Miglioramento del recupero cognitivo e della neuroplasticità in pazienti con ictus: uno studio pilota sull'Adattamento Prismatico combinato con Serious Games

Stroke is the second leading cause of death and the third leading cause of serious long-term disability among non-communicable disorders. Functional and cognitive impairment are frequent after a stroke, hindering patients’ independence and quality of life. Prism Adaptation (PA) is a promising treatment in right-brain lesions (RBL) and spatial neglect. However, PA effects are scarcely investigated in patients with left-brain (LBL) lesions. Moreover, research suggests PA may increase cortical excitability, with effects similar to those of other neuromodulatory techniques. Leveraging this hypothesis, preliminary studies combining PA with Serious Games (SG) for improving visual-constructive abilities in stroke patients reported improved cognitive outcomes. However, it remains unclear whether these benefits arise from the combination of PA and SG, or from SG alone. To address these questions, this study first examined differences in pointing deviation task performance during PA across patients with RBL, LBL, and healthy controls (HC). Subsequently, it compared the efficacy in improving cognitive performance of PA combined with SG to SG alone and to a traditional cognitive training, as well as changes in plasticity-related mechanisms by analyzing pre- to post-treatment levels of the Brain-Derived Neurotrophic Factor (BDNF). In the pointing deviation task, RBL patients exhibited significantly greater rightward deviations than HC in the Pre-Adaptation phase, likely indicating spatial neglect, and overall in pointing to leftward-presented stimuli. Conversely, LBL patients showed greater leftward deviations than HC in the Pre-Adaptation phase, also suggesting the presence of right-spatial neglect, and when responding to rightward-presented stimuli. Comparisons between patient groups revealed that LBL patients showed higher magnitude of after-effect, suggesting they may have benefitted more from the adaptation procedure. Regarding treatment efficacy, between-group comparisons showed that the PA+SG group performed significantly better on the Attentional Matrices test than patients undergoing standard rehabilitation. Moreover, they performed better on the digit learning test and made fewer perseverative errors on the MSCT than the SG-only group. In within-group comparisons, the PA+SG group showed significant pre- to post-treatment improvements in Attentional Matrices, Phonological Fluency, and Rey Complex Figure Delayed Recall. The other two groups did not show any significant improvements. Moreover, the magnitude of the after-effect was found to predict the performance on Attentional Matrices and Phonological Fluency. However, no significant pre-to-post treatment changes were observed in BDNF serum levels. Overall, these findings suggest that PA may help alleviate neglect across both lesion sides, highlighting the importance of extending research to include LBL rather than focusing exclusively on RBL. In addition, the results support the idea that integrating PA into SG treatment may enhance its efficacy, outperforming both SG alone and traditional approaches in specific cognitive domains.