Visuomotor imagery and rehabilitation of neglect

Objective: To assess the effectiveness of visuomotor imagery training in the rehabilitation of unilateral neglect. Design: Before-after trial. Behavioral analysis of single cases. Setting: Neurologic rehabilitation unit of a university hospital. Patients: Two patients with acquired brain injury who were suffering from severe and long-lasting unilateral neglect consequent to large lesions of cortical and subcortical right-brain. Intervention: A behavioral training program consisting of visual and movement imagery exercises. Forty experimental sessions, each lasting 50 minutes, were delivered. Main Outcome Measures: Six neuropsychological tests evaluating unilateral neglect; seven 'functional' tests assessing neglect behavior under daily life conditions; a questionnaire (filled out by the patients' relatives) concerning the patients' disability in the family context attributable to neglect. All the outcome measures were recorded at three different times: before, soon after, and 6 months after the end of the experimental training. Results: The visuomotor 'imagery training' ameliorated the deficit in performance related to neglect in both patients. All the outcome measures (neuropsychological and functional tests and the questionnaire) were positively influenced by the treatment. Moreover, the improvement was stable over a 6-month period, suggesting that the treatment had a long-term effect. Conclusions: The results show the possible effectiveness of a training method based on visuomotor imagery in diminishing impairment and functional disability associated with contralateral neglect.