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Luvizutto GJ, Moliga AF, Rizzatti GRS, Fogaroli MO, de Moura E, Nunes HRDC, Resende LADL, Bazan R. Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity. Clinics (Sao Paulo) 2018; 73:e131. [PMID: 29791600 PMCID: PMC5952049 DOI: 10.6061/clinics/2018/e131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/13/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors. RESULTS We studied 60 patients with a median age of 68 (34-89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03-1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13-2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78-0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48-0.92], p=0.017). CONCLUSION The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.
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Affiliation(s)
- Gustavo José Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG, BR
- *Corresponding author. E-mail:
| | - Augusta Fabiana Moliga
- Departamento de Reabilitacao, Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP, BR
| | | | | | - Eduardo de Moura
- Departamento de Fisioterapia, Faculdade de Talentos Humanos (FACTHUS), Uberaba, MG, BR
| | | | | | - Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP, BR
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Martín-Arévalo E, Schintu S, Farnè A, Pisella L, Reilly KT. Adaptation to Leftward Shifting Prisms Alters Motor Interhemispheric Inhibition. Cereb Cortex 2018; 28:528-537. [PMID: 27993820 PMCID: PMC6248503 DOI: 10.1093/cercor/bhw386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 11/14/2022] Open
Abstract
Adaptation to rightward shifting prisms (rightward prism adaptation, RPA) ameliorates neglect symptoms in patients while adaptation to leftward shifting prisms (leftward prism adaptation, LPA) induces neglect-like behaviors in healthy subjects. It has been hypothesized that prism adaptation (PA) modulates interhemispheric balance between the parietal cortices by inhibiting the posterior parietal cortex (PPC) contralateral to the prismatic deviation, but PA's effects on interhemispheric inhibition (IHI) have not been directly investigated. Since there are hyper-excitable connections between the PPC and primary motor cortex (M1) in the left hemisphere of neglect patients, we reasoned that LPA might mimic right hemisphere lesions by reducing parietal IHI, hyper-exciting the left PPC and PPC-M1 connections, and in turn altering IHI at the motor level. Namely, we hypothesized that LPA would increase IHI from the left to the right M1. We examined changes in left-to-right and right-to-left IHI between the 2 M1s using the ipsilateral silent period (iSP) (Meyer et al. 1995) before and after either LPA or RPA. The iSP was significantly longer after LPA but only from left-to-right and it did not change at all after RPA. This is the first physiological demonstration that LPA alters IHI in the healthy brain.
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Affiliation(s)
- Elisa Martín-Arévalo
- ImpAct team, Lyon Neuroscience Research Center, INSERM
U1028, CRNS-UMR5292, 16 Ave. Doyen Lépine, 69676 Bron
Cedex, France
- Lyon 1 University, F-69373 Lyon, France
| | - Selene Schintu
- ImpAct team, Lyon Neuroscience Research Center, INSERM
U1028, CRNS-UMR5292, 16 Ave. Doyen Lépine, 69676 Bron
Cedex, France
- Lyon 1 University, F-69373 Lyon, France
- Behavioral Neurology Unit, National Institute of
Neurological Disorders and Stroke, National Institutes of Health,
10 Center Bethesda, MD, USA
| | - Alessandro Farnè
- ImpAct team, Lyon Neuroscience Research Center, INSERM
U1028, CRNS-UMR5292, 16 Ave. Doyen Lépine, 69676 Bron
Cedex, France
- Lyon 1 University, F-69373 Lyon, France
- Hospices Civils de Lyon, Neuro-immersion & Mouvement
et Handicap, F-69676 Lyon, France
| | - Laure Pisella
- ImpAct team, Lyon Neuroscience Research Center, INSERM
U1028, CRNS-UMR5292, 16 Ave. Doyen Lépine, 69676 Bron
Cedex, France
- Lyon 1 University, F-69373 Lyon, France
| | - Karen T Reilly
- ImpAct team, Lyon Neuroscience Research Center, INSERM
U1028, CRNS-UMR5292, 16 Ave. Doyen Lépine, 69676 Bron
Cedex, France
- Lyon 1 University, F-69373 Lyon, France
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Glize B, Lunven M, Rossetti Y, Revol P, Jacquin-Courtois S, Klinger E, Joseph PA, Rode G. Improvement of Navigation and Representation in Virtual Reality after Prism Adaptation in Neglect Patients. Front Psychol 2017; 8:2019. [PMID: 29209253 PMCID: PMC5701812 DOI: 10.3389/fpsyg.2017.02019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 11/06/2017] [Indexed: 11/13/2022] Open
Abstract
Prism adaptation (PA) is responsible for an expansion of sensori-motor after-effects to cognitive domains for patients with spatial neglect. One important question is whether the cognitive after-effects induced by PA may also concern higher aspects of spatial cognition, such as navigation and topographic memory, which are critical in everyday life. The aim of this study was to assess whether multiple sessions of right PA can affect navigation and topographic memory. Seven right brain-damaged (RBD) patients with chronic neglect were included. We used a virtual supermarket named VAP-S which is an original paradigm, similar to the "shopping list test" during which patients had to purchase items from a list of eight products. Furthermore, in order to assess generalization of PA effects on constructing a spatial map from virtual information, each participant was then asked to draw the map of the virtual supermarket from memory. Regarding navigation performance, significant results were obtained: session duration reduction, fewer numbers of pauses and omissions, more items purchased on the left side and more items purchased over all. A long-lasting effect was noted, up to one month after PA. The representational task performance was also significantly increased for map drawing, with a reduction of the right shift of the symmetry axis of the map, more items drawn on the left side of maps and over all, and more items correctly located on the map. Some of these effects lasted for at least 7 days. These results suggest an expansion of PA benefit to a virtual environment. Crucially, the cognitive benefits induced by PA were noted for complex spatial cognition tasks required in everyday life such as navigation and topographic memory and this improvement was maintained for up to 1 month.
