Spatial neglect is a common attentional disorder after stroke that is associated with poorer rehabilitation outcomes and reduced independence in daily living. Despite evidence supporting prism adaptation as a promising intervention for neglect, clinical uptake has been limited by barriers such as restricted accessibility, the repetitive nature of traditional training, and the need for specialized equipment. The EMPATH protocol proposes a portable, gamified, computerized prism adaptation procedure—named Peg-the-Mole—designed to increase engagement, accessibility, and adherence in both inpatient and community rehabilitation settings.
The study uses a longitudinal, double-blind, quasi-randomized, controlled design. A total of 42 participants with right-hemisphere stroke and mild to severe spatial neglect will be allocated to one of two groups. The trial compares two levels of prism deviation while preserving participant engagement and task structure across arms to control for non-specific effects of the intervention.
Eligible participants are adults with right-hemisphere stroke who demonstrate mild to severe symptoms of spatial neglect. The source provides the planned sample size of 42 individuals. Additional inclusion and exclusion criteria, recruitment pathways, and screening procedures were not reported in detail in the source abstract.
Participants will be quasi-randomized into:
Both arms use the same gamified, mobile computerized procedure to isolate the therapeutic effect of a clinically meaningful prism deviation compared with a smaller deviation control.
Each participant will complete 10 treatment sessions over a 2-week period. Sessions consist of engaging with the Peg-the-Mole procedure for 15 minutes daily. The study is designed to allow delivery in both inpatient and outpatient community rehabilitation settings. The source does not provide additional procedural specifics about the Peg-the-Mole tasks, hardware specifications, or exact session structure beyond session length and frequency.
The primary outcome is the Star Cancellation conventional subtest of the Behavioural Inattention Test (BIT). Secondary outcome measures include additional conventional and behavioural subtests of the BIT, one subtest of the Eschenbeck Standardized Activities of Daily Living battery, caregiver- and self-reported forms of the Halifax Neglect Impact Scale, objective measures of prism adaptation after-effects, and standard symptom scales: the Hospital Anxiety and Depression Scale and the Fatigue Severity Scale. The protocol also collects data on feasibility and acceptability of the Peg-the-Mole procedure.
The trial is described as double-blind: participants and outcome assessors are blinded to group allocation. The design is characterized as quasi-randomized; specific randomization procedures and allocation concealment methods were not detailed in the abstract provided.
Blinded assessments will take place at three time points: immediately before the treatment course (baseline), immediately after the 2-week treatment period (post-treatment), and at one-month follow-up. The source lists the primary and secondary instruments that will be used at these time points but does not provide the schedule of which specific secondary measures will be collected at each visit beyond general timing.
Planned feasibility and acceptability outcomes include participant adherence to the 10-session schedule and subjective acceptability as measured by study-specific data collection. The Peg-the-Mole platform’s portable and gamified format is intended to overcome previously identified barriers to prism adaptation delivery. The source abstract does not report results; it only outlines intent to measure these implementation outcomes as part of the trial.
The protocol authors posit that the Peg-the-Mole procedure could improve recovery and quality of life after stroke by increasing accessibility and adherence to prism adaptation therapy. The gamified mobile approach aims to facilitate implementation in both inpatient and community rehabilitation contexts. The abstract emphasizes that trial findings will inform whether this mobile prism adaptation intervention can be effectively and acceptably integrated into routine care to reduce neglect symptoms and improve daily functioning.
The trial is registered on ClinicalTrials.gov under identifier NCT05595668; registration date reported in the source is October 27, 2022. The source includes DOI information for the published protocol. The abstract does not specify ethical approval details beyond trial registration.
The authors declared that no competing interests exist in the source abstract.