Right Unilateral Spatial Neglect Improves with Intrinsic Motivation

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Psychology

Background:

• Unilateral spatial neglect (USN) is more common after right-hemisphere stroke but increasingly detected after left-hemisphere injuries.
• Left-hemisphere USN detection is rising due to behavioral assessments accommodating conditions like aphasia.
• Right USN and post-stroke apathy share lesion sites, leading to overlapping symptoms and diagnostic challenges.

Observation:

• A 62-year-old male with right USN and apathy underwent a 6-week, 3-term treatment protocol.
• Weeks 1-2: Conventional therapy for right USN.
• Weeks 3-4: Goal-directed therapy (GDT) based on affinity behavior for right USN and apathy.
• Weeks 5-6: Conventional therapy only.

Findings:

• GDT significantly improved apathy (spontaneity) compared to conventional therapy.
• No significant differences were observed in USN (Catherine Bergego Scale) or intrinsic motivation (Pittsburgh Rehabilitation Participation Scale) between GDT and conventional therapy.
• Effect size for apathy improvement trended higher during GDT (weeks 3-4) than during the return to conventional therapy (weeks 5-6).

Implications:

• Highlights limitations of current treatments for patients with co-occurring right USN and apathy.
• Suggests GDT based on affinity behavior may complement conventional therapy for apathy in stroke rehabilitation.
• Further research is needed to validate GDT's efficacy for USN and motivation alongside apathy.