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Affiliation(s)
- Bertrand Glize
- Centre de Recherche en Neurosciences de Lyon, ImpAct Team, Institut National de la Santé et de la Recherche Médicale U1028, Centre National de la Recherche Scientifique UMR5292, Université Claude Bernard Lyon 1, Lyon, France.,Service de Médecine Physique et de Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Lyon, France.,EA4136, Service de Médecine Physique et de Réadaptation, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Marine Lunven
- Centre de Recherche en Neurosciences de Lyon, ImpAct Team, Institut National de la Santé et de la Recherche Médicale U1028, Centre National de la Recherche Scientifique UMR5292, Université Claude Bernard Lyon 1, Lyon, France.,Service de Médecine Physique et de Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Lyon, France.,Groupe Hospitalier Pitié-Salpêtrière, Institut National de la Santé et de la Recherche Médicale U1127, UPMC-Paris 6, Centre National de la Recherche Scientifique UMR 7225, Institut du Cerveau et de la Moelle épinière ICM, Paris, France
| | - Yves Rossetti
- Centre de Recherche en Neurosciences de Lyon, ImpAct Team, Institut National de la Santé et de la Recherche Médicale U1028, Centre National de la Recherche Scientifique UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Patrice Revol
- Centre de Recherche en Neurosciences de Lyon, ImpAct Team, Institut National de la Santé et de la Recherche Médicale U1028, Centre National de la Recherche Scientifique UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Sophie Jacquin-Courtois
- Centre de Recherche en Neurosciences de Lyon, ImpAct Team, Institut National de la Santé et de la Recherche Médicale U1028, Centre National de la Recherche Scientifique UMR5292, Université Claude Bernard Lyon 1, Lyon, France.,Service de Médecine Physique et de Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Lyon, France
| | - Evelyne Klinger
- ESIEA, Digital Interactions Health and Disability, Laval, France.,Institut Fédératif de Recherche sur le HANDICAP, Paris, France
| | - Pierre-Alain Joseph
- EA4136, Service de Médecine Physique et de Réadaptation, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France.,Institut Fédératif de Recherche sur le HANDICAP, Paris, France
| | - Gilles Rode
- Centre de Recherche en Neurosciences de Lyon, ImpAct Team, Institut National de la Santé et de la Recherche Médicale U1028, Centre National de la Recherche Scientifique UMR5292, Université Claude Bernard Lyon 1, Lyon, France.,Service de Médecine Physique et de Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Lyon, France.,Institut Fédératif de Recherche sur le HANDICAP, Paris, France
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Spaccavento S, Cellamare F, Falcone R, Loverre A, Nardulli R. Effect of subtypes of neglect on functional outcome in stroke patients. Ann Phys Rehabil Med 2017; 60:376-381. [PMID: 28958616 DOI: 10.1016/j.rehab.2017.07.245] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Because of the loss of autonomy in daily-life activities, spatial neglect after stroke is one of the main causes of disability. According to the spatial domains, neglect can be divided into personal (body), peripersonal (reaching) and extrapersonal (far) space. We evaluated the effect of these subtypes of neglect on functional outcome of rehabilitation in stroke patients. METHODS A total of 1350 stroke patients were consecutively admitted into our neurorehabilitation unit from 2002 to 2016. We analyzed data for patients with a first ischemic or hemorrhagic right-hemispheric stroke in this observational retrospective study. The presence of neglect was evaluated by using structured tests for specific spatial domains. Patients underwent individual physical and occupational therapy, and those with neglect received specific therapy for 8 consecutive weeks consisting of visual scanning, reading and copying, copying line drawings on a dot matrix and describing scenes. The Functional Independence Measure (FIM) instrument was administered at both admission and discharge to assess functional autonomy. Rehabilitation effectiveness for FIM (percentage of potential improvement achieved) was calculated. Multiple regression analyses were performed. RESULTS Among 359 patients with right-brain damage, 130 showed left neglect, or unilateral spatial neglect (USN), and 229 only left hemiparesis, without neglect. Overall, 90 patients (69%) with USN showed peripersonal neglect, 89 (68%) extrapersonal neglect and 60 (46%) personal neglect. Functional motor and cognitive impairment was greater with than without USN as measured by FIM at admission and discharge and the rehabilitation hospital stay was longer. USN affected functional status at admission and rehabilitation effectiveness for FIM. Extrapersonal and peripersonal neglect significantly affected both function at admission and effectiveness. CONCLUSIONS Our data confirm the negative prognostic effect of neglect on functional outcome in a large sample. We also show the importance of evaluating and training according to neglect subtype to improve functional independence.
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Affiliation(s)
- Simona Spaccavento
- Neuroriabilitation Unit, ICS Maugeri SPA SB, Institute of Cassano Murge, I.R.C.C.S., Via per Mercadante Km 2, 70020 Cassano Murge (Bari), Italy.
| | - Fara Cellamare
- Neuroriabilitation Unit, ICS Maugeri SPA SB, Institute of Cassano Murge, I.R.C.C.S., Via per Mercadante Km 2, 70020 Cassano Murge (Bari), Italy
| | - Rosanna Falcone
- Neuroriabilitation Unit, ICS Maugeri SPA SB, Institute of Cassano Murge, I.R.C.C.S., Via per Mercadante Km 2, 70020 Cassano Murge (Bari), Italy
| | - Anna Loverre
- Neuroriabilitation Unit, ICS Maugeri SPA SB, Institute of Cassano Murge, I.R.C.C.S., Via per Mercadante Km 2, 70020 Cassano Murge (Bari), Italy
| | - Roberto Nardulli
- Neuroriabilitation Unit, ICS Maugeri SPA SB, Institute of Cassano Murge, I.R.C.C.S., Via per Mercadante Km 2, 70020 Cassano Murge (Bari), Italy
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Tobler-Ammann BC, Surer E, de Bruin ED, Rabuffetti M, Borghese NA, Mainetti R, Pirovano M, Wittwer L, Knols RH. Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study. JMIR Serious Games 2017; 5:e17. [PMID: 28842388 PMCID: PMC5591404 DOI: 10.2196/games.7923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 01/08/2023] Open
Abstract
Background Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames—games based on therapeutic principles—aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. Objectives The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. Methods A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. Results The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%). Conclusions The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations—for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.
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Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute (CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Marco Rabuffetti
- Polo Tecnologico, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Renato Mainetti
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Michele Pirovano
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Lia Wittwer
- Parkinson Center, Epileptology, Neurorehabilitation, Clinic Bethesda, Tschugg, Switzerland
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
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Tobler-Ammann BC, Surer E, Knols RH, Borghese NA, de Bruin ED. User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study. JMIR Serious Games 2017; 5:e18. [PMID: 28842390 PMCID: PMC5591406 DOI: 10.2196/games.8013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/12/2017] [Accepted: 07/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. OBJECTIVE The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. METHODS A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. RESULTS The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. CONCLUSIONS Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. TRIAL REGISTRATION Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ).
