Prism adaptation improves voluntary but not automatic orienting in neglect

Prism adaptation has been shown to temporarily ameliorate the symptoms of unilateral neglect. The underlying mechanisms of change are not yet fully understood. In this study, we investigate the influence of this treatment on attentional orienting under conditions of exogenous (peripheral onset) and endogenous (central symbolic) cueing. In one patient with left visual extinction and recovered neglect, and another patient with left visual neglect, visuo-motor adaptation to a rightward prismatic shift of 10 degrees improved leftward orienting of attention following an endogenous but not an exogenous cue; leftward re-orienting of attention was also improved in the endogenous task for the second patient. We suggest that prism adaptation may ameliorate neglect by improving compensatory processes of leftward voluntary orienting, rather than by a fundamental change in attentional bias.