Computer-assisted training for improving wheelchair mobility in unilateral neglect patients

Objective: To investigate whether a computer-assisted training (CAT) program for patients with left unilateral neglect would decrease symptoms of this disorder. Design: Case-control study. Setting: inpatient rehabilitation unit of a government medical center. Patients: Twenty right-handed patients who showed left unilateral neglect on screening measures (Rey-Osterrieth Complex Figure, Random Letter Cancellation Test) were assigned to a CAT treatment group; and 20 patients who showed similar levels of unilateral neglect on the screening measures were assigned to a control group. Interventions: All subjects were inpatients in an acute rehabilitation unit and received rehabilitation therapy, including physical and occupational therapy. The treatment group received the experimental, CAT program, 12 to 20 sessions of about 45 minutes each. Treatment consisted of 5 modules, each of increasing complexity, to improve attention to stimuli in the left hemisphere, and 2 simulated wheelchair obstacle courses to propel a wheelchair while avoiding obstacles. Main Outcome Measures: Computer tasks designed for this study (Video Tracking Test, Video Obstacle Course Test), a real-life wheelchair obstacle course (WCOC), and incident reports indicating falls and accidents. Results: Trained subjects performed significantly better on the WCOC than control subjects (F-1,F-36 = 23.41, p = .00003). Also, trained subjects had fewer incident reports than control subjects during their hospitalization (chi (2) (l.n=38) = 5.15, p = .023), Conclusions: CAT can reduce unilateral neglect symptoms on experimental tasks and some measures of accident risk. (C) 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.