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Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Nyffeler T, Paladini RE, Hopfner S, Job O, Nef T, Pflugshaupt T, Vanbellingen T, Bohlhalter S, Müri RM, Kerkhoff G, Cazzoli D. Contralesional Trunk Rotation Dissociates Real vs. Pseudo-Visual Field Defects due to Visual Neglect in Stroke Patients. Front Neurol 2017; 8:411. [PMID: 28861036 PMCID: PMC5562679 DOI: 10.3389/fneur.2017.00411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022] Open
Abstract
In stroke patients, the clinical presentation of visual field defects (VFDs) is frequently accompanied by visual neglect, i.e., the inability to attend and respond to the contralesional space. However, the diagnostic discrimination between the lack of reactions to contralesional stimuli due to VFDs or visual neglect is challenging during clinical examination. This discrimination is particularly relevant, since both clinical pictures are associated with different therapeutic approaches and outcomes. The aim of this study was to systematically investigate the effectiveness of trunk rotation toward the contralesional side-a manipulation dissociating the coordinate system of the trunk from that of the head and eyes-in disentangling real VFDs from "pseudo-VFDs" that occur due to visual neglect. Twenty patients with a left-sided VFD after a right-hemispheric stroke (10 additionally showing visual neglect in neuropsychological testing, VFD + neglect; 10 without neglect, VFD) were tested with Goldmann perimetry in both standard and trunk rotation conditions. In the standard condition, both VFD and VFD + neglect patients showed a conspicuous narrowing of the left visual field. However, trunk rotation triggered strikingly different patterns of change in the two groups: it elicited a significant increase in visual field extension in the VFD + neglect group, but left visual field extension virtually unchanged in the VFD group. Our results highlight contralesional trunk rotation as a simple, viable manipulation to effectively and rapidly disentangle real VFDs from "pseudo-VFDs" (i.e., due to visual neglect) during clinical examination.
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Affiliation(s)
- Thomas Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Rebecca E. Paladini
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Simone Hopfner
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Oliver Job
- Eye Clinic, Luzerner Kantonsspital, Luzern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tobias Pflugshaupt
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Tim Vanbellingen
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stephan Bohlhalter
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - René M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- University Neurorehabilitation Clinics, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Georg Kerkhoff
- Clinical Neuropsychology and Neuropsychological Outpatient Unit, Saarland University, Saarbrücken, Germany
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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58
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Prism adaptation speeds reach initiation in the direction of the prism after-effect. Exp Brain Res 2017; 235:3193-3206. [DOI: 10.1007/s00221-017-5038-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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59
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Vanbellingen T, Ottiger B, Maaijwee N, Pflugshaupt T, Bohlhalter S, Müri RM, Nef T, Cazzoli D, Nyffeler T. Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living. Cerebrovasc Dis 2017; 44:122-127. [DOI: 10.1159/000477500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/12/2017] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose: Motor tests performed at stroke onset have been shown to predict the recovery of upper limb motor impairment. Less is known about upper limb recovery at the level of functional activity or of participation and how spatial neglect may influence the integration of the upper limb in the activities of daily living (ADL). Our objective was to investigate whether the initial severity of spatial neglect may predict upper limb use in ADL. Methods: Eighty-two patients with a right-hemispheric stroke (RHS) were prospectively included in the study. They were assessed twice in the acute/subacute and in the subacute/chronic phases (mean time interval of 45 days) after stroke. The Catherine Bergego Scale (CBS) was used to quantify the influence of spatial neglect on the ADL. Contralesional upper limb use in the ADL was evaluated with the Lucerne international classification of function, disability and health-based Multidisciplinary Observation Scale. Hand strength was measured using the Jamar, dexterity with the Nine Hole Peg test, and tactile perception using the stereognosis subtest of the Nottingham Sensory Assessment. Cognitive functions were assessed with the Montreal Cognitive Assessment. Results: Regression analyses revealed that spatial neglect is an independent and a significant predictor of upper limb outcome. A CBS score of ≤5 at the time of admission to neurorehabilitation care was highly predictive for good upper limb use in the ADL 45 days later. Conclusions: This study demonstrates that spatial neglect severity, as observed in the ADL, is a significant and an independent predictor of upper limb outcome. Neglect therapy is thus needed to further improve contralesional upper limb use in the ADL in RHS patients.
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Allart E, Delval A, Caux-Dedeystere A, Labreuche J, Viard R, Lopes R, Devanne H. Parietomotor connectivity in the contralesional hemisphere after stroke: A paired-pulse TMS study. Clin Neurophysiol 2017; 128:707-715. [DOI: 10.1016/j.clinph.2017.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/09/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
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Volkening K, Kerkhoff G, Keller I. Effects of repetitive galvanic vestibular stimulation on spatial neglect and verticality perception-a randomised sham-controlled trial. Neuropsychol Rehabil 2016; 28:1179-1196. [PMID: 27820972 DOI: 10.1080/09602011.2016.1248446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recent evidence shows that bipolar galvanic vestibular stimulation (GVS) with the cathode on the left (CL) or right (CR) mastoid ameliorates spatial neglect, extinction and verticality perception transiently and partly permanently. However, no randomised controlled trial evaluated the long-term effects of repetitive GVS in comparison to sham-GVS on exploration and verticality perception. To compare the effects of CL-GVS, CR-GVS and Sham-GVS on spatial exploration and verticality perception in right-hemispheric stroke patients with left neglect we conducted a randomised controlled trial with minimisation. Twenty-four patients completed 10-12 training sessions on a daily basis, 5 days/week. The CL-and CR-GVS group received 20 min of stimulation at 1.5 mA, the Sham-GVS group only 30 s of CL-GVS. Simultaneously, all patients performed a standard therapy of smooth pursuit eye movement training (SPT) followed by visual scanning training (VST). Outcome measures (Neglect test, visuo-tactile search task, subjective visual and tactile vertical) were assessed before and immediately after the intervention and at 2- and 4-week follow-ups. Our results show that neither our standard therapy nor the combination of standard therapy and GVS improved neglect symptoms significantly. The reasons for our non-significant results are discussed.
