忽略症(neglect)為中風患者臨床常見之知覺症狀，不但導致個案較為嚴重的各項功能缺失，也影響其日常活動表現和復健治療的療效。近年的研究已顯示稜鏡調適療法(prism adaptation)可改善忽略症患者的忽略現象，並反映在多項紙筆測驗中；然而，並非所有的患者都能獲得此療效，且紙筆測驗表現的進步是否可概化至日常生活功能則仍不清楚。故本研究的目的為由生態學的觀點，使用自然場景視覺搜尋作業及按桌鈴的功能性作業，輔以眼球運動分析的方法，進一步檢測例行性多次稜鏡調適的短期和長期療效。此外，本研究將同時結合動作分析技術以客觀測量稜鏡調適的後效(after effect)與稜鏡調適對患者上肢運動學表現的影響。本研究共招募11位參加者分配至兩組，稜鏡調適組6人而一般治療組5人。稜鏡調適組的患者將進行每天一次為期10天的稜鏡調適治療；而一般治療組的患者則延長復健時間15分鐘。所有受試者皆在治療開始前、第一次治療結束後、10次治療結束後，以及治療結束後第1、4和8週接受紙筆測驗、自然場景視覺搜尋作業與功能性作業-按桌鈴的評量，以檢驗稜鏡調適的短期和長期療效。稜鏡調適組在接受完稜鏡調適治療後並無不適現象，且出現明顯後效。稜鏡調適療效主要表現在指向身體中線測驗中，而星狀刪除測驗及卡氏日常活動量表中兩組個案皆出現改善。在自然場景視覺搜尋作業及功能性作業-按桌鈴中兩組的表現則無出現顯著差異，但在前項作業中兩組眼球動作皆有改善，而在後項作業中兩組皆無改善，但在運動學變項方面，目標物位置不同不會影響動作反應時間，而兩組個案在按左桌鈴時的尖峰速度及尖峰加速度都比按右桌鈴慢。依後效值分組後，後效小組在星狀刪除測驗、圖片搜尋測驗及自然場景視覺搜尋作業的口頭報告得分皆有顯著進步，而在功能性作業中僅後效大組出現運動學變項之改善。本研究使用的所有測驗皆無法支持稜鏡調適療法具有長期的療效，因此本研究結果部分支持例行性稜鏡調適療法的療效，但其長期療效則仍需進一步的驗證。

A large proportion of stroke patients show unilateral neglect that inducing many functional debilitating and effect on everyday life, and responsible for poor functional recovery and ability to benefit from treatment. Prism adaptation (PA) has been demonstrated to be effective in improving unilateral neglect. Previous studies used paper-pencil tests rather than functional tasks to examine the effects of PA, but weather the effects on paper-pencil tests will be generalized to activities of daily living is still uncertain. The purpose of this current study is to examine whether the effects of routine PA could improve the performances not only on paper-pencil tasks but also on visual searching task and functional task in unilateral neglect. Furthermore we try to explore the long-term effect of PA. Eleven neglect patients were divided into 2 groups, 6 patients were submitted to PA(PA group) and the other to traditional treatment for 10 daily sessions. Neglect was assessed before, after first treatment, after overall treatment and 1 weeks, 1 month and 2 month after the end of treatment by paper-pencil tests, visual searching task and functional task. All patients in PA group ameliorated their subjective body midline to the left after 10 times PA treatment. Both groups improved their performance on Star Cancellation Test and Catherine Bergego Scale. In visual searching task, the percentage of first fixation point on the left was increased after treatment in PA group. In functional task, both group performed slower peak velocity and peak acceleration on left target. After grouping by value of after effect of PA, the small-value group appeared improvement on Star Cancellation Test, Picture Scanning Test and scores of oral report of visual searching task. In functional task, only the large-value group appeared improving on kinematic performances. The results of this study only partially support PA effect on neglect, and the long-term effect of PA still need future examined.

