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Prism Adaptation Moves Neglect-related Perseveration to Contralesional Space

Nys, Gudrun M. S. PhD*; Seurinck, Ruth PhD* †; Dijkerman, H. Chris PhD‡ §

Cognitive and Behavioral Neurology: December 2008 - Volume 21 - Issue 4 - p 249-253
doi: 10.1097/WNN.0b013e31818a5cc1
Case Reports

Background Hemi-neglect is a disorder characterized by a disregard of contralesional stimuli. Some neglect patients also show an “exaggerated attention” for the ipsilesional field, reflected in perseverative responses, such as repetitive fixations in the ipsilesional field, ipsilesional revisitings on standard cancellation, or exaggerations in drawings on the ipsilesional side.

Objective and Method It is still unclear whether neglect and perseveration are due to a single underlying mechanism. In the present study, we will examine the effect of 4-day-in-a-row prism adaptation on neglect and perseveration severity in a patient with severe perseverations. Additionally, we will examine whether the position of omissions and perseverations on the Star Cancellation will change during the intervention.

Results Our patient showed a decrease in neglect severity and an increase in perseveration severity, suggesting that perseveration and neglect are dissociated phenomena. Interestingly, 4-day-in-a-row prism adaptation gradually moved the predominant position of perseverative responses from right to left as neglect decreased with treatment.

Conclusions Perseverative responses do not necessarily occur in the ipsilesional sector of space as is generally assumed. Instead, the position of the revisits may be determined by the severity of the neglect, and may shift when the focus of attention moves more contralesionally with recovery.

*Laboratory for Neuropsychology, Department of Neurology, Ghent University, Belgium

Department of Experimental Psychology, Ghent University

Department of Neurology, University Medical Center Utrecht

§Department of Experimental Psychology, Utrecht University, the Netherlands

Sponsored by the Dutch Brain Foundation.

Reprints: Gudrun M. S. Nys, PhD, Laboratory for Neuropsychology, Ghent University Hospital, De Pintelaan 185 (4K3), B-9000 Ghent, Belgium (e-mail:

Gudrun M. S. Nys is now a postdoctoral researcher for Fonds voor Wetenschappelijk Onderzoek (FWO Belgium).

This study was performed when Gudrun M. S. Nys was working at Utrecht University.

Received for publication November 27, 2007; accepted July 13, 2008

© 2008 Lippincott Williams & Wilkins, Inc.