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Affiliation(s)
- Katharina Volkening
- a Department of Neuropsychology , Schoen Klinik Bad Aibling , Bad Aibling , Germany.,b German Center for Vertigo and Balance Disorders (IFB) , Ludwig-Maximilians-University , Munich , Germany
| | - Georg Kerkhoff
- c Clinical Neuropsychology & Neuropsychological University Clinic , Saar University , Saarbruecken , Germany
| | - Ingo Keller
- a Department of Neuropsychology , Schoen Klinik Bad Aibling , Bad Aibling , Germany
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Paired-Pulse Parietal-Motor Stimulation Differentially Modulates Corticospinal Excitability across Hemispheres When Combined with Prism Adaptation. Neural Plast 2016; 2016:5716179. [PMID: 27418979 PMCID: PMC4933861 DOI: 10.1155/2016/5716179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
Rightward prism adaptation ameliorates neglect symptoms while leftward prism adaptation (LPA) induces neglect-like biases in healthy individuals. Similarly, inhibitory repetitive transcranial magnetic stimulation (rTMS) on the right posterior parietal cortex (PPC) induces neglect-like behavior, whereas on the left PPC it ameliorates neglect symptoms and normalizes hyperexcitability of left hemisphere parietal-motor (PPC-M1) connectivity. Based on this analogy we hypothesized that LPA increases PPC-M1 excitability in the left hemisphere and decreases it in the right one. In an attempt to shed some light on the mechanisms underlying LPA's effects on cognition, we investigated this hypothesis in healthy individuals measuring PPC-M1 excitability with dual-site paired-pulse TMS (ppTMS). We found a left hemisphere increase and a right hemisphere decrease in the amplitude of motor evoked potentials elicited by paired as well as single pulses on M1. While this could indicate that LPA biases interhemispheric connectivity, it contradicts previous evidence that M1-only MEPs are unchanged after LPA. A control experiment showed that input-output curves were not affected by LPA per se. We conclude that LPA combined with ppTMS on PPC-M1 differentially alters the excitability of the left and right M1.
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Hreha K, Mulry C, Gross M, Jedziniak T, Gramas N, Ohevshalom L, Sheridan A, Szabo G, Davison C, Barrett AM. Assessing chronic stroke survivors with aphasia sheds light on prevalence of spatial neglect. Top Stroke Rehabil 2016; 24:91-98. [PMID: 27322860 DOI: 10.1080/10749357.2016.1196906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stroke is a chronic disease. Standardized assessment is essential in order to determine areas for treatment. Individuals with aphasia are often excluded from research, because it is believed that their language impairments may impact their ability to provide informed consent. Thus, right spatial neglect could be under-diagnosed. OBJECTIVE This study was developed to (1) determine the frequency of spatial neglect in chronic left-brain stroke survivors with aphasia, (2) determine the clinical utility of an aphasia-friendly consent form, and (3) determine any differences between neglect and no-neglect groups regarding activities of daily living (ADL) performance and community independence. METHODS Forty-six people were consented at community center. Three were screen failures secondary to the exclusion criteria. A novel, aphasia-friendly consent form was developed to facilitate participation of individuals with aphasia. This enabled 93% or 40 out of the 43 recruited participants to be included in this study. The Behavioral Inattention Test-conventional and the Catherine Bergego Scale via Kessler Foundation Neglect Assessment Process (CBS via KF-NAP) were utilized to determine neglect. The Life Space Questionnaire was used to determine community mobility and independence. The Barthel Index (BI) was used for objective clarification of performance in ADL. RESULTS Successful use of the consent form resulted in determination that five out of 40 (12.5%) met criteria for spatial neglect; (on the CBS via KF-NAP). The neglect group had lower scores on the Life Space, suggesting less community mobility and independence, however, it was not statistically significant (p = 0.16). Differences in BI scores were also not significant (p = .013) but the neglect group did have reduced independence. CONCLUSIONS This study demonstrates the need to administer functional neglect assessments in left-brain stroke and to include individuals with aphasia in research.
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Affiliation(s)
- Kimberly Hreha
- a Department of Medicine , Kessler Institute for Rehabilitation , Saddle Brook , NJ , USA.,b Stroke Lab, Kessler Foundation , West Orange , NJ , USA.,d Biobehavioral Sciences, Teachers College , Columbia University , New York , NY , USA
| | - Claire Mulry
- e Occupational Therapy Department , Kean University , Union , NJ , USA
| | - Melissa Gross
- e Occupational Therapy Department , Kean University , Union , NJ , USA
| | - Tarah Jedziniak
- e Occupational Therapy Department , Kean University , Union , NJ , USA
| | - Natanya Gramas
- e Occupational Therapy Department , Kean University , Union , NJ , USA
| | - Leora Ohevshalom
- e Occupational Therapy Department , Kean University , Union , NJ , USA
| | - Alisha Sheridan
- e Occupational Therapy Department , Kean University , Union , NJ , USA
| | - Gretchen Szabo
- f Speech Therapy Department , Adler Aphasia Center , Maywood , NJ , USA
| | - Christina Davison
- g Occupational Therapy Department , Genesis Rehab Services: Brandywine Senior Living at Middlebrook Crossing , Bridgewater , NJ , USA
| | - A M Barrett
- b Stroke Lab, Kessler Foundation , West Orange , NJ , USA.,c Rutgers - New Jersey Medical School , Newark , NJ , USA
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Klinke ME, Hjaltason H, Hafsteinsdóttir TB, Jónsdóttir H. Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study. Disabil Rehabil 2016; 38:2429-44. [DOI: 10.3109/09638288.2015.1130176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marianne E. Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Haukur Hjaltason
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thóra B. Hafsteinsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Convento S, Russo C, Zigiotto L, Bolognini N. Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation. EUROPEAN PSYCHOLOGIST 2016. [DOI: 10.1027/1016-9040/a000238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. Cognitive rehabilitation is an important area of neurological rehabilitation, which aims at the treatment of cognitive disorders due to acquired brain damage of different etiology, including stroke. Although the importance of cognitive rehabilitation for stroke survivors is well recognized, available cognitive treatments for neuropsychological disorders, such as spatial neglect, hemianopia, apraxia, and working memory, are overall still unsatisfactory. The growing body of evidence supporting the potential of the transcranial Electrical Stimulation (tES) as tool for interacting with neuroplasticity in the human brain, in turn for enhancing perceptual and cognitive functions, has obvious implications for the translation of this noninvasive brain stimulation technique into clinical settings, in particular for the development of tES as adjuvant tool for cognitive rehabilitation. The present review aims at presenting the current state of art concerning the use of tES for the improvement of post-stroke visual and cognitive deficits (except for aphasia and memory disorders), showing the therapeutic promises of this technique and offering some suggestions for the design of future clinical trials. Although this line of research is still in infancy, as compared to the progresses made in the last years in other neurorehabilitation domains, current findings appear very encouraging, supporting the development of tES for the treatment of post-stroke cognitive impairments.
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Affiliation(s)
- Silvia Convento
- Department of Psychology, University of Milano Bicocca, Milan, Italy
| | - Cristina Russo
- Department of Psychology, University of Milano Bicocca, Milan, Italy
| | - Luca Zigiotto
- Department of Psychology, University of Milano Bicocca, Milan, Italy
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano Bicocca, Milan, Italy
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
- NeuroMi – Milan Center for Neuroscience, Milan, Italy
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Olgiati E, Russell C, Soto D, Malhotra P. Motivation and attention following hemispheric stroke. PROGRESS IN BRAIN RESEARCH 2016; 229:343-366. [DOI: 10.1016/bs.pbr.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Klinke ME, Zahavi D, Hjaltason H, Thorsteinsson B, Jónsdóttir H. "Getting the Left Right": The Experience of Hemispatial Neglect After Stroke. QUALITATIVE HEALTH RESEARCH 2015; 25:1623-1636. [PMID: 25563629 DOI: 10.1177/1049732314566328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We used a phenomenological approach to gain insight into the experiences of self, other, and world in patients with hemispatial neglect within the first month following stroke. Comprehensive descriptions of circumstances were conjoined with open-ended interviews of 12 participants. The neglect experience was captured in the overarching theme, "getting the left right," which encompasses the two subthemes of (a) surreal awareness of the left and (b) emergence of a different world. Patients had unclear perceptions of their own body and surroundings, their attention was brittle, and they encountered bewildering reactions from other people. They simultaneously pursued the ineffable neglected space and searched for coherence. The vulnerability, loss, and conflicting perceptions that patients with neglect face should be acknowledged and alleviation sought. Facilitating methods should provide additional opportunities for patients to communicate their experiences. We underscore the importance of readjusting the current approaches of neglect and emphasizing meaningfulness in professional guidance.
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Affiliation(s)
- Marianne E Klinke
- University of Iceland, Reykjavik, Iceland The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Haukur Hjaltason
- University of Iceland, Reykjavik, Iceland The National University Hospital of Iceland, Reykjavik, Iceland
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Spaccavento S, Cellamare F, Cafforio E, Loverre A, Craca A. Efficacy of visual-scanning training and prism adaptation for neglect rehabilitation. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:313-21. [DOI: 10.1080/23279095.2015.1038386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Simona Spaccavento
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Fara Cellamare
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Elisabetta Cafforio
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Anna Loverre
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Angela Craca
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
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Nadeau SE, Dobkin B, Wu SS, Pei Q, Duncan PW. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience. Neurorehabil Neural Repair 2015; 30:615-25. [PMID: 26498434 DOI: 10.1177/1545968315613851] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait.
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Affiliation(s)
- Stephen E Nadeau
- Malcom Randall VA Medical Center, Gainesville, FL, USA University of Florida College of Medicine, Gainesville, FL, USA
| | - Bruce Dobkin
- Geffen/UCLA School of Medicine, Los Angeles, CA, USA
| | - Samuel S Wu
- University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL, USA
| | - Qinglin Pei
- University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL, USA
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Cunningham LJ, O'Rourke K, Finlay C, Gallagher M. A preliminary investigation into the psychometric properties of the Dublin Extrapersonal Neglect Assessment (DENA): A novel screening tool for extrapersonal neglect. Neuropsychol Rehabil 2015; 27:349-368. [DOI: 10.1080/09602011.2015.1084334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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A Systematic Research Review Assessing the Effectiveness of Pursuit Interventions in Spatial Neglect Following Stroke. Transl Stroke Res 2015; 6:410-20. [DOI: 10.1007/s12975-015-0420-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
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Hopfner S, Cazzoli D, Müri RM, Nef T, Mosimann UP, Bohlhalter S, Vanbellingen T, Nyffeler T. Enhancing treatment effects by combining continuous theta burst stimulation with smooth pursuit training. Neuropsychologia 2015; 74:145-51. [DOI: 10.1016/j.neuropsychologia.2014.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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Fan YT, Wu CY, Tsai WC, Lin KC. Effects of lateralized light flash and color on unilateral neglect. Disabil Rehabil 2015; 37:2400-2406. [PMID: 25893400 DOI: 10.3109/09638288.2015.1031284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Bottom-up-based sensory stimulation has been useful in promoting recovery from post-stroke neglect. Light and color are salient stimuli for guiding our orienting behaviors and influence the degree of spatial bias. This study evaluated the effects of lateralized light flash and color on spatial bias in unilateral neglect (UN). METHOD We enrolled 15 individuals with UN as a consequence of a right hemispheric stroke of less than 65 d. This was a 3 × 3 design study with three conditions of lens color (colorless, red, and blue) and three conditions of flash light locations (no flash, left, and right). RESULTS All participants showed a decrease in ipsilesional spatial bias under left-side light flash and a red lens. Right-side light flash and a blue lens induced more rightward bias than other conditions. CONCLUSIONS This evidence confirms the use of sensory stimulation to complement post-stroke UN remediation. Lateralized light flash to the contralesional space and red-colored lenses have beneficial effects on amelioration of UN, whereas ipsilesional light flash and the color blue may exacerbate ipsilesional spatial bias in stroke survivors with UN. Implications for Rehabilitation Contralesional light flash and the color red may ameliorate ipsilesional spatial bias in stroke survivors with unilateral neglect (UN). Ipsilesional flash of light and the color blue may worsen ipsilesional spatial bias in stroke survivors with UN.