Angeli, V., Benassi, M. G., & Ladavas, E. (2004). Recovery
of oculo-motor bias in neglect patients after prism adaptation. Neuropsychologia, 42(9), 1223-1234.
Angeli, V., Meneghello, F., Mattioli, F., & Ladavas, E. (2004). Mechanisms underlying visuo-spatial amelioration of neglect after prism adaptation. Cortex, 40(1), 155-156.
Appelros, P., Nydevik, I., Karlsson, G. M., Thorwalls, A. & Seiger, A. (2003). Assessing unilateral neglect: shortcomings of standard test methods. Disability & Rehabilitation, 25(9), 473-479.
Arene, N. U. & Hillis, A. E. (2007). Rehabilitation of unilateral spatial neglect and neuroimaging. Europa Medicophysica, 43, 255-269.
Azouvi1, P., Samuel1, C., Louis-Dreyfus1, A., Bernati, T., Bartolomeo, P., Beis, J-M., Chokron, S., Leclercq, M., Marchal, F., Martin, Y., de Montety, G., Olivier, S., Perennou, D., Pradat-Diehl, P., Prairial, C., Rode, G., Siéroff, E., Wiart, L. & Rousseaux, M. (2002). Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke. Journal of Neurology Neurosurgery and Psychiatry, 73, 160-166.
Behrmann, M., Watt, S., Black, S. E., & Barton, J. J. S. (1997). Impaired visual search in patients with unilateral neglect: an oculographic analysis. Neuropsychologia, 35(11), 1445-1458.
Coulthard, E., Parton, A. & Husain, M. (2006). Action control in visual neglect. Neuropsychologia, 44(13), 2717-2733.
Courtois-Jacquin, S., Rossetti, Y., Rode, G., Fischer, C., Michel, C., Allard, C., & Boission, D. (2001). Effect of prism adaptation on auditory extinction: an attentional effect? International Symposium on Neural Control of Space Coding and Action Production, 22-24.
Datié, A. M., Paysanta, J., Destainvillea, S., Sageza, A., Beisa, J. M. & André, J. M. (2006). Eye movements and visuoverbal descriptions exhibit heterogeneous and dissociated patterns before and after prismatic adaptation in unilateral spatial neglect. European Journal of Neurology, 13, 772-779.
Dijkerman, H. C., McIntosh, R. D., Milner, A. D., Rossetti, Y., Tilikete, C., & Roberts, R. C. (2003). Ocular scanning and perceptual size distortion in hemispatial neglect: effects of prism adaptation and sequential stimulus presentation. Experimental Brain Research, 153(2), 220-230.
Dijkerman, H. C., Webeling, M., ter Wal, J. M., Groet, E., & van Zandvoort, M. J. E. (2004). A long-lasting improvement of somatosensory function after prism adaptation, a case study. Neuropsychologia, 42(12), 1697-1702.
Doricchi, F., Guariglia, P., Figliozzi, F., Silvetti, M., Bruno, G., & Gasparini, M. (2005). Causes of cross-over in unilateral neglect: between-group comparisons, within-patient dissociations and eye movements. Brain, 128(6), 1386.
Fisk, J. D. & Goodale, M. A. (1988). The effects of unilateral brain-damage on visually guided reaching: hemispheric differences in the nature of the deficit. Experimental Brain Research, 77(2), 425-435.
Farnè, A., Rossetti, Y., Toniolo, S., & Ladavas, E. (2002). Ameliorating neglect with prism adaptation: visuo-manual and visuo-verbal measures. Neuropsychologia, 40(7), 718-729.
Ferber, S., Danckert, J., Joanisse, M., Goltz, H. C., & Goodale, M. A. (2003). Eye movements tell only half the story. Neurology, 60(11), 1826-1829.
Frassinetti, F., Angeli, V., Meneghello, F., Avanzi, S., & Ladavas, E. (2002). Long-lasting amelioration of visuospatial neglect by prism adaptation. Brain, 125(3), 608-623.
