Dynamic Auditory Cueing for Spatial Neglect in Stroke (DAC-SN)

The Effect of Dynamic Auditory Cueing on Spatial Neglect in Patients With Stroke: A Randomized Controlled Trial

Spatial neglect is a common condition after stroke and can make it difficult for people to pay attention to one side of space. This problem can negatively affect daily activities and functional independence. This study aims to evaluate whether dynamic auditory cueing for spatial neglect (DAC-SN) can improve spatial neglect in people with stroke. Participants are randomly assigned to one of two groups. One group receives conventional rehabilitation, while the other group receives conventional rehabilitation combined with dynamic auditory cueing. Dynamic auditory cueing uses moving sounds to guide attention toward the affected side. The intervention is applied for about ten minutes per day, five days a week, for four weeks. Spatial neglect and functional outcomes are assessed using standardized clinical tests and scales at baseline and at predefined time points during and after the intervention. The results of this study may provide evidence for the use of auditory-based approaches in the rehabilitation of spatial neglect after stroke.

Study Overview

• Status: Active, not recruiting
• Conditions: Stroke; Perceptual Disorders; Spatial Neglect; Spatial Neglect After Stroke
• Intervention / Treatment: Other: Dynamic Auditory Cueing; Other: Conventional Rehabilitation

Detailed Description

Spatial neglect is a common and disabling condition following stroke, characterized by reduced awareness of stimuli on one side of space. It is associated with impaired functional recovery and decreased independence in daily activities. Despite conventional rehabilitation approaches, spatial neglect may persist and continues to be a significant challenge in stroke rehabilitation. Dynamic auditory cueing for spatial neglect (DAC-SN) has been proposed as a method to facilitate attentional orientation by providing external sensory input directed toward the affected side. This approach may enhance spatial exploration and support recovery by promoting engagement with the neglected hemispace. The aim of this randomized controlled trial is to investigate the effect of dynamic auditory cueing in patients with stroke and spatial neglect. Participants are randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation combined with dynamic auditory cueing. The intervention is delivered in addition to standard rehabilitation in structured sessions over a four-week period. The control group receives conventional rehabilitation according to standard clinical practice. Spatial neglect severity and functional outcomes are assessed using standardized clinical measures at baseline and at predefined time points during and after the intervention period. The findings of this study are expected to provide evidence on the potential role of auditory-based interventions as an adjunct to conventional rehabilitation in improving spatial neglect and functional outcomes in patients with stroke.

• Study Type: Interventional
• Enrollment (Actual): 18
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara
    • Ankara, Ankara, Turkey (Türkiye), 06560
      • Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 18 years or older
• Subacute or chronic stroke
• Clinical diagnosis of left-sided spatial neglect confirmed by standardized tests (e.g., Line Bisection Test (LBT), Star Cancellation Test (SCT))
• Normal or corrected visual acuity
• Absence of auditory extinction
• Ability to understand and comply with study procedures
• Provision of written informed consent

Exclusion Criteria:

• Hearing impairment (Hearing Handicap Inventory score ≥26)
• Presence of hemianopia
• Impaired visual acuity due to ocular pathology (e.g., cataract, glaucoma)
• History of neurological disease (e.g., dementia, Parkinson's disease)
• Structural brain lesions unrelated to stroke
• Inability to participate in rehabilitation sessions or assessments