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Affiliation(s)
- Yang-Teng Fan
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Ching-Yi Wu
- b Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University , Taoyuan , Taiwan.,c Healthy Aging Research Center, Chang Gung University , Taoyuan , Taiwan
| | - Wen-Chung Tsai
- d Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University , Taoyuan , Taiwan , and
| | - Keh-Chung Lin
- a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.,e Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital , Taipei , Taiwan
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Stein MS, Kilbride C, Reynolds FA. What are the functional outcomes of right hemisphere stroke patients with or without hemi-inattention complications? A critical narrative review and suggestions for further research. Disabil Rehabil 2015; 38:315-28. [PMID: 25893401 PMCID: PMC4720036 DOI: 10.3109/09638288.2015.1037865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: There is widespread acceptance that patients demonstrating neglect/hemi-inattention (HI) following right hemisphere stroke (RHS) underachieve functionally compared to their counterparts without neglect. However, empirical evidence for this view needs examination. The purpose of this review is to critically appraise relevant studies that compared outcomes from RHS patients with/without hemi-attention and suggest more robust follow-up research. Method: Twelve studies published in 1995–2013 were critically reviewed. Two independent reviewers appraised design features including sample representation, assessment and data analysis methods. Strengths and limitations were highlighted. Results: Results were largely inconsistent. Considerable heterogeneity within patient groups and across studies complicated interpretation. Evidence suggested average group disparity in scores between patients with and without HI at discharge but the cause of functional disparity could not be attributed specifically to HI from the data and modelling results available. Conclusion: The relationship between HI status and functional recovery warrants further investigation in studies with stronger methodology to ensure rigour and robustness in the results. Pending further research, HI status should not be regarded as a key predictor of functional recovery or rehabilitation potential in patients with RHSs. This group should continue to receive appropriate therapeutic intervention aimed at maximising their functional recovery post-stroke.Implications for Rehabilitation Findings from this review demonstrate a paucity of evidence to support the presence of hemi-inattention as a key predictor of functional recovery in patients with right hemisphere stroke; as such, practitioners should take this into consideration when planning rehabilitation programmes of their patients. In the initial months following right hemisphere stroke, there are wide-ranging differences in the rate and amount of functional recovery in patients, with and without hemi-inattention. Practitioners should not limit the aspirations of their patients based on the presence or absence of hemi-inattention. This review has identified a number of measurement limitations in commonly employed assessment tools for hemi-inattention and overall functional recovery. As such, practitioners should take the limitations of specific measures into account when interpreting the results contextually and with respect to their patients’ situation.
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Affiliation(s)
| | - Cherry Kilbride
- a Department of Clinical Sciences , Brunel University , London , UK
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Mirror neuron therapy for hemispatial neglect patients. Sci Rep 2015; 5:8664. [PMID: 25727354 PMCID: PMC4345335 DOI: 10.1038/srep08664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/28/2015] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED Mirror neuron system(MNS) based therapy has been employed to treat stroke induced movement disorders. However, its potential effects on patients with hemispatial neglect were uninvestigated. The present study set out to test the therapeutic efficiency of video watching of series of hand actions/movements (protocol A) in two patients with left hemispatial neglect, due to the right hemisphere stroke. The video containing dynamic landscape of natural scene or cities but not human/animals was used as the protocol B. The "ABA" training procedure for 3 weeks therefore allows us to internally control the individual differences. Before and after each week of training, the Chinese behavioral inattention test- Hongkong version (CBIT-HK) was implemented to evaluate the hemispatial neglect severity. Functional magnetic resonance imaging (fMRI) experiment was implemented in two health subjects to reveal the difference of brain activation between protocol A and B. The results showed that protocol A rather than protocol B significantly improved the CBIT-HK scores at first and third weeks, respectively. Protocol A induced more bilateral activations including right inferior parietal lobe (supramarginal gyrus), which belongs to MNS and is also critical region resulting to hemineglect. CONCLUSION MNS activation can provide a novel therapy for hemispatial neglect patients.
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Mercer VS, Freburger JK, Yin Z, Preisser JS. Recovery of paretic lower extremity loading ability and physical function in the first six months after stroke. Arch Phys Med Rehabil 2014; 95:1547-55.e4. [PMID: 24755045 DOI: 10.1016/j.apmr.2014.03.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate poststroke recovery of paretic lower extremity loading, walking ability, and self-reported physical function; and to identify subject characteristics associated with recovery. DESIGN Inception cohort study, with testing at monthly intervals from 1 to 6 months poststroke. SETTING Medical center and research laboratory. PARTICIPANTS Volunteer sample of individuals with first-ever, unilateral, noncerebellar stroke (N=33). A total of 78 individuals underwent screening, and 45 were found to be eligible. Of these, 8 declined participation, 2 were excluded because of deteriorating cognitive status, and 2 were lost to follow-up. The remaining 33 individuals enrolled in the study, and 30 (91%) completed the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Outcomes were loading of the paretic lower extremity when standing up from a chair, self-selected gait speed (GS), and Physical Functioning Index. RESULTS Data analyses using linear mixed models indicated that subjects improved over time for all outcomes. Baseline Fugl-Meyer (FM) lower extremity motor scale score was a predictor of immediate poststroke performance for paretic lower extremity loading and self-selected GS, and a predictor of recovery rate for paretic lower extremity loading. Factors identified as having significant effects on performance at 6 months poststroke were baseline FM lower extremity motor scale score for paretic lower extremity loading and self-selected GS and baseline star cancellation score (from the Behavioral Inattention Test) for paretic lower extremity loading. CONCLUSIONS Individuals with better baseline paretic lower extremity motor function have better ability to load that extremity during functional activities and faster walking speeds, and these advantages are still present at 6 months poststroke. Individuals with severe visuospatial neglect demonstrate less ability to load the paretic leg during functional activities at 6 months poststroke.
