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Spatial neglect is a common condition after stroke and can make it difficult for people to pay attention to one side of space. This problem can negatively affect daily activities and functional independence. This study aims to evaluate whether dynamic auditory cueing for spatial neglect (DAC-SN) can improve spatial neglect in people with stroke. Participants are randomly assigned to one of two groups. One group receives conventional rehabilitation, while the other group receives conventional rehabilitation combined with dynamic auditory cueing. Dynamic auditory cueing uses moving sounds to guide attention toward the affected side. The intervention is applied for about ten minutes per day, five days a week, for four weeks. Spatial neglect and functional outcomes are assessed using standardized clinical tests and scales at baseline and at predefined time points during and after the intervention. The results of this study may provide evidence for the use of auditory-based approaches in the rehabilitation of spatial neglect after stroke.
Spatial neglect is a common and disabling condition following stroke, characterized by reduced awareness of stimuli on one side of space. It is associated with impaired functional recovery and decreased independence in daily activities. Despite conventional rehabilitation approaches, spatial neglect may persist and continues to be a significant challenge in stroke rehabilitation. Dynamic auditory cueing for spatial neglect (DAC-SN) has been proposed as a method to facilitate attentional orientation by providing external sensory input directed toward the affected side. This approach may enhance spatial exploration and support recovery by promoting engagement with the neglected hemispace. The aim of this randomized controlled trial is to investigate the effect of dynamic auditory cueing in patients with stroke and spatial neglect. Participants are randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation combined with dynamic auditory cueing. The intervention is delivered in addition to standard rehabilitation in structured sessions over a four-week period. The control group receives conventional rehabilitation according to standard clinical practice. Spatial neglect severity and functional outcomes are assessed using standardized clinical measures at baseline and at predefined time points during and after the intervention period. The findings of this study are expected to provide evidence on the potential role of auditory-based interventions as an adjunct to conventional rehabilitation in improving spatial neglect and functional outcomes in patients with stroke.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dynamic Auditory Cueing Group | Experimental | Participants in this group receive dynamic auditory cueing for spatial neglect (DAC-SN) in addition to their standard conventional rehabilitation program. The intervention involves exposure to moving environmental sounds (such as animal or transportation noises) designed to redirect attention toward the neglected hemispace. The intervention is administered for 10 minutes per day, 5 days per week, over a total period of 4 weeks. |
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| Conventional Rehabilitation Group | Active Comparator | Participants in this group receive only the standard conventional rehabilitation program provided by the clinic. This group does not receive dynamic auditory cueing for spatial neglect (DAC-SN). The frequency and duration of the standard therapy are matched to those of the experimental group to ensure a fair comparison of the additional effects of auditory cueing. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dynamic Auditory Cueing | Other | The intervention consists of structured 10-minute sessions using digitized environmental sounds (e.g., animal sounds, moving vehicles, or sirens) as auditory cues. Dynamic auditory cueing for spatial neglect (DAC-SN) is applied using sounds presented with a dynamic spatial movement pattern across the horizontal plane. The auditory stimulus is designed to move from the intact hemispace toward the neglected hemispace or to follow a continuous scanning trajectory to guide attention toward the affected side. Stimuli are delivered through a stereo headset to ensure clear perception of directional movement. The intervention is administered in standardized sessions over a four-week period (5 sessions per week). This approach aims to promote active spatial attention and scanning behavior and differs from conventional static auditory stimulation. |
| Measure | Description | Time Frame |
|---|---|---|
| Line Bisection Test (LBT) deviation score | The Line Bisection Test (LBT) is used to assess spatial bias by measuring deviation from the true midpoint of horizontal lines. Deviation toward the right side indicates more severe left-sided spatial neglect. | Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment) |
| Catherine Bergego Scale (CBS) score | The Catherine Bergego Scale (CBS) is used to assess the impact of spatial neglect on daily activities. Higher scores indicate greater severity of neglect in functional tasks. | Baseline and after 20 sessions (end of treatment) |
| Measure | Description | Time Frame |
|---|---|---|
| Star Cancellation Test (SCT) score | The Star Cancellation Test (SCT) is used to assess spatial neglect by measuring the number and spatial distribution of correctly identified targets. Omission of targets on the left side indicates more severe left-sided spatial neglect. | Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gulcin Kaymak Karatas, MD | Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation | Principal Investigator |
| Elif E Kurtul, MD | Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation | Ankara | Ankara | 06560 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35176552 | Background | Kaufmann BC, Cazzoli D, Bartolomeo P, Frey J, Pflugshaupt T, Knobel SEJ, Nef T, Muri RM, Nyffeler T. Auditory spatial cueing reduces neglect after right-hemispheric stroke: A proof of concept study. Cortex. 2022 Mar;148:152-167. doi: 10.1016/j.cortex.2021.12.009. Epub 2022 Jan 19. | |
| 15949510 | Background | Golay L, Hauert CA, Greber C, Schnider A, Ptak R. Dynamic modulation of visual detection by auditory cues in spatial neglect. Neuropsychologia. 2005;43(9):1258-65. doi: 10.1016/j.neuropsychologia.2004.12.006. Epub 2005 Feb 5. |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D010468 | Perceptual Disorders |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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Participants are randomly assigned to one of two parallel groups. The experimental group receives dynamic auditory cueing in addition to conventional rehabilitation, while the control group receives conventional rehabilitation alone.
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Outcome assessors are blinded to group allocation. Due to the nature of the intervention, participants and therapists are not blinded.
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| Conventional Rehabilitation | Other | Participants receive standard stroke rehabilitation, including physical and occupational therapy focused on motor function, mobility, and activities of daily living. This group follows the same rehabilitation schedule as the experimental group but does not receive dynamic auditory cueing for spatial neglect (DAC-SN). |
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| Line Cancellation Test (LCT) score | The Line Cancellation Test (LCT) evaluates spatial neglect by assessing the ability to detect and cancel target lines. Omission of lines on the left side indicates more severe left-sided spatial neglect. | Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment) |
| Functional Independence Measure (FIM) score | The Functional Independence Measure (FIM) assesses functional independence in activities of daily living. Higher scores indicate greater functional independence. | Baseline and after 20 sessions |
| Center of Cancellation (CoC) value | The Center of Cancellation (CoC) quantifies spatial bias based on cancellation task performance. Higher absolute values indicate more severe spatial neglect. | Baseline, after 1 session, after 10 sessions, and after 20 sessions |
| 17041819 | Background | Barrett AM, Burkholder S. Monocular patching in subjects with right-hemisphere stroke affects perceptual-attentional bias. J Rehabil Res Dev. 2006 May-Jun;43(3):337-46. doi: 10.1682/jrrd.2005.01.0015. |
| 22578712 | Background | Van Vleet TM, DeGutis JM. Cross-training in hemispatial neglect: auditory sustained attention training ameliorates visual attention deficits. Cortex. 2013 Mar;49(3):679-90. doi: 10.1016/j.cortex.2012.03.020. Epub 2012 Apr 9. |
| 35980394 | Background | Long J, Zhang Y, Liu X, Gao Q, Pan M. Music-based interventions for unilateral spatial neglect: A systematic review. Neuropsychol Rehabil. 2023 Oct;33(9):1462-1487. doi: 10.1080/09602011.2022.2111314. Epub 2022 Aug 18. |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |