Background Spatial neglect is a common attentional condition post-stroke linked to poor rehabilitation outcomes. Prism adaptation, though a promising intervention, is not yet widely used clinically due to various barriers to its implementation, including limited accessibility, the repetitive nature of the therapy, and the need for specialized equipment. This protocol aims to examine the effectiveness, feasibility, and acceptability of an engaging, mobile, computerized prism adaptation procedure (Peg-the-Mole) for treating spatial neglect in stroke inpatient and outpatient community settings. Methods/design The present study uses a longitudinal, double-blind, quasi-randomized, controlled design. Forty-two individuals with right-hemisphere stroke experiencing mild to severe symptoms of neglect will be randomized into two groups: Use of Peg-the-Mole with 15-degree rightward-deviating prism goggles (intervention) or use of Peg-the-Mole with 5-degree rightward-deviating prism goggles (active control). Participants will complete 10 treatment sessions over 2 weeks, engaging with the Peg-the-Mole procedure for 15 minutes daily. Blinded assessments will take place immediately before and after treatment, as well as at one-month follow-up. The primary outcome measure will be the Star Cancellation conventional subtest of the Behavioural Inattention Test. Secondary outcomes will include additional conventional and behavioural subtests of the Behavioural Inattention Test, one subtest of the Eschenbeck Standardized Activities of Daily Living battery, the caregiver- and self-reported forms of the Halifax Neglect Impact Scale, data measuring feasibility and acceptability, prism adaptation after-effects, the Hospital Anxiety and Depression Scale, and the Fatigue Severity Scale. Discussion The Peg-the-Mole procedure has the potential to improve patient recovery and quality of life after stroke due to its gamified, portable features that promote treatment accessibility and adherence. Results from this study will help determine if the treatment can be implemented successfully in inpatient and community settings to improve neglect symptoms and daily living. Trial registration Clinicaltrials.gov, Identifier: NCT05595668 ; registered October 27, 2022.

Research Objectives Spatial neglect is a common attention disorder after stroke. It is important to develop treatment plans that can be used across the lifespan. Prism adaptation is a promising treatment for spatial neglect. This study is the first to investigate prism adaptation effects across the lifespan as a first step towards the validation of a home-friendly protocol (Peg-the-Mole app). Design This study used a mixed-model design. Participants were randomly assigned to the use of the Peg-the-Mole app with 15-degree rightward deviating goggles (experimental condition) or 5-degree rightward deviating goggles (active control condition). Each participant alternated between using the app with prism and clear goggles to allow for repeated adaptation. Setting The study was conducted in a research laboratory at Acadia University. Participants 128 healthy participants were enrolled in the study. Forty participants were between the ages of 8 to 13 (child group), 44 were between the ages of 18 and 30 (younger adult group), and 44 were between the ages of 60 and 80 (older adult group). Interventions The exposure task was an interactive software (Peg-the-Mole). Participants performed pointing movements towards a Surface Pro after being instructed to rapidly touch the location where a cartoon mole holding a bull's eye target was presented on the screen. Participants completed 3 blocks of 63 adaptation trials (with prism goggles) and 2 blocks of deadaptation trials (with sham goggles). Main Outcome Measures A proprioceptive-guided pointing straight ahead task, a proprioceptive-and-visual pointing straight ahead task, and a balance task were administered before and after each exposure block. Results Post prism adaptation, children experienced larger after-effects compared to younger and older adults (p < 0.05). During Peg-the-Mole, younger adults experienced larger direct effects and steeper adaptation rates compared to children and older adults. Conclusions Slower visuomotor learning may ultimately result in larger remapping process, which has important implications for the use of the Peg-the-Mole app as a treatment for spatial neglect across the lifespan. Author(s) Disclosures No conflict of interest. Spatial neglect is a common attention disorder after stroke. It is important to develop treatment plans that can be used across the lifespan. Prism adaptation is a promising treatment for spatial neglect. This study is the first to investigate prism adaptation effects across the lifespan as a first step towards the validation of a home-friendly protocol (Peg-the-Mole app). This study used a mixed-model design. Participants were randomly assigned to the use of the Peg-the-Mole app with 15-degree rightward deviating goggles (experimental condition) or 5-degree rightward deviating goggles (active control condition). Each participant alternated between using the app with prism and clear goggles to allow for repeated adaptation. The study was conducted in a research laboratory at Acadia University. 128 healthy participants were enrolled in the study. Forty participants were between the ages of 8 to 13 (child group), 44 were between the ages of 18 and 30 (younger adult group), and 44 were between the ages of 60 and 80 (older adult group). The exposure task was an interactive software (Peg-the-Mole). Participants performed pointing movements towards a Surface Pro after being instructed to rapidly touch the location where a cartoon mole holding a bull's eye target was presented on the screen. Participants completed 3 blocks of 63 adaptation trials (with prism goggles) and 2 blocks of deadaptation trials (with sham goggles). A proprioceptive-guided pointing straight ahead task, a proprioceptive-and-visual pointing straight ahead task, and a balance task were administered before and after each exposure block. Post prism adaptation, children experienced larger after-effects compared to younger and older adults (p < 0.05). During Peg-the-Mole, younger adults experienced larger direct effects and steeper adaptation rates compared to children and older adults. Slower visuomotor learning may ultimately result in larger remapping process, which has important implications for the use of the Peg-the-Mole app as a treatment for spatial neglect across the lifespan.