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Affiliation(s)
- Vicki Stemmons Mercer
- Center for Human Movement Science and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Janet Kues Freburger
- Center for Human Movement Science and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zhaoyu Yin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Functional assessment of region-specific neglect: are there differential behavioural consequences of peripersonal versus extrapersonal neglect? Behav Neurol 2014; 2014:526407. [PMID: 24825959 PMCID: PMC4006611 DOI: 10.1155/2014/526407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/29/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Region-specific types of neglect (peripersonal and extrapersonal) have been dissociated, yet, differential behavioural consequences are unknown. OBJECTIVE The aim of the current study was to investigate behavioural consequences at the level of basic activities of daily living of region-specific neglect, using the Catherine Bergego Scale (CBS). METHODS 118 stroke patients were screened within the first two weeks after admission to the rehabilitation center for inpatient rehabilitation. RESULTS Patients with peripersonal neglect and patients with neglect for both regions had significantly higher total score on the CBS compared to nonneglect patients. Total scores for patients with extrapersonal neglect were comparable to non-neglect patients. ADL impairments were found across activities (e.g., looking towards one side, forgetting body parts, colliding) for both patients with peripersonal neglect and patients with neglect for both regions. Patients with extrapersonal neglect were only impaired on the item on way finding. CONCLUSIONS When diagnosing neglect, it is relevant to distinguish the type of region-specific neglect and, where needed, to adjust the rehabilitation program accordingly. As the CBS is not developed to typically measure ADL in extrapersonal neglect, it would be of importance to add other (instrumental) activities that heavily rely on processing information in farther space.
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79
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Fasotti L, van Kessel M. Novel insights in the rehabilitation of neglect. Front Hum Neurosci 2013; 7:780. [PMID: 24298249 PMCID: PMC3828556 DOI: 10.3389/fnhum.2013.00780] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/29/2013] [Indexed: 11/13/2022] Open
Abstract
Visuospatial neglect due to right hemisphere damage, usually a stroke, is a major cause of disability, impairing the ability to perform a whole range of everyday life activities. Conventional and long-established methods for the rehabilitation of neglect like visual scanning training, optokinetic stimulation, or limb activation training have produced positive results, with varying degrees of generalization to (un)trained tasks, lasting from several minutes up to various months after training. Nevertheless, some promising novel approaches to the remediation of left visuospatial neglect have emerged in the last decade. These new therapy methods can be broadly classified into four categories. First, non-invasive brain stimulation techniques by means of transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS), after a period of mainly diagnostic utilization, are increasingly applied as neurorehabilitative tools. Second, two classes of drugs, dopaminergic and noradrenergic, have been investigated for their potential effectiveness in rehabilitating neglect. Third, prism adaptation treatment has been shown to improve several neglect symptoms consistently, sometimes during longer periods of time. Finally, virtual reality technologies hold new opportunities for the development of effective training techniques for neglect. They provide realistic, rich, and highly controllable training environments. In this paper the degree of effectiveness and the evidence gathered to support the therapeutic claims of these new approaches is reviewed and discussed. The conclusion is that for all these approaches there still is insufficient unbiased evidence to support their effectiveness. Further neglect rehabilitation research should focus on the maintenance of therapy results over time, on a more functional evaluation of treatment effects, on the design and execution of true replication studies and on the exploration of optimal combinations of treatments.
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Affiliation(s)
- Luciano Fasotti
- Rehabilitation Medical Centre Groot Klimmendaal, SIZA Support and Rehabilitation , Arnhem , Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen , Nijmegen , Netherlands
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80
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Koh GCH, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open 2013; 3:e003483. [PMID: 24068767 PMCID: PMC3787469 DOI: 10.1136/bmjopen-2013-003483] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system to harmonise the names of RIIs. DESIGN Systematic review. DATA SOURCES PubMed and references in primary articles. STUDY SELECTION First, we identified all available RII through preliminary literature review. Then, various names of the same formula were used to identify studies, limited to articles in English and up to 31 December 2011, including case-control and cohort studies, and controlled interventional trials where RIIs were outcome variable and matching or multivariate analysis was performed. RESULTS The five RIIs identified were (1) absolute functional gain (AFG)/absolute efficacy/total gain, (2) rehabilitation effectiveness (REs)/Montebello Rehabilitation Factor Score (MRFS)/relative functional gain (RFG), (3) rehabilitation efficiency (REy)/length of stay-efficiency (LOS-EFF)/efficiency, (4) relative functional efficiency (RFE)/MRFS efficiency and (5) revised MRFS (MRFS-R). REy/LOS-EFF/efficiency had the most number of supporting studies, followed by REs and AFG. Although evidence for different predictors of RIIs varied according to the RII and study population, there is good evidence that older age, lower prerehabilitation functional status and cognitive impairment are predictive of poorer AFG, REs and REy. CONCLUSIONS 5 RIIs have been developed in the past two decades as composite rehabilitation outcome measures controlling premorbid and prerehabilitation functional status, rate of functional improvement, each with varying levels of evidence for its predictors. To address the issue of multiple names for the same RII, a new nomenclature system is proposed to harmonise the names based on common mathematical formula and a first-named basis.
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Affiliation(s)
- Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
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81
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van Kessel ME, Geurts ACH, Brouwer WH, Fasotti L. Visual Scanning Training for Neglect after Stroke with and without a Computerized Lane Tracking Dual Task. Front Hum Neurosci 2013; 7:358. [PMID: 23847519 PMCID: PMC3707289 DOI: 10.3389/fnhum.2013.00358] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/21/2013] [Indexed: 11/13/2022] Open
Abstract
Neglect patients typically fail to explore the contralesional half-space. During visual scanning training, these patients learn to consciously pay attention to contralesional target stimuli. It has been suggested that combining scanning training with methods addressing non-spatial attention might enhance training results. In the present study, a dual task training component was added to a visual scanning training (i.e., Training di Scanning Visuospaziale - TSVS; Pizzamiglio et al., 1990). Twenty-nine subacute right hemisphere stroke patients were semi-randomly assigned to an experimental (N = 14) or a control group (N = 15). Patients received 30 training sessions during 6 weeks. TSVS consisted of four standardized tasks (digit detection, reading/copying, copying drawings, and figure description). Moreover, a driving simulator task was integrated in the training procedure. Control patients practiced a single lane tracking task for 2 days a week during 6 weeks. The experimental group was administered the same training schedule, but in weeks 4-6 of the training, the TSVS digit detection task was combined with lane tracking on the same projection screen, so as to create a dual task (computerized visual reaction time task designed for training). Various neglect tests and driving simulator tasks were administered before and after training. No significant group and interaction effects were found that might reflect additional positive effects of dual task training. Significant improvements after training were observed in both groups taken together on most assessment tasks. Ameliorations were generally not correlated to post-onset time, but spontaneous recovery, test-retest variability, and learning effects could not be ruled out completely, since these were not controlled for. Future research might focus on increasing the amount of dual task training, the implementation of progressive difficulty levels in driving simulator tasks, and further exploration of relationships between dual task training and daily functioning.