Gillen, G. (2007). Cognitive and Perceptual Rehabilitation: Optimizing Function (pp.32-44). US: Mosby Elevier
Goodale, M. A, Milner, A. D., Jakobson, L. S. & Carey, D. P. (1990). Kinematic analysis of limb movements in neuropsychological research: Subtle deficits and recovery of function. Canadian Journal of Psychology, 44(2), 180-195.
Golisz, K. W. & Toglia J. P. (2003). Evaluation of Performance Skills and Client Factors: section II: Perception and Cognition. In E. B. Crepeau , E. S. Cohn , & B. A. B. Schell. (Eds.), Wallard and Spackman’s occupation therapy (10th ed., pp.365-426). Philadelphia: Lippincott, Williams & Wilkins.
Heilman, K. M., Bowers, D., Coslett, H. B., Whelan, H. & Watson, R. T. (1985). Directional hypokinesia: Prolonged reaction times for leftward movements in patients with right hemisphere lesions and neglect. Neurology, 35(6), 855-859.
Himmelbach, M. & Karnath, H. (2003). Goal-directed hand movements are not affected by the biased space representation in spatial neglect. Journal of Cognitive Neuroscience, 15(7), 972-980.
Harvey, M., Milner, A. D. & Roberts, R. C. (1994). Spatial bias in visually-guided reaching and bisection following right cerebral stroke. Cortex, 30(2), 343-50.
Halligan, P. W., Marshall, J. C., & Wade, D. T. (1989). Visuaospatial neglect: Underlying factors and sensitivity. Lancet, 2, 908-911.
Heilman, K. M., Watson, R. T., & Valenstein, E. (1993). Neglect and related disorders. In K. M. Heillman & E. Valenstein (Eds.). Clinical neuropsychology (pp. 279-336). New York: Oxford University Press.
Humphreys, G. W., Watelet, A., & Riddoch, M. J. (2006). Long-term effects of prism adaptation in chronic visual neglect: A single case study. Cognitive Neuropsychology, 23, 463-478.
Jackson, S. R., Newport, R., Husian, M., Harvey, M. & Hindle , J. V. (2000). Reaching movements may reveal the distorted topography of spatial representation after neglect. Neuropsychologia, 38, 500-507.
Jacquin-Courtois, S., Rode, G., Pisella, L., Boisson, D. & Rosseti, Y. (2008). Wheel-chair driving improvement following viauo-manual prism adaptation. Cortex, 44, 90-96.
Karnath, H., Dick, H. & Konczak, J. (1997). Kinematics of goal-directed arm movements in neglect: Control of hand in space. Neuropsychologia, 35(4), 435-444.
Katz, N., Hartman-Maeir, A., Ring, H., & Soroker, N. (1999). Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect. Archives of Physical Medicine & Rehabilitation, 80(4), 379-384.
Konczak, J. & Karnath, H. O. (1998). Kinematics of goal-directed arm movements in neglect: Control of hand velocity. Brain and Cognition, 37(3), 387-403
Keane, S., Turner, C., Sherrington, C., & Beard, J. R. (2006). Use of fresnel prism glasses to treat stroke patients with hemispatial neglect. Archives of Physical Medicine & Rehabilitation, 87(12), 1668-1672.
Linden, M. A., Crothers, I. R., & Rauch, R. J. (2006). Exploring eye movement analysis as a measure of selective visual attention in brain injured individuals. Brain Injury, 20, 143-150.
Luaute, J., Halligan, P., Rode, G., Rossetti, Y., & Boisson, D. (2006). Visuo-spatial neglect: a systematic review of current interventions and their effectiveness. Neuroscience & Biobehavioral Reviews, 30(7), 961-982.
Land, M. F. & Hayhoe, M. (2001). In what ways do eye movements contribute to everyday activities? Vision Research, 41, 3559-3565.