•Chronic pain (CP) is pain that is experienced for longer than three months.•Exercise interventions longer than 12 weeks improve brain function and pain perception in individuals suffering from CP.•The cortico-limbic, default mode, and dorsolateral prefrontal cortex appear to be critical brain regions.•Changes in brain function may be responsible for improvements in the subjective experience of CP post-exercise intervention.•Exercise may represent a cost-effective therapy for managing CP via its positive influence on brain function.

BACKGROUND: While prism adaptation (PA) has been recognized as a promising tool for treating spatial neglect, implementation as a standard treatment in clinical care has been lagging. Limited evidence for the generalization of after-effects to everyday activities has been a barrier towards implementation. OBJECTIVES: This study examined whether a home-friendly standardized PA protocol (Peg-the-Mole, PTM) induces after-effects that can transfer to wheelchair maneuvering. We also examined the impact of using constant (1 starting hand position) or variable (3 starting hand positions) training conditions on the transfer of after-effects to wheelchair maneuvering. METHODS: Sixty participants were randomly assigned to one of four PTM conditions: 1) prisms/constant training; 2) prisms/variable training; 3) sham goggles/constant training; 4) sham goggles/variable training. RESULTS: The use of PTM with rightward shifting prisms induced after-effects on proprioceptive and visual pointing outcome tasks. Groups using PTM with prism goggles showed a leftward shift in their position within a wheelchair course and a reduction in the number of right-sided collisions. The training condition did not have an impact on the transfer of after-effects to wheelchair driving. CONCLUSION: PTM is a clinically appealing PA protocol that induces after-effects that can transfer to an everyday activity relevant to patients with neglect.

Objective: The Clock Drawing Test (CDT) is commonly used as a screening tool for the assessment of dementia. The association between the CDT in acute stroke and long-term functional and cognitive outcomes in this population is unknown. The present prospective study is the first to examine if CDT scores in the acute stage after stroke are related to long-term outcomes and to compare the predictive ability of two scoring systems in a large sample of stroke patients. Method: A total of 340 patients admitted to an acute stroke unit were included in the present study. Separate stepwise multiple linear regression analyses were performed with eight independent variables (demographic/pre-stroke variables - age, sex, premorbid functioning; stroke-related variables - stroke severity, localization; cognitive variables - Orientation Test, CDT [2 scoring systems]), and four dependent variables administered one year post-stroke (Barthel Index, modified Rankin Scale, Reintegration to Normal Living index, Global Deterioration Scale). Results: Although both CDT scoring methods were related to all long-term outcome measures, the more comprehensive scoring system was the only baseline variable that significantly explained the variance in outcome measures in all four multiple regression models. Conclusion: Performance on the CDT in acute stroke is related to long-term outcomes including patients' degree of independence in performing activities of daily living, the degree to which they achieved reintegration into daily occupations, and the degree of cognitive decline observed one-year post-stroke. Future studies are needed to clarify the nature of the relationship between different CDT scoring systems and post-stroke outcomes.