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Affiliation(s)
- M. E. van Kessel
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
- Medisch Spectrum Twente Hospital Group, Enschede, Netherlands
| | - A. C. H. Geurts
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - W. H. Brouwer
- Department of Neurology, University Medical Center Groningen, Groningen, Netherlands
- Department of Psychology, University of Groningen, Groningen, Netherlands
| | - L. Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
- Medical Rehabilitation Centre Groot Klimmendaal/SIZA Support and Rehabilitation, Arnhem, Netherlands
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82
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Vossel S, Weiss PH, Eschenbeck P, Fink GR. Anosognosia, neglect, extinction and lesion site predict impairment of daily living after right-hemispheric stroke. Cortex 2013; 49:1782-9. [DOI: 10.1016/j.cortex.2012.12.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 11/13/2012] [Accepted: 12/11/2012] [Indexed: 12/01/2022]
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83
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Müri RM, Cazzoli D, Nef T, Mosimann UP, Hopfner S, Nyffeler T. Non-invasive brain stimulation in neglect rehabilitation: an update. Front Hum Neurosci 2013; 7:248. [PMID: 23772209 PMCID: PMC3677145 DOI: 10.3389/fnhum.2013.00248] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/19/2013] [Indexed: 11/13/2022] Open
Abstract
Here, we review the effects of non-invasive brain stimulation such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) in the rehabilitation of neglect. We found 12 studies including 172 patients (10 TMS studies and 2 tDCS studies) fulfilling our search criteria. Activity of daily living measures such as the Barthel Index or, more specifically for neglect, the Catherine Bergego Scale were the outcome measure in three studies. Five studies were randomized controlled trials with a follow-up time after intervention of up to 6 weeks. One TMS study fulfilled criteria for Class I and one for Class III evidence. The studies are heterogeneous concerning their methodology, outcome measures, and stimulation parameters making firm comparisons and conclusions difficult. Overall, there are however promising results for theta-burst stimulation, suggesting that TMS is a powerful add-on therapy in the rehabilitation of neglect patients.
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Affiliation(s)
- René Martin Müri
- Division of Cognitive and Restorative Neurology, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital, and University of Bern , Bern , Switzerland ; Gerontechnology and Rehabilitation Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern , Bern , Switzerland
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84
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Nijboer T, van de Port I, Schepers V, Post M, Visser-Meily A. Predicting functional outcome after stroke: the influence of neglect on basic activities in daily living. Front Hum Neurosci 2013; 7:182. [PMID: 23675336 PMCID: PMC3650314 DOI: 10.3389/fnhum.2013.00182] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/23/2013] [Indexed: 11/13/2022] Open
Abstract
One prominent deficit resulting from stroke is visuo-spatial neglect, which has been associated with slower and more attenuated recovery patterns of sensory-motor impairment as well as limitations in activities of daily living (ADL). The aim of the current study was to further specify the relationship between neglect and recovery of different domains of ADL. One hundred eighty four patients were assessed with the Functional Independence Measure in the first week of inpatient rehabilitation, and again at 6, 12, and 36 months post-stroke. On average, neglect patients scored significantly lower on Self-care, Transfers, and Locomotion compared to non-neglect patients, but these differences became smaller with progress of time. Overall, no differences between groups were found for Sphincter control and Cognition. Patients with more severe neglect scored significantly lower on Self-care and Transfers compared to patients with mild neglect. During rehabilitation, it would be of importance to test for independence in ADL domains in neglect in order to define realistic treatment goals. The current findings could be taken into account in early multidisciplinary intervention planning in the sub-acute phase, to optimize regaining ADL.
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Affiliation(s)
- Tanja Nijboer
- Experimental Psychology, Helmholtz Institute, Utrecht University Utrecht, Netherlands ; Rudolf Magnus Institute of Neuroscience, Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation Utrecht, Netherlands
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85
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Borghese NA, Bottini G, Sedda A. Videogame based neglect rehabilitation: a role for spatial remapping and multisensory integration? Front Hum Neurosci 2013; 7:116. [PMID: 23565089 PMCID: PMC3613896 DOI: 10.3389/fnhum.2013.00116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/16/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- N A Borghese
- Laboratory of Applied Intelligent Systems, Computer Science Department, University of Milan Milan, Italy
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Cazzoli D, Muri RM, Schumacher R, von Arx S, Chaves S, Gutbrod K, Bohlhalter S, Bauer D, Vanbellingen T, Bertschi M, Kipfer S, Rosenthal CR, Kennard C, Bassetti CL, Nyffeler T. Theta burst stimulation reduces disability during the activities of daily living in spatial neglect. Brain 2012; 135:3426-39. [DOI: 10.1093/brain/aws182] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maravita A, Cigada M, Posteraro L. Talking to the senses: modulation of tactile extinction through hypnotic suggestion. Front Hum Neurosci 2012; 6:210. [PMID: 22822395 PMCID: PMC3398471 DOI: 10.3389/fnhum.2012.00210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/27/2012] [Indexed: 11/13/2022] Open
Abstract
Following brain damage, typically of the right hemisphere, patients can show reduced awareness of sensory events occurring in the space contralateral to the brain damage. The present work shows that a hypnotic suggestion can temporarily reduce tactile extinction to double bilateral stimulation, i.e., a loss of contralesional stimuli when these are presented together with ipsilesional ones. Patient EB showed an improved detection of contralesional targets after a single 20-min hypnosis session, during which specific suggestions were delivered with the aim of increasing her insight into somatosensory perception on both sides of the body. Simple overt attention orienting toward the contralesional side, or a hypnotic induction procedure not accompanied by specifically aimed suggestions, were not effective in modulating extinction. The present result is the first systematic evidence that hypnosis can temporarily improve a neuropsychological condition, namely Extinction, and may open the way for the use of this technique as a fruitful rehabilitative tool for brain-damaged patients affected by neuropsychological deficits.
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Affiliation(s)
- Angelo Maravita
- Department of Psychology, University of Milano-Bicocca Milano, Italy
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