- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05983185
Prism Adaptation Therapy (PAT) for Right Brain Stroke Rehabilitation
April 2, 2024 updated by: VA Office of Research and Development
Prism Adaptation Treatment (PAT) for Right Brain Stroke Rehabilitation
After a right brain stroke, >50% of Veterans experience problems with dressing, eating, self-care or steering their wheelchairs because their ability to move, orient, and respond toward the left side is limited: spatial neglect.
Spatial neglect prevents them from functioning independently, and their needs in the hospital and at home are greatly increased.
An effective treatment for spatial neglect is 10 days of visuomotor training while wearing optical prisms (PAT), however many clinicians [fail to diagnose spatial neglect and use this approach.
In this study, the investigators will develop a brain scanning test that could objectively identify the Veterans with spatial neglect after stroke who are the best candidates to receive PAT and recover their ability to function.
When the research is complete, the investigators expect that brain scans done in the hospital can guide the team to refer Veterans to PAT rehabilitation: improving daily life function] and quality of life.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Project Summary/Abstract The application addresses the formidable treatment gap for cognitive rehabilitation of spatial neglect (SN), defined as asymmetric orienting, perception, and responding to left space after right brain stroke, causing functional disability.
Although Veterans with SN are half as likely to return home, have one-third the community mobility, require 3x as much caregiver supervision, and have longer hospitalizations, increased fall risk and increased rehospitalization compared with similar right brain stroke survivors, a personalized approach to SN rehabilitation is not available in Veteran-specific systems of care.
The investigators discovered that frontal lobe damage and "Aiming" SN both predict optimal recovery of functional independence after prism adaptation treatment (PAT).
These findings argue for the development of an [objective, biomarker-based process to identify patients who should be administered PAT.
The algorithm will be developed by identifying specific neurobiological features predictive of PAT treatment response.
Thus, the investigators expect this research will deliver a critical missing element to rehabilitation, eliminating clinician uncertainty about SN diagnosis and appropriateness of PAT, and allowing a more personalized health care approach to SN rehabilitation.
The team of researchers at three high-performing VA medical centers, distinguished in cognitive neurology analysis of brain imaging predictors, and stroke rehabilitation, from both advanced and clinical data, will develop the first biological parameter that can be used to assign SN rehabilitation.
In 180 Veterans (120 with SN, 60 without), the investigators will define and validate brain imaging biomarkers that predict the presence of Aiming SN (Aim 1), a strong predictor of functional recovery after receiving PAT.
The expectation that disconnection of frontal regions with subcortical and parietal regions will predict Aiming SN.
The investigators will also examine the correlation between the brain imaging biomarkers predicting Aiming SN and improvements in daily life function after PAT (Aim 2).]
Then, the investigators will determine if adding behavioral predictors to biomarker predictors (Aim 3) accounts for additional variance in the trajectory of functional recovery.
The overall impact of the investigators' work will be to establish the utility of a validated biomarker that routinely identifies Veterans with SN after stroke who are the best candidates for PAT.
Armed with a biomarker-based algorithm, the investigators can then carry out a large-scale PAT clinical trial, and personalized SN care.
This care pathway could reduce reliance on specialized SN assessment, [coordinate VA and community systems providing Veteran stroke care,] and improve stroke care efficiency, to enhance outcomes and quality of life after stroke for thousands of Veterans.
Study Type
Interventional
Enrollment (Estimated)
244
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Lisa Shenette
- Phone Number: (413) 463-1835
- Email: lisa.shenette@va.gov
Study Contact Backup
- Name: Anna M Barrett, MD
- Email: Anna.Barrett2@va.gov
Study Locations
-
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Georgia
-
Decatur, Georgia, United States, 30033-4004
- Recruiting
- Atlanta VA Medical and Rehab Center, Decatur, GA
-
Contact:
- Michael Dattilo, MD
- Phone Number: 20660 4043216111
- Email: michael.datillo@va.gov
-
Contact:
- Mychaela Eatmon
- Phone Number: 404-725-3256
- Email: mychaela.eatmon@va.gov
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-
Massachusetts
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Leeds, Massachusetts, United States, 01053-9764
- Recruiting
- VA Central Western Massachusetts Healthcare System, Leeds, MA
-
Principal Investigator:
- Anna M. Barrett, MD
-
Contact:
- Anna M Barrett, MD
- Email: Anna.Barrett2@va.gov
-
Contact:
- Stacey W Wainaina
- Phone Number: 413-584-4040
- Email: Stacey.Wainaina@va.gov
-
-
Ohio
-
Cleveland, Ohio, United States, 44106-1702
- Recruiting
- Louis Stokes VA Medical Center, Cleveland, OH
-
Contact:
- Jessica McCabe, PT
- Phone Number: 8203830 216-791-3800
- Email: jessica.mccabe@va.gov
-
Contact:
- Svetlana Pundik
- Phone Number: 63732 2167913800
- Email: svetlana.pundik@va.gov
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Has had a first right brain stroke >18 years of age
- 1-4 months post-diagnosis of right brain stroke
- Can sit up, see out of both eyes and point to objects (>20/50 vision in both eyes)
- Can give informed consent to participate
Exclusion Criteria:
- Has been diagnosed with other chronic, disabling neurological disorder (e.g. multiple sclerosis, Alzheimer Disease)
- Has had a clinical left brain stroke or has neuroimaging evidence of prior stroke(s) including the presence of more than two lacunes with diameter greater than 15 mm.
