Effects of Prism Adaptation on Reference Systems for Extrapersonal Space in Neglect Patients

Up to now, rehabilitation of unilateral spatial neglect has focused on egocentric forms of neglect, whereas less is known about the possibility to improve allocentric deficits. The present study aimed to examine the efficacy of prism adaptation (PA) training on patients with different forms of neglect: egocentric, allocentric, or mixed. Twenty-eight patients were assessed with specific neglect tests before (T0) and after (T1) 10 sessions of PA training. Performance in the Apples Cancellation test was used to identify patients with egocentric (n = 6), allocentric (n = 5), or mixed (n = 17) forms of neglect. In the overall group of patients, PA training produced significant improvements in performance across different neglect tests. In terms of the egocentric-allocentric distinction, the training was effective in reducing omissions in the left part of space in the Apples Cancellation test both for patients with egocentric neglect and mixed neglect. By contrast, errors of commissions (marking the inability to detect the left part of the target stimulus, i.e., allocentric neglect) remained unchanged after PA in patients with allocentric neglect and actually increased marginally in patients with mixed neglect. The PA training is effective in improving egocentric neglect, while it is ineffective on the allocentric form of the disturbance. Notably, the allocentric component of neglect is frequently impaired, although this is most often in conjunction with the egocentric impairment, yielding the mixed form of neglect. This stresses the importance of developing exercises tuned to improving allocentric neglect.