Auditory spatial cueing reduces neglect after right-hemispheric stroke: A proof of concept study

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Auditory Perception

Background:

• Spatial neglect, a common deficit after right-hemispheric stroke, impairs attention to the contralesional side and predicts poor outcomes.
• Neglect is a supramodal disorder affecting visual and auditory modalities, with cross-modal effects showing potential for short-term attention improvement.
• Current rehabilitation strategies for spatial neglect require enhancement to improve long-term patient recovery.

Purpose of the Study:

• To introduce and evaluate a novel auditory stimulation technique combining preferred music with dynamic auditory spatial cueing for spatial neglect.
• To investigate the immediate and long-term effects of this music-based auditory stimulation on neglect severity.
• To identify the neural correlates associated with the therapeutic effects of the auditory stimulation technique.

Main Methods:

• Two proof-of-concept experiments with repeated-measures, cross-over designs were conducted on 21 patients with visual neglect post-right-hemispheric stroke.
• Experiment I assessed immediate effects using Letter Cancellation tasks comparing music with and without spatial cueing.
• Experiment II utilized video-oculography during Free Visual Exploration to evaluate long-term effects (up to 3 hours) and performed voxel-based-lesion-symptom mapping.

Main Results:

• Patients showed significantly greater improvement in Letter Cancellation when listening to preferred music with auditory spatial cueing compared to music alone.
• Auditory spatial cueing combined with music significantly improved neglect severity, as evidenced by enhanced visual exploration behavior for up to 3 hours.
• Voxel-based-lesion-symptom mapping indicated that the right inferior parietal lobule, superior longitudinal fascicle, and parieto-parietal callosal fibers are crucial for the response variability.

Conclusions:

• Listening to preferred music with auditory spatial cueing is a feasible and effective method for reducing spatial neglect severity.
• This music-based auditory stimulation demonstrates significant short-term and extended aftereffects on spatial attention.
• The technique holds promise as an adjunctive therapy in the neurorehabilitation of patients with spatial neglect.