May 12, 2019
Medical Research
Marie Benz MD

Dr. Tom Van Vleet,  presented results on a common symptom of stroke and acquired brain injury (hemi-spatial neglect) at the American Academy of Neurology May 2019 What makes this study newsworthy?

Response For the first time ever a highly-scalable intervention — computerized brain training (BrainHQ made by Posit Science) —was found to improve symptoms of hemi-spatial neglect, which is a common and often intractable and debilitating problem after stroke or other acquired brain injury. What can you tell us about the medical condition (hemi-spatial neglect) investigated in this study?

Response About a third of patients with a brain injury exhibit a complex and debilitating array of neurological deficits known as the “neglect syndrome” (sometimes called, “hemi-spatial neglect” or “neglect”).

The most apparent symptom of neglect is the inability of patients to efficiently process information on the side of space opposite the injury; often completely missing relevant events without awareness. As a result, patients often fail to adopt compensatory strategies or respond to other conventional rehabilitation protocols.

The cost is significant, as patients with neglect experience longer hospital stays and have higher requirements for assistance, including greater skilled nursing home placements relative to patients with similar extent of brain injury without neglect.

To date, there’s been no broadly-applicable and highly-scalable intervention for addressing neglect. An alarming reality given the increasing cost of stroke, which is currently estimated to exceed $34 billion per annum How was the study organized?

Response This was a multi-site, double-blind, randomized controlled trial, in which 49 patients were randomized into either (

1) an intervention group asked to complete 12 hours of BrainHQ alertness training (Freeze Frame), or

(2) an active control group asked to complete an equal number of hours training on computerized casual games. The study was run at Washington University, Spalding Rehabilitation Hospital, and the Boston Veterans Administration Medical Center.

The study was funded by the National Institute of Neurological Diseases and Stroke of the National Institutes of Health. What are the main findings? 

Response: The researchers found a relatively small number of hours of computerized brain training (self-administered by the patients in their homes) can drive significant neurological and functional improvements. The researchers found a significant improvement in the primary outcome, a validated measure of spatial bias (Posner cueing task), and in the secondary composite measure of functional ability, as compared to the active control. What can you tell us about the computerized training as compared to ore traditional cognitive rehabilitation?

Response: While rehabilitation efforts have previously tended to focus on simple interventions (e.g., repeatedly reminding patients to look toward the neglected side), this brain training takes a unique approach by focusing on underlying post-injury deficits in both general alertness and momentary heightened attention that together negatively affect the deployment of spatial attention {spatial awareness}. The training makes increasing demands on both general and momentary alertness by having the patient sustain engagement in a target detection task over increasingly longer epochs, while remaining alert to an unexpected and infrequently-presented target stimulus; which serves as a cue to interrupt the predominant button-press mediated behavior and withhold response. This is referred to in the literature as Tonic and Phasic Alertness Training (TAPAT), and, notably, does not target spatial attention. What should readers take away from your report?

Response: Neglect is a common symptom following stroke or acquired brain injury that sometimes goes unaddressed both because there is not an easily available method for evidence-based intervention, and because it sometimes is not manifestly obvious (unlike the loss of language or use of a limb following a stroke) and goes undiagnosed.

Patients and their advocates should ask if neglect has been tested for, and identified, among the post-injury symptoms. Clinicians now have these results to consider when they evaluate evidence-based treatment options. What recommendations do you have for future research as a result of this work?

Response: Further research is always worthwhile. We are studying alternatives to make the training even more effective and ways to make it more accessible. Is there anything else you would like to add? 

Response: Many of us believe we are entering a new era in which treatment alternatives will be more easily accessible, and can be more quickly personalized, by being delivered digitally. That version of the future requires solid studies and changes in our healthcare delivery, payment, and regulatory systems. This study is another foundation stone in building the case for that version of 21st century medicine.

Any disclosures?

Dr. Tom Van Vleet, and other supporting members of the research team from Posit Science, are employed by, and have equity in, Posit Science, the maker of BrainHQ (used as the intervention in the study). The researchers at the three sites, who administered the study and collected the data, have no financial interest in Posit Science and no conflicts to declare.

Citation: AAN2019 May 2019 abstract

April 09, 2019; 92 (15 Supplement) MAY 8, 2019

Improvements in Spatial Bias and Functional Outcomes in Chronic Hemispatial Neglect: Results of a Multi-Site Phase II Efficacy Trial of a Novel Computerized Attention Training Program. (S33.001)

Tom Van Vleet, Joseph DeGutis, Maurizio Corbetta, Paolo Bonato, Eric Fabara