- Cannot sit up to be tested and receive PAT
- Has <20/50 vision when viewing with both eyes
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Prism adaptation Therapy
People with spatial neglect will receive this effective treatment to reduce symptoms, which the investigators' previous work indicated may be particularly effective for Aiming SN symptoms.
|
The investigators' research and clinical group is the US leader in implementing this intervention for spatial neglect and have brought it to more than 50 clinical centers, hospitals, and treatment organizations.
Other Names:
|
No Intervention: No spatial neglect
People without spatial neglect symptoms will not receive an intervention for spatial neglect.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Spatial neglect (SN) type (Aiming SN versus Where SN)
Time Frame: baseline
|
This variable is assignment to category defining spatial neglect.
This is based on a data collection with computerized line bisection, which generates a profile score.
Veterans whose computerized line bisection profile score indicates that they have spatial neglect that primarily affects movement, intention and action have Aiming SN; these Veterans responded best to prism adaptation therapy (PAT) in prior research.
Alternately, Veterans may have a profile score consistent with Where SN, affecting perception and action.
|
baseline
|
Functional independence Measure (FIM) improvement trajectory
Time Frame: 5 weeks after enrollment
|
This outcome variable measures how well Veterans can carry out their daily life self-care activities independently on a validated measure, the Functional Independence Measure (FIM).
|
5 weeks after enrollment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
SN severity, as assessed by the Behavioral Inattention Test-conventional subtest (BIT-c)
Time Frame: 5 weeks after enrollment
|
This variable examines the severity of spatial neglect as measured by functionally-valid assessment, the Behavioral Inattention Test-conventional subtest (BIT-c; max value 146, min value 0, lower is abnormal).
Functionally-valid spatial neglect assessments predict independence for activities of daily living, and care needs.
|
5 weeks after enrollment
|
SN severity, as assessed by the Catherine Bergego Scale (CBS)
Time Frame: 5 weeks after enrollment
|
This variable (max value 30, min value 0, higher is abnormal) examines the severity of spatial neglect as measured by a functionally-valid assessment, the CBS.
Functionally-valid spatial neglect assessments predict independence for activities of daily living, and care needs.
|
5 weeks after enrollment
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Anna M. Barrett, MD, VA Central Western Massachusetts Healthcare System, Leeds, MA
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
February 1, 2023
Primary Completion (Estimated)
December 31, 2026
Study Completion (Estimated)
December 31, 2027
Study Registration Dates
First Submitted
July 14, 2023
First Submitted That Met QC Criteria
August 7, 2023
First Posted (Actual)
August 9, 2023
Study Record Updates
Last Update Posted (Actual)
April 4, 2024
Last Update Submitted That Met QC Criteria
April 2, 2024
Last Verified
April 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- C3662-R
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Spatial Neglect After Right Brain Stroke
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Schoen Clinic Bad AiblingGerman Center for Vertigo and Balance DisordersUnknownSpatial Neglect After Right Brain-damageGermany
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Hospices Civils de LyonSuspendedBrain Lesion of the Right Hemisphere | Unilateral Spatial Neglect for Half of ThemFrance
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University GhentFund for Scientific Research, Flanders, BelgiumCompletedSpatial Neglect After StrokeBelgium
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Assistance Publique - Hôpitaux de ParisCompletedCerebrovascular Disorders | Cerebral Stroke | VISIO-spatial Neglect | VISUO-spatial ExtinctionFrance
-
Hopitaux de Saint-MauriceRecruitingStroke | Unilateral Spatial NeglectFrance
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Emory UniversityNational Institute of Neurological Disorders and Stroke (NINDS)Recruiting
-
Kessler FoundationRecruitingStroke | Spatial NeglectUnited States
-
Kessler FoundationRecruitingStroke | Spatial NeglectUnited States
-
Hopitaux de Saint-MauriceCompleted
-
Hopitaux de Saint-MauriceCompletedStroke | Unilateral Spatial Neglect
Clinical Trials on Prism adaptation therapy
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University of UtahNot yet recruitingStroke | Perceptual Disorders | BiomarkerUnited States
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Seoul National University HospitalBundang Rusk Rehabilitation Specialty HospitalTerminatedStroke | Rehabilitation | Perceptual Disorders | Recovery of Function | Virtual Reality Exposure TherapyKorea, Republic of
-
Dartmouth-Hitchcock Medical CenterMichael J. Fox Foundation for Parkinson's ResearchCompleted
-
Kessler FoundationCompleted
-
University of RochesterRecruitingExotropiaUnited States, Italy, Canada, India, Israel
-
Kessler FoundationU.S. Department of EducationActive, not recruitingSpatial Neglect | Deficits in Attention Motor Control and PerceptionUnited States
-
VA Office of Research and DevelopmentCompleted
-
Sunnyview Rehabilitation HospitalCompleted
-
Kessler FoundationCompletedStroke | Aphasia | Spatial NeglectUnited States
-
Emory UniversityNational Institute of Neurological Disorders and Stroke (NINDS)Recruiting