THE
BEST
STUDY
Best Evidence Stroke Therapies
HOW TO GUIDE: PRISM ADAPTATION
INTENSITY AND DURATION
Nil dose-response specific findings
Recommend minimum 10 brief (15-30mins) sessions over a two-week period.
Number of repetitions or session length varied.
Follow up booster sessions may be considered.
Prisms to be worn during therapy sessions only.
HOW TO?
1. Patient is seated at a table with three objects placed
to the left of midline, centre and to the right of
midline. The reaching trajectory area (from chest to
target) is covered so that the client cannot see the
movement of their arm towards the target.
2. Patient completes practice pointing to each target
(without wearing prism glasses).
3. Patient then wears prisms and completes pointing
to individual targets.
4. Prisms are removed and client again completes
pointing to target.
The stages of prism adaptation are described in this table (Jacquin-Courtois et al, 2013).
SPECIFIC STUDY
INTERVENTION PROTOCOLS
1. Kessler Foundation – Prism Adaptation Treatment.
Visit website for manual, assessment sheets, instructional videos and training opportunities.
https://kesslerfoundation.org/researchcenter/stroke/networkforspatialneglect.php
2. Mizuno et al 2011 – Prism Adaptation intervention
Summary of intervention: Repeated pointing movements to targets using the “unaffected” hand whilst wearing the prism glasses.
Intensity: 2 daily sessions, 20 minutes duration, 5 days/week for 2 weeks – totaling 20 sessions.
Intervention program
1. Patient sit at a desk on which a wooden table (height 30cm) was placed.
2. Top of the table has 3 targets marked at centre, right and left corners of its edge.
3. Distance between patient and target adjusted to arm’s length.
4. Patient points to individual target as randomly chosen by therapist (arm under table to block vision of reach) with non-affected hand.
5. Patient instructed to move hand as quickly as possible.
6. Patient points 30 times without wear of prism glasses.
7. Patient then wears prism glasses and repeats pointing 90 times.
8. Patient removes prisms and repeats pointing 60 times.
Study result: Patient s with mild unilateral spatial neglect post stroke (subacute) improved FIM and BIT scores. Severe neglect did not
demonstrate significant FIM changes compared to control group.
Reference: Mizuno, K. et al (2011). Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial; neglect:
a randomised controlled trial. Neurorehabilitation and Neural Repair, 25(8) 711-720.