---
title: "EMPATH trial: Mobile prism adaptation (Peg-the-Mole) for post-stroke spatial neglect"
id: "pubmed-42607058"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42607058"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42607058/"
doi: "10.1371/journal.pone.0356055"
published_at: "2026-08-17T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# EMPATH trial: Mobile prism adaptation (Peg-the-Mole) for post-stroke spatial neglect
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42607058
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42607058/)
- **DOI:** [10.1371/journal.pone.0356055](https://doi.org/10.1371%2Fjournal.pone.0356055)
- **Published At:** 2026-08-17T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The EMPATH protocol describes a randomized, double-blind, quasi-randomized controlled trial testing a gamified, mobile **prism adaptation** procedure called **Peg-the-Mole** for treating **spatial neglect** after right-hemisphere stroke. - The study will enroll 42 participants with mild to severe neglect following right-hemisphere stroke and randomize them to intervention or active control groups. - Intervention uses 15° rightward-deviating prism goggles with Peg-the-Mole; active control uses 5° rightward-deviating prism goggles with the same procedure. - Participants complete 10 treatment sessions over 2 weeks, performing 15 minutes of Peg-the-Mole daily. - Blinded assessments occur immediately before and after the treatment course and at one-month follow-up. - The primary outcome is the Star Cancellation conventional subtest of the **Behavioural Inattention Test** (BIT). - Secondary outcomes include additional BIT subtests, an Eschenbeck Standardized Activities of Daily Living subtest, caregiver- and self-reported Halifax Neglect Impact Scale forms, measures of feasibility and acceptability, prism adaptation after-effects, the Hospital Anxiety and Depression Scale, and the Fatigue Severity Scale. - The protocol emphasizes portability, engagement, and potential for inpatient and community implementation to improve accessibility and adherence to prism adaptation therapy. - Trial registration: ClinicalTrials.gov NCT05595668; registered October 27, 2022. - Authors declared no competing interests; full affiliation details and DOI are provided in the source.
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Affiliations Expand ### Affiliations * 1 Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada. * 2 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. * 3 Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. * PMID: **42607058** * DOI: [ 10.1371/journal.pone.0356055 ](https://doi.org/10.1371/journal.pone.0356055) Item in Clipboard Randomized Controlled Trial # EMPATH protocol: Randomized, double-blind trial of an Engaging and Mobile Prism Adaptation Treatment for spatial neglect in Home and rehabilitation settings Catrina MacPhee et al. PLoS One. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS One Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+One%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+One%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42607058/) . 2026 Aug 17;21(8):e0356055. doi: 10.1371/journal.pone.0356055. eCollection 2026. ### Authors [Catrina MacPhee](https://pubmed.ncbi.nlm.nih.gov/?term=MacPhee+C&cauthor_id=42607058)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42607058/#short-view-affiliation-1 "Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada."), [Gail Eskes](https://pubmed.ncbi.nlm.nih.gov/?term=Eskes+G&cauthor_id=42607058)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42607058/#short-view-affiliation-1 "Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42607058/#short-view-affiliation-2 "Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada."), [Sean P Mackinnon](https://pubmed.ncbi.nlm.nih.gov/?term=Mackinnon+SP&cauthor_id=42607058)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42607058/#short-view-affiliation-1 "Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada."), [Anne Sophie Champod](https://pubmed.ncbi.nlm.nih.gov/?term=Champod+AS&cauthor_id=42607058)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42607058/#short-view-affiliation-1 "Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42607058/#short-view-affiliation-2 "Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42607058/#short-view-affiliation-3 "Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada.") ### Affiliations * 1 Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada. * 2 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. * 3 Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. * PMID: **42607058** * DOI: [ 10.1371/journal.pone.0356055 ](https://doi.org/10.1371/journal.pone.0356055) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **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](http://clinicaltrials.gov/show/NCT05595668 "See in ClinicalTrials.gov"); registered October 27, 2022. Copyright: © 2026 MacPhee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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