Different cognitive trainings in the rehabilitation of visuo-spatial neglect

Background. This study was conducted in order to verify the effects of different cognitive training techniques with regard to neglect recovery and to determine whether the simultaneous use of two stimulations (cognitive and Transcutaneous Electrical Nerve Stimulation) increases improvement in spatial neglect. Methods. We selected 20 right brain-damaged patients with hemispatial neglect. All patients were submitted to a neuropsychological test battery and randomly assigned to 1 of 4 groups for cognitive rehabilitation treatment (training for neglect type 1, training for neglect type 1 with TENS, training for neglect type 2, training for neglect type 2 with TENS). The testing took place at baseline, after 1 month of a training free interval and after 1 and 2 months of cognitive training, respectively. The cognitive training consists in attentive, visuo-spatial and visuo-constructive tasks with (type 1) or without (type 2) specific cueing and feedback. Results. After 1 month of neuro-motor rehabilitation, the patients showed an improvement in a few tasks for neglect. After 1 and 2 months of cognitive treatment, all groups showed an improvement in most visuo-spatial tasks although the recovery was incomplete in those tasks which involve other than visuo-spatial scanning abilities. Conclusions. Our data confirm the effectiveness of a specific cognitive rehabilitation training in patients with neglect. In our sample, it seems that TENS does not provide more effective and enduring results compared to cognitive training alone. Moreover, our data indicate that cognitive rehabilitation may ameliorate extrapersonal neglect but it does not influence the representational/imagery component.