Land, M., Mennie, N. & Rusted, J. (1999). The role of vision and eye movements in the control of activities of daily living. Perception, 28, 1311-1328.
Morton, S. M., & Bastian, A. J. (2004). Prism adaptation during walking generalizes to reaching and requires the cerebellum. Journal of neurophysiology, 92, 2497-2509.
Mattingley, J. B., Phillipsa, J. G. & Bradshawa, J. L. (1994). Impairments of movement execution in unilateral neglect: A kinematic analysis of directional bradyskinesia. Neuropsychologia, 32(9), 1111-1134.
Morris, A. P., Kritikos, A., Berberovic, N., Pisella, L., Champers, D. C., & Mattingley, J. B. (2004). Prism adaptation and spatial attention: A study of visual search in normals and patients with unilateral neglect. Cortex, 40, 703–721.
Menon, A. & Korner-Bitensky, N. (2002). Evaluating unilateral spatial neglect post stroke: working your way through the maze of assessment choices. Topics in Stroke Rehabilitation, 11(3), 41-66.
Maravita, A., McNeil, J., Malhotra, P., Greenwood, R., Husain, M., & Driver, J. (2003). Prism adaptation can improve contralesional tactile perception in neglect. Neurology, 60(11), 1829-1831.
Nijboer, T., Vree, A., Dijkerman, C. & Stigchel, S. V. (2010). Prism adaptation influences perception but not attention: Evidence from antisaccades. Neuroreport, 21, 386-389.
Ota, H., Fujii, T., Suzuki, K., Fukatsu, R., & Yamadori, A. (2001). Dissociation of body-centered and stimulus-centered representations in unilateral neglect. Neurology, 57, 2064-2069.
Plummer, P., Norris, M. E. & Dunai, J. (2003). Assessment of unilateral neglect. Physical Therapy, 83(8), 732-740.
Pisella, L., Rode, G., Farne, A., Boisson, D., & Rossetti, Y. (2002). Dissociated long lasting improvements of straight-ahead pointing and line bisection tasks in two hemineglect patients. Neuropsychologia, 40(3), 327-334.
Quintana, L. A. (2002). Optimizing Vision, Visual Perception, and Praxis Abilities. In Trombly, C. A. & Radomski M. V. (5th Eds.), Occupational Therapy for Physical Dysfunction(pp.597-608). Philadelphia: Lippincott, Williams & Wilkins.
Radomski, M. V. (2002). Planning, Guiding, and Documenting Therapy. In Trombly, C. A. & Radomski M. V. (5th Eds.), Occupational Therapy for Physical Dysfunction(pp.443-461). Philadelphia: Lippincott, Williams & Wilkins.
Redding, G. M. & Wallace, B. (2005). Prism adaptation and unilateral neglect: Review and analysis. Neuropsychologia, 44(1), 1-20.
Rode, G., Klos, T., Courtois-Jacquin, S., Rossetti, Y.& Pisella, L. (2006). Neglect and prism adaptation: A new therapeutic tool for spatial cognition disorders. Restorative Neurology and Neuroscience, 24, 347-356.
Rode, G., Rossetti, Y., & Boisson, D. (2001). Prism adaptation improves representational neglect. Neuropsychologia, 39(11), 1250-1254.
Rossetti, Y., Rode, G., Pisella, L., Farne, A., Li, L., Boisson, D. & Marie-Therese, P. (1998). Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect. Nature, 395(6698), 166-169.
Rousseaux, M., Bernati, T., Saj, A., & Kozlowski, O. (2006). Ineffectiveness of prism adaptation on spatial neglect signs. Stroke, 37(2), 542-543.
Sarri, M., Greenwood, R., Kalra, L., Papps, B., Husain, M. & Driver, J. (2008). Prism adaptation aftereffects in stroke patients with spatial neglect: Pathological effects on subjective straight ahead but not visual open-loop pointing. Neuropsychologia, 46, 1069-1080.
