Implementing Prism Adaptation Treatment for Spatial Neglect in the Outpatient Setting

Research Objectives: To implement two evidence-based care tools for spatial neglect in outpatient rehabilitation facilities

Design: Retrospective observation

Setting: Outpatient clinic

Participants: Occupational therapists

Interventions: Professional education and skill acquisition on spatial neglect assessment and treatment

Main Outcome Measures: Number of neurological patients received the newly implemented care

Results: We trained two therapists as the leads for the implementation of both the Kessler Foundation Neglect Assessment Process (KF-NAP) and Prism Adaptation Treatment (KF-PAT) in the outpatient occupational therapy care and the cognitive rehabilitation program affiliated with one rehabilitation care provider. The two lead therapists then trained 6 other therapists. From March 2017 to July 2019, when suspecting a patient of having spatial neglect, these 8 therapists assessed 45 individuals (27 men and 18 women; median age = 62) using the Catherine Bergego Scale (CBS) via the KF-NAP. Among those patients, 37 (82%) had stroke, 4 (9%) had traumatic brain injury, and 4 (9%) had other neurological conditions. The median days post neurological diagnosis was 210 (IQR = 123-710), and the median CBS score was 6.25 (IQR = 4-12.5) out of 30 (higher value = greater severity of neglect). 39 (87%) patients received prism adaptation treatment following the KF-PAT protocol, which recommends the treatment course being 10 once-daily sessions over two weeks. 23 (59%) of them received 10 sessions over 24 to 100 days, median = 38 days (IQR = 31-49). 21 (91%) were assessed for spatial neglect after treatment, and the median improvement was CBS change of 3.75 (IQR = 2-5.5).

Conclusions: Clinicians found the KF-NAP assessment tool useful and informative. The KF-PAT treatment, however, could not be delivered as recommended. Further work is needed to ensure the implementation of treatment to be completed within two weeks.

Author(s) Disclosures: KF-NAP and KF-PAT are registered trademarks owned by Kessler Foundation, which is the employer of three authors (Chen, Kaplan, and Masmela). None of the authors receive financial incentive related to the sales of the tools. Mauch and Chirdon have nothing to disclose.