51
|
Sobrinho KRF, Santini ACM, Marques CLS, Gabriel MG, Neto EDM, de Souza LAPS, Bazan R, Luvizutto GJ. Impact of unilateral spatial neglect on chronic patient's post-stroke quality of life. Somatosens Mot Res 2018; 35:199-203. [DOI: 10.1080/08990220.2018.1521791] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | | | | | - Rodrigo Bazan
- Department of Neurology, Botucatu Medical School (UNESP), Botucatu, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| |
Collapse
|
52
|
Kim SB, Lee KW, Lee JH, Lee SJ, Park JG, Lee JB. Effect of Combined Therapy of Robot and Low-Frequency Repetitive Transcranial Magnetic Stimulation on Hemispatial Neglect in Stroke Patients. Ann Rehabil Med 2018; 42:788-797. [PMID: 30613071 PMCID: PMC6325312 DOI: 10.5535/arm.2018.42.6.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/16/2018] [Indexed: 11/08/2022] Open
Abstract
Objective To investigate the effect of upper limb rehabilitation combining robot with low-frequency repetitive transcranial magnetic stimulation (rTMS) on unilateral spatial neglect in stroke patients. Methods Patients who had hemispatial neglect after right hemisphere stroke were randomly divided into rTMS only group, robot only group, and combined group. All groups received conventional neglect therapy and additional treatment for each group. rTMS group received rTMS therapy. Robot group received robot therapy, while combined group received both therapies. The effect of therapy was assessed with Motor-Free Visual Perception Test-3 (MVPT-3), line bisection test, star cancellation test, Catherine Bergego Scale (CBS), Mini-Mental State Examination (MMSE), and the Korean version of Modified Barthel Index (K-MBI). These measurements were evaluated before and after treatment. Results For each group, 10 patients were recruited. There were no significant differences in baseline characteristics or initial values among the three groups. Two weeks after the therapy, all groups showed significant improvement in MVPT-3, line bisection test, star cancellation test, CBS, MMSE, and K-MBI. However, changes in measurements showed no significant differences among groups. Conclusion Treatment effect of the combined therapy of robotic therapy and low-frequency rTMS therapy for hemispatial neglect was not statistically different from that of each single treatment. Results of this study did not prove the superiority of any of the three treatments. Further study with large number of patients is needed to evaluate the superiority of these treatments.
Collapse
Affiliation(s)
- Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea.,Regional Cardiocerebrovascular Center, Dong-A University Medical Center, Busan, Korea
| | - Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea.,Regional Cardiocerebrovascular Center, Dong-A University Medical Center, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea.,Regional Cardiocerebrovascular Center, Dong-A University Medical Center, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea.,Regional Cardiocerebrovascular Center, Dong-A University Medical Center, Busan, Korea
| | - Jin Gee Park
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea.,Regional Cardiocerebrovascular Center, Dong-A University Medical Center, Busan, Korea
| | - Joung Bok Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea.,Regional Cardiocerebrovascular Center, Dong-A University Medical Center, Busan, Korea
| |
Collapse
|
53
|
Barrett AM, Boukrina O, Saleh S. Ventral attention and motor network connectivity is relevant to functional impairment in spatial neglect after right brain stroke. Brain Cogn 2018; 129:16-24. [PMID: 30522777 DOI: 10.1016/j.bandc.2018.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022]
Abstract
Emerging research suggests spatial neglect after right stroke is linked to dysfunctional attention and motor networks. Advanced functional connectivity analysis clarified brain network recovery, however we need to know how networks participate in adaptive motor performance. We need to verify network changes associated with validated functional measures and spatial-motor performance in spatial neglect, especially in patients with large brain lesions and significant disability. This study tested whether disability-relevant spatial neglect associates with different patterns of resting state functional connectivity between motor, dorsal and ventral attention networks (MN, DAN and VAN). Right stroke patients had spatial neglect (n = 8) or not (n = 10) on the Behavioural Inattention Test-conventional. Spatial neglect patients had weaker intranetwork VAN connectivity, and reduced internetwork connectivity between VAN and left frontal eye field (DAN), and between VAN and the left primary motor area (MN). These network impairments might explain the co-occurrence of attention and motor deficits in spatial neglect, and open a path to assessing functional connectivity in clinical trials of combined spatial retraining and motor rehabilitation after stroke.