Meditation practice may be a useful intervention to reduce cravings and impulsivity among gamblers. Fifty-nine participants (90% female, mean age = 21.6 years) completed pre-intervention questionnaires including the Gambling Craving Scale (GACS) and a delay discounting task. Next, they were randomly assigned to one of two conditions: (1) audio-guided mindfulness-based meditation exercises or (2) audiobook recordings (control condition). After listening to 10-min daily audio recordings for a week, participants completed post-intervention measures. Contrary to hypothesis, gambling measures were not correlated with delay discounting. However, dispositional mindfulness was inversely related to a self-report measure of impulsivity and problem gambling severity. The hypothesized interaction between time (pre- vs. post-intervention) and condition (meditation exercises vs. audiobook recordings) was significant for gambling cravings among gamblers (n = 39), with those in the meditation condition showing a significant reduction in gambling cravings which highlights the potential benefits of meditation practice to reduce gambling cravings.

Studies investigating the use of prism adaptation to treat symptoms of spatial neglect have used goggles inducing a rightward shift of 6 to 15°. However, the impact of prism power (i.e., the magnitude of visual shift) on after-effects (i.e., leftward shift in pointing movements after prism exposure), and effects on more functional tasks (e.g., a throwing task) are unknown. The purpose of this study was to clarify the relationship between these variables in a sample of healthy young adults as a first step towards the validation of a new home-friendly prism adaptation procedure (Peg-the-Mole/PTM). Sixty participants were randomly assigned to one of four conditions and used PTM with 5° (condition 1), 10° (condition 2), 5°/10°/15° deviating goggles (gradual shift – condition 3) or with sham/non-deviating goggles (condition 4). Pointing tasks and a throwing task were administered before and after PTM to assess a prism-induced leftward shift in pointing or throwing movements. The main effect of prism power on after-effects and throwing effects was significant (P < 0.05). After-effects were larger in the gradual and 10° group when compared to the 5° and sham groups (gradual = 10° > 5° > sham). For the throwing task, only the effects in the gradual condition differed from the sham condition (only participants in the gradual condition threw significantly more to the left after PTM). Direct effects (pointing errors during PTM) predicted after-effects (P < 0.05) but not throwing effects. Furthermore, after-effects did not correlate with throwing (functional) effects. These findings suggest that larger prism power induces larger after-effects and a gradual transition from increasingly larger prism power may facilitate the generalization of after-effects to functional tasks. The lack of relationship between after-effects and throwing effects should be investigated further as it may explain the mixed findings regarding the generalization of prism effects to functional activities.

Studies that have investigated prism adaptation (PA) effects on symptoms of visuospatial neglect have primarily used neuropsychological tests as outcome measures. An important question that remains to be answered is whether PA effects translate into improvements in patients' daily life activities. In the present review, we examined systematically the evidence for the effect of PA treatment on daily life activities in patients with neglect. Two authors independently assessed the methodological quality of 25 intervention and 1 follow-up studies using validated scales. PA effects were evaluated for reading/writing, activities of daily living (ADL) direct tests, ADL questionnaires, and navigation tests. Studies were evaluated as being of excellent (n = 1), good (n = 12), fair (n = 10), or poor (n = 3) quality. Among the 26 articles, a total of 32 measurements showed significant PA effects (one measurement from a study of excellent quality, 17 from studies of good quality, 10 from studies of fair quality, four from studies of poor quality), whereas non-significant effects were found in 15 measurements (two from a study of excellent quality, three from studies of good quality, eight from studies of fair quality, two from studies of poor quality). There is some evidence suggesting that PA can improve daily functioning, particularly as measured by reading/writing and ADL direct tests. The impact of several variables on PA effects should be investigated further including sample heterogeneity and time since injury.

There is considerable debate regarding the involvement of the medial frontal cortex in motor and cognitive functions. Recent neuroimaging data suggest a fundamental underlying process that links the motor and cognitive roles of the mid-cingulate cortex (MCC), namely the processing of feedback during trial and error learning in the cingulate motor region that is related to the modality of the feedback. These data suggest that the specific motor context of a task may be a critical determinant of how its outcome is processed in the MCC. We assessed a patient before and after surgery for brain tumour removal in the medial frontal cortex, and a group of matched control subjects. Subjects had to find by trial and error the stimulus associated with the correct feedback amongst four or five similar stimuli. Subjects performed the task in two different visuo-motor contexts: with the response pad and hand visible and with no sight of either pad or hand. The patient showed a selective impairment in this task relative to control subjects in the hardest conditions and the impairment was most marked when the response pad and the hand were not visible. The results support a specific role of the medial frontal cortex in the construction of a sensorimotor representation of choices and related feedback by encoding the contingency between an efference copy of the action and its outcome.

