The practical constraints of developing new therapies for hemi-spatial neglect in the US and UK.

Hemi-spatial neglect is a disabling, neuropsychological impairment that restricts the ability to attend to incoming information on one side space. Most frequently associated with a lesion to the right hemisphere, the disorder is strongly predictive of general functional recovery from stroke. Although the standard therapy is of limited effectiveness, pilot studies indicate that more effective treatments may follow. Interest in these new potential treatments is, however, beginning to wane as few have progressed to the stage of randomised, controlled clinical trials. In this brief commentary, we point out that the absence of trials data not only reflects the preliminary nature of new treatments, but also the practical difficulties associated with meeting the target enrolment figures of large-scale trials. These problems have likewise slowed the development of treatments for other cognitive disorders. We suggest ways in which this problem may be overcome.