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dynamic Auditory Cueing Group; Participants in this group receive dynamic auditory cueing for spatial neglect (DAC-SN) in addition to their standard conventional rehabilitation program. The intervention involves exposure to moving environmental sounds (such as animal or transportation noises) designed to redirect attention toward the neglected hemispace. The intervention is administered for 10 minutes per day, 5 days per week, over a total period of 4 weeks.	Other: Dynamic Auditory Cueing; The intervention consists of structured 10-minute sessions using digitized environmental sounds (e.g., animal sounds, moving vehicles, or sirens) as auditory cues. Dynamic auditory cueing for spatial neglect (DAC-SN) is applied using sounds presented with a dynamic spatial movement pattern across the horizontal plane. The auditory stimulus is designed to move from the intact hemispace toward the neglected hemispace or to follow a continuous scanning trajectory to guide attention toward the affected side. Stimuli are delivered through a stereo headset to ensure clear perception of directional movement. The intervention is administered in standardized sessions over a four-week period (5 sessions per week). This approach aims to promote active spatial attention and scanning behavior and differs from conventional static auditory stimulation.; Other: Conventional Rehabilitation; Participants receive standard stroke rehabilitation, including physical and occupational therapy focused on motor function, mobility, and activities of daily living. This group follows the same rehabilitation schedule as the experimental group but does not receive dynamic auditory cueing for spatial neglect (DAC-SN).
Active Comparator: Conventional Rehabilitation Group; Participants in this group receive only the standard conventional rehabilitation program provided by the clinic. This group does not receive dynamic auditory cueing for spatial neglect (DAC-SN). The frequency and duration of the standard therapy are matched to those of the experimental group to ensure a fair comparison of the additional effects of auditory cueing.	Other: Conventional Rehabilitation; Participants receive standard stroke rehabilitation, including physical and occupational therapy focused on motor function, mobility, and activities of daily living. This group follows the same rehabilitation schedule as the experimental group but does not receive dynamic auditory cueing for spatial neglect (DAC-SN).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Line Bisection Test (LBT) deviation score	The Line Bisection Test (LBT) is used to assess spatial bias by measuring deviation from the true midpoint of horizontal lines. Deviation toward the right side indicates more severe left-sided spatial neglect.	Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment)
Catherine Bergego Scale (CBS) score	The Catherine Bergego Scale (CBS) is used to assess the impact of spatial neglect on daily activities. Higher scores indicate greater severity of neglect in functional tasks.	Baseline and after 20 sessions (end of treatment)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Star Cancellation Test (SCT) score	The Star Cancellation Test (SCT) is used to assess spatial neglect by measuring the number and spatial distribution of correctly identified targets. Omission of targets on the left side indicates more severe left-sided spatial neglect.	Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment)
Line Cancellation Test (LCT) score	The Line Cancellation Test (LCT) evaluates spatial neglect by assessing the ability to detect and cancel target lines. Omission of lines on the left side indicates more severe left-sided spatial neglect.	Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment)
Functional Independence Measure (FIM) score	The Functional Independence Measure (FIM) assesses functional independence in activities of daily living. Higher scores indicate greater functional independence.	Baseline and after 20 sessions
Center of Cancellation (CoC) value	The Center of Cancellation (CoC) quantifies spatial bias based on cancellation task performance. Higher absolute values indicate more severe spatial neglect.	Baseline, after 1 session, after 10 sessions, and after 20 sessions

Collaborators and Investigators

• Sponsor: Gazi University
• Investigators: Principal Investigator: Gulcin Kaymak Karatas, MD, Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation; Study Director: Elif E Kurtul, MD, Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation

Publications and helpful links

General Publications

• Van Vleet TM, DeGutis JM. Cross-training in hemispatial neglect: auditory sustained attention training ameliorates visual attention deficits. Cortex. 2013 Mar;49(3):679-90. doi: 10.1016/j.cortex.2012.03.020. Epub 2012 Apr 9.
• Kaufmann BC, Cazzoli D, Bartolomeo P, Frey J, Pflugshaupt T, Knobel SEJ, Nef T, Muri RM, Nyffeler T. Auditory spatial cueing reduces neglect after right-hemispheric stroke: A proof of concept study. Cortex. 2022 Mar;148:152-167. doi: 10.1016/j.cortex.2021.12.009. Epub 2022 Jan 19.
• Golay L, Hauert CA, Greber C, Schnider A, Ptak R. Dynamic modulation of visual detection by auditory cues in spatial neglect. Neuropsychologia. 2005;43(9):1258-65. doi: 10.1016/j.neuropsychologia.2004.12.006. Epub 2005 Feb 5.
• Barrett AM, Burkholder S. Monocular patching in subjects with right-hemisphere stroke affects perceptual-attentional bias. J Rehabil Res Dev. 2006 May-Jun;43(3):337-46. doi: 10.1682/jrrd.2005.01.0015.
• Long J, Zhang Y, Liu X, Gao Q, Pan M. Music-based interventions for unilateral spatial neglect: A systematic review. Neuropsychol Rehabil. 2023 Oct;33(9):1462-1487. doi: 10.1080/09602011.2022.2111314. Epub 2022 Aug 18.

Study record dates

Study Major Dates

• Study Start (Actual): August 21, 2024
• Primary Completion (Estimated): April 10, 2026
• Study Completion (Estimated): April 10, 2026

Study Registration Dates

• First Submitted: March 27, 2026
• First Submitted That Met QC Criteria: March 27, 2026
• First Posted (Actual): April 2, 2026

Study Record Updates

• Last Update Posted (Actual): April 7, 2026
• Last Update Submitted That Met QC Criteria: April 1, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Cognitive Rehabilitation; Spatial Neglect; Neurorehabilitation; Stroke Rehabilitation; Auditory Stimulation; Unilateral Neglect; Visual Scanning; Hemispatial Neglect; Spatial Attention; Dynamic Auditory Cueing
• Additional Relevant MeSH Terms: Neurologic Manifestations; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Neurobehavioral Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Stroke; Perceptual Disorders
• Other Study ID Numbers: GAZI-DAC-2026-01

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