Stroke Structured Abstract - S #5
A combination of visual and motor cuing may be more effective than motor cuing alone in reducing left neglect
CITATION: Lin, K-C., Cermak, S. A., Kinsbourne, M., & Trombly, C. A. (1996). Effects of left-sided movements on line bisection in unilateral neglect. Journal of the International Neuropsychological Society, 2, 404-411.
LEVEL OF EVIDENCE: IC1b
How does performance in line bisection compare among four conditions: no cue, visual cuing involving the report of a digit placed at the left end of the line, circling the left-end digit, and digit circling plus tracing of the line with the right index finger from its left end to its midpoint before bisection?
Counterbalanced repeated measures design, an RCT.
Subjects were randomly assigned to one of four sequences of conditions; each subject experienced all four conditions.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Inclusion criteria: Right handed (self-report), unilateral right brain lesion (CT scan & clinical exam).
N = 13
Male = 12
Female = 1
Mean age = 57.5
LCVA = 0
RCVA = 13
Attrition = 0
Bias Index of Line Bisection = Raw deviation score (defined as site of bisection minus true center)/half of line length.
Original test of Line Bisection has been validated and reliability established.)
Condition 1: Visual Cuing - A digit was placed at the left end of each of the lines to be bisected. The subject was instructed to report the digit before bisecting the line.
Condition 2: Circling the Digit - The subject was asked to direct his or her right hand leftward to draw a circle around the digit at the left end of the line before bisecting the line.
Condition 3: Circling + Finger Tracing - Using the right index finger, the subject was required to circle the left-end digit and then trace the line from the left end toward the midpoint before bisecting the line.
Condition 4: No cue.
WHO DELIVERED INTERVENTION
FREQUENCY & DURATION
There were 21 trials for one condition on the same day. Subjects experienced all four conditions on 4 consecutive days.
Significant differences for:
Visual Cuing Condition (p < .001, r = .72)
Digit Circling Condition (p < .0001, r = .87)
Digit Circling + Tracing Condition (p < .0001, r = .95) as compared with the no-cue condition.
Within Groups/Conditions/Times: Not tested
THREATS TO VALIDITY
Digit Circling + Finger Tracing was unequivocally more effective in reducing left neglect than Digit Circling alone, which was in turn more effective than Visual Cuing. Indeed, Digit Circling with Tracing completely abolished the rightward bisection bias.
Digit Circling + Finger Tracing was more effective in reducing left neglect than Digit Circling alone, which was more effective than Visual Cuing. The study suggests the use of visualmotor cuing to reduce left neglect in patients acutely poststroke.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.