Perceptual Disorders, Spatial Neglect, Spatial Neglect After Stroke, Stroke
Conditions
Keywords
Spatial Neglect, Hemispatial Neglect, Stroke Rehabilitation, Dynamic Auditory Cueing, Auditory Stimulation, Spatial Attention, Unilateral Neglect, Visual Scanning, Neurorehabilitation, Cognitive Rehabilitation
Brief summary
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.
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.
Interventions
OTHERDynamic 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.
OTHERConventional 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).
Sponsors
Gazi University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessors are blinded to group allocation. Due to the nature of the intervention, participants and therapists are not blinded.
Intervention model description
Participants are randomly assigned to one of two parallel groups. The experimental group receives dynamic auditory cueing in addition to conventional rehabilitation, while the control group receives conventional rehabilitation alone.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Line Bisection Test (LBT) deviation score | Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment) | 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. |
| Catherine Bergego Scale (CBS) score | Baseline and after 20 sessions (end of treatment) | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Star Cancellation Test (SCT) score | Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment) | 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. |
| Line Cancellation Test (LCT) score | Baseline, after 1 session, after 10 sessions, and after 20 sessions (end of treatment) | 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. |
| Functional Independence Measure (FIM) score | Baseline and after 20 sessions | The Functional Independence Measure (FIM) assesses functional independence in activities of daily living. Higher scores indicate greater functional independence. |
| Center of Cancellation (CoC) value | Baseline, after 1 session, after 10 sessions, and after 20 sessions | The Center of Cancellation (CoC) quantifies spatial bias based on cancellation task performance. Higher absolute values indicate more severe spatial neglect. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORGulcin Kaymak Karatas, MD
Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation
STUDY_DIRECTORElif E Kurtul, MD
Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation
Outcome results
None listed