Background: Prism adaptation (PA) is a promising rehabilitation technique for visuo-spatial neglect. However, PA effects are often inconsistent across studies and the clinical application of this technique has been limited. The purpose of the present studies was to validate an easily standardized, home-friendly, and game-like PA technique (Peg-the-Mole) with healthy participants as a first step toward clinical development.New method: In study 1, we used Peg-the-Mole with 32 participants wearing prism or sham goggles to investigate whether this procedure can induce significant after-effects on midline judgment and pointing tasks. In study 2, we compared Peg-the-Mole to a typical PA protocol in 42 participants for after-effects and level of enjoyment and to determine if the after-effects generalize to a throwing task.Results and comparison with existing method: Study 1 showed that Peg-the-Mole induced significant aftereffects on all outcome measures. Study 2 demonstrated that after-effects induced by Peg-the-Mole were equivalent to those induced by the typical PA procedure on all outcome measures. Peg-the-Mole was rated as more enjoyable than the typical procedure.Conclusions: Peg-the-Mole is a new computerized PA procedure that can be easily standardized and successfully used to induce significant after-effects. The present findings demonstrate that alterations can be made to the typical PA procedure to make it easier to use and more enjoyable, factors that could increase treatment availability, adherence and intensity. (C) 2014 Elsevier B.V. All rights reserved.

Concomitant increase in activity within the mid-dorsolateral prefrontal cortex (MDLFC) and the posterior parietal cortex (PPC) is observed in most functional neuroimaging studies of working memory (Collette et al., 1999; Gerton et al., 2004; Sun et al., 2005; Postle et al., 2006; Champod and Petrides, 2007; Emery et al., 2008). Despite broad consensus on the importance of these two brain regions in working memory, their unique contribution, especially that of the PPC, remains a matter of heated debate (Paulesu et al., 1993; Smith and Jonides, 1998; Postle et al., 1999; Berryhill and Olson, 2008). The main objective of the present parametric event-related functional magnetic resonance imaging study was to examine the hypothesis that the cortex in the intraparietal sulcus region in the PPC is involved in the manipulation (i.e., rearrangement) of verbal information in working memory and to dissociate the involvement of this brain region from that of the MDLFC in working memory processes. The results demonstrated a linear increase in activity within the MDLFC during the manipulation and monitoring of a linearly increasing number of words in working memory. In sharp contrast, there was a linear increase in activity within the PPC during the manipulation but not the monitoring of a linearly increasing number of words. This study provides the first parametric dissociation of activation in these two cortical regions indicating a crucial role of the PPC in the manipulation of information in working memory, with the MDLFC playing a major role in monitoring this information.

OBJECTResection of brain tumors has been shown to increase patient survival. The extent of the possible resection, however, depends on whether the tumor has invaded brain regions important for motor, sensory, or cognitive processes and whether the brain tissue surrounding the tumor maintains its functional role. The goal of the present study was to develop new pre- and intraoperative tools to specifically assess the function of the rostral part of the dorsal premotor cortex (PMdr) in 4 patients with brain tumors close to this region.METHODSUsing functional magnetic resonance (fMR) imaging and a task developed to assess accurate selection between competing responses based on conditional rules, the authors preoperatively assessed the function of the PMdr in 4 patients with brain tumors close to this region. In 1 patient, the authors developed an intraoperative procedure to assess performance on the task during the tumor resection.RESULTSPreoperative fMR imaging data showed specific activity increases in the vicinity of the tumors, that is, in the PMdr. As confirmed by postoperative structural MR imaging, the extent of the tumor resection was optimal and the functional region within the PMdr was preserved. Furthermore, patients exhibited no postoperative deficits during task performance, demonstrating that the function was preserved. Intraoperative behavioral results demonstrated that the cognitive processes underlying performance on the task remained intact throughout the tumor resection.CONCLUSIONSThese findings suggest that preoperative fMR imaging, together with intraoperative behavioral evaluation, may be a useful paradigm to assist neurosurgeons in preserving cognitive function in patients with brain tumors.