Sarri, M., Kalra, L., Greenwood, R., & Driver, J. (2006). Prism adaptation changes perceptual awareness for chimeric visual objects but not for chimeric faces in spatial neglect after right-hemisphere stroke. Neurocase, 12(3), 127-135.
Seidel, A. C. (2003).Theories Derived from Rehabilititation Perspective: section II: Rehabilitation Frame of Reference. In E. B. Crepeau , E. S. Cohn , & B. A. B. Schell. (Eds.), Wallard and Spackman’s occupation therapy(10th ed., pp.240-242). Philadelphia: Lippincott, Williams & Wilkins.
Serino, A., Angeli, V., Frassinetti, F., & Ladavas, E. (2006). Mechanisms underlying neglect recovery after prism adaptation. Neuropsychologia, 44(7), 1068-1078.
Serino, A., Bonifazi, S., Pierfederici, L., & Ladavas, E. (2007). Neglect treatment by prism adaptation: What recovers and for how long. Neuropsychol Rehabil, 17(6), 657-687.
Serino, A., Barbiani, M., Rinaldesi, M. L. & Làdavas, E. (2009). Effectiveness of prism adaptation in neglect rehabilitation: A controlled trail study. Stroke, 40, 1392-1398.
Saevarsson, S., Kristjánsson, Á., Hildebrandt, H. & Halsband, U. (2009). Prism adaptation improves visual search in hemispatial neglect. Neueropsychologia, 47, 717-725.
Sheliga, B. M., Riggio, L. & Rizzolatti, G. (1994). Orienting of attention and eye movements. Experimental Brain Research, 98(3), 507-522.
Shinsha, H. A., ＆ Ishigami, I. A. (1999). Rehabilitation approach to patients with unilateral spatial neglect. Topics in Stroke Rehabilitation, 6, 1-14.
Stone, S. P., Halligan, P. W., & Greenwood, R. J. (1993). The incidence of neglect phenomena and related disorders in patients with an acute right or left hemisphere stroke. Age and Ageing, 22, 46-52.
Stone, S. P., Patel, P., Greenwood, R. J. ＆ Halligan, P. W. (1992). Measuring visual neglect in acute stroke and predicting its recovery: the visual neglect index. Journal of Neurology, Neurosurgery, and Psychiatry, 55, 431-436.
Turton, A. J., O’Leary, K., Gabb, J., Woodward, R. & Gilchrist, I. D. (2010). A single blinded randomised controlled pilot trial of prism adaptation for improving self-care in stroke patients with neglect. Neuropsychological Rehabilitation, 20(2), 180-196.
Tilikete, C., Rode, G., Rossetti, Y., Pichon, J., Li, L., & Boisson, D. (2001). Prism adaptation to rightward optical deviation improves postural imbalance in left-hemiparetic patients. Current Biology, 11(7), 524-528.
Toglia, J. P. (2003). Interventions to improve personal skills and abilities. In E. B. Crepeau , E. S. Cohn , & B. A. B. Schell. (Eds.), Wallard and Spackman’s occupation therapy(10th ed., pp.579-650). Philadelphia: Lippincott, Williams & Wilkins.
Valler, G. ＆ Perani, D. (1986). The anatomy of unilateral neglect after right-hemisphere stroke lesions. A clinical/CT scan correlation study in man. Neuropsychologia, 24,609-622.
Watanabe, S. & Amimoto, K. (2010). Generalization of prism adaptation for wheelchair driving task in patients with unilateral spatial neglect. Archives of Physical Medicine and Rehabilitation, 91, 443-447.
Wilson B, Cockburn J, Halligan P. Behavioural Inattention Test. Titchfield Hants, England: Thames Valley Test Company; 1987.
Zoccolotti, P., Antonucci, G., Judica, A., Montenero, P., Pizzamiglio, L.＆Razzano, C. (1989). Incidence and Evolution of hemineglect disorder in chronic patients with unilateral right brain damage. The International Journal of Neuroscience, 47, 209-216.