bergego scale and Barthel index), spatial cognition, executive function, quality of life, and sleep. Assessments were conducted before and immediately after participation in the experimental intervention or control condition, and again after a 3-month no-contact period. RESULTS: Compared with the active control group, the intervention group exhibited a significant improvement in the primary outcome, a reduction in spatially biased attention on the Posner cueing task (p = 0.010, Cohen's d = 0.96), in addition to significant improvements in functional abilities as measured on the Catherine Bergego and Barthel indices (p = 0.027, Cohen's d = 0.24). INTERPRETATION: Our results demonstrate that our attention training program was effective in improving the debilitating attention deficits common to hemispatial neglect. This benefit generalized to improvements in real-world functional abilities. This safe, highly scalable, and self-administered treatment for hemispatial neglect might serve as a useful addition to the existing standard of care. ANN NEUROL 2020;88:747-758.