Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect.

OBJECTIVE We conducted a multi-site, 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 that demonstrated significant spatially biased attention following acquired brain injury were randomly assigned to the experimental attention remediation treatment or active control group. The participants engaged with the remotely administered interventions for twelve weeks. The primary outcome was spatial bias on the Posner cueing task (response time difference: left - 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 prior to and immediately following participation in the experimental intervention or control condition, and again after a three-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)-as well as 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 may serve as a useful addition to the existing standard of care. This article is protected by copyright. All rights reserved.