Strategy Training for Optimizing Attention for Individuals With Spatial Neglect

Examining Strategy Training for Optimizing Attention in Rehabilitation for Community-Dwelling Individuals With Spatial Neglect

It is common for individuals after stroke to have a cognitive perceptual impairment called unilateral spatial neglect (neglect). Individuals with neglect have difficulty paying attention to one side of their body or one side of the environment and therefore experience difficulty performing daily activities. There are a lack of effective treatments for neglect and new interventions are needed to help reduce disability for these individuals. Metacognitive strategy training (strategy training) is an intervention that has the potential to reduce neglect-related disability and improve individuals' attention and awareness of their neglect. This study seeks to examine the effects of strategy training on neglect, self-awareness, and disability, specifically for individuals who are living in the community after their stroke.

Unilateral spatial neglect (neglect) post stroke is characterized by a lack of attention to one side of the body or one side of the environment. Individuals with neglect experience significant disability and are often unaware of their neglect symptoms which can make it even more difficult to treat. There are a lack of effective treatments for neglect and new interventions are needed to help reduce disability for these individuals. Metacognitive strategy training (strategy training) is an intervention that has the potential to reduce neglect-related disability and improve individuals' attention and awareness of their neglect. Strategy training teaches individuals to develop personalized goals, self-assess their performance of daily activities, and develop and evaluate strategies designed to overcome barriers and improve their performance of daily activities. While strategy training shows promise for individuals with neglect, no studies have tailored the intervention for this group of individuals or examined the effects of strategy training for individuals with neglect specifically with individuals living in the community. This study examines whether strategy training facilitates reductions in neglect and disability and improves self-awareness.

Inclusion Criteria:

• had a stroke
• presence of neglect as determined by score of <18 or 2 or more collisions on the Virtual Reality Lateralized Attention Test (VRLAT); score below established cutoff for neglect on one of the six subtests of the Behavioral Inattention Test (BIT); OR reported signs/symptoms of neglect
• ≥18 years old
• lives within 30 miles of the University of Pittsburgh in a community dwelling.

Exclusion Criteria:

• Boston Diagnostic Aphasia Examination (BDAE) Severity Scale score of 0
• dementia per medical record
• active major depressive disorder per medical record
• not willing to be videotaped
• subject is currently receiving rehabilitation therapy as part of their usual care