Collapse
Affiliation(s)
- A M Barrett
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Rutgers New Jersey Medical School, Newark, NJ 07102, USA; Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
| | - Olga Boukrina
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Rutgers New Jersey Medical School, Newark, NJ 07102, USA.
| | - Soha Saleh
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Rutgers New Jersey Medical School, Newark, NJ 07102, USA.
| |
Collapse
|
54
|
Spreij LA, Ten Brink AF, Visser-Meily JMA, Nijboer TCW. Simulated driving: The added value of dynamic testing in the assessment of visuo-spatial neglect after stroke. J Neuropsychol 2018; 14:28-45. [PMID: 30325578 PMCID: PMC7154737 DOI: 10.1111/jnp.12172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visuo-spatial neglect (VSN) is generally assessed with neuropsychological paper-and-pencil tasks, which are often not sensitive enough to detect mild and/or well-compensated VSN. It is of utmost importance to develop dynamic tasks, resembling the dynamics of daily living. OBJECTIVE A simulated driving task was used to assess (1) differences in performance (i.e., position on the road and magnitude of sway) between patients with left- and right-sided VSN, recovered VSN, without VSN, and healthy participants; (2) the relation between average position and VSN severity; and (3) its diagnostic accuracy in relation to traditional tasks. METHODS Stroke inpatients were tested with a cancellation task, the Catherine Bergego Scale and the simulated driving task. RESULTS Patients with left-sided VSN and recovered VSN deviated more regarding position on the road compared to patients without VSN. The deviation was larger in patients with more severe VSN. Regarding diagnostic accuracy, 29% of recovered VSN patients and 6% of patients without VSN did show abnormal performance on the simulated driving task. The sensitivity was 52% for left-sided VSN. Right-sided VSN was not well detected, probably due to the asymmetric layout. CONCLUSIONS Based on these results, the simulated driving task should not be the only task to assess VSN, especially in its current form. Given the heterogenic nature of VSN, the assessment should always consist of several tasks varying in nature and complexity and include a dynamic task to detect mild and/or recovered VSN. A symmetric design should be used when designing novel tasks to assess right-sided VSN.
Collapse
Affiliation(s)
- Lauriane A Spreij
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands
| | - Antonia F Ten Brink
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Tanja C W Nijboer
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands.,Department of Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands
| |
Collapse
|
55
|
Pitteri M, Chen P, Passarini L, Albanese S, Meneghello F, Barrett AM. Conventional and functional assessment of spatial neglect: Clinical practice suggestions. Neuropsychology 2018; 32:835-842. [PMID: 29975073 PMCID: PMC6188804 DOI: 10.1037/neu0000469] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Spatial neglect (SN) constitutes a substantial barrier to functional recovery after acquired brain injury. However, because of its multimodal nature, no single test can capture all the signs of SN. To provide a clinically feasible solution, we used conventional neuropsychological tests as well as the Catherine Bergego Scale (CBS) via the Kessler Foundation Neglect Assessment Process (KF-NAP). The goal was to add evidence that a global approach should detect better even subtle signs of SN. METHOD Fourteen individuals with lesions located in the right cerebral hemisphere participated in the study. Participants were assessed with a comprehensive battery of neuropsychological tests, comprising a set of visuospatial tests to evaluate several spatial domains. In addition, patients underwent functional assessment with the Barthel Index, the Functional Independence Measure (FIM), and the CBS via KF-NAP. RESULTS The CBS via KF-NAP was associated with the visuospatial paper-based tests (p = .004) as well as the Motor FIM (p = .003), and was more sensitive than the Behavioral Inattention Test-Conventional in detecting SN (p = .014). CONCLUSIONS We showed that the CBS via KF-NAP was able: (a) to detect functional impairment, especially motor, related to SN; (b) to selectively measures spatial rather than nonspatial dysfunctions; and (c) to be highly sensitive in detecting SN signs especially in those patients with mild severity, covering several aspects of SN manifestations. The patient's SN diagnosis based on the CBS via KF-NAP is clinically important and directly relevant to care planning and goal setting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
- Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona
| | | | - Laura Passarini
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital Foundation
| | - Silvia Albanese
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital Foundation
| | | | | |
Collapse
|
56
|
Kashiwagi FT, El Dib R, Gomaa H, Gawish N, Suzumura EA, da Silva TR, Winckler FC, de Souza JT, Conforto AB, Luvizutto GJ, Bazan R. Noninvasive Brain Stimulations for Unilateral Spatial Neglect after Stroke: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Controlled Trials. Neural Plast 2018; 2018:1638763. [PMID: 30050569 PMCID: PMC6046134 DOI: 10.1155/2018/1638763] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Unilateral spatial neglect (USN) is the most frequent perceptual disorder after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve perception and functional capacity. Objective To assess the impact of NIBS on USN after stroke. Methods An extensive search was conducted up to July 2016. Studies were selected if they were controlled and noncontrolled trials examining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS) in USN after stroke, with outcomes measured by standardized USN and functional tests. Results Twelve RCTs (273 participants) and 4 non-RCTs (94 participants) proved eligible. We observed a benefit in overall USN measured by the line bisection test with NIBS in comparison to sham (SMD -2.35, 95% CI -3.72, -0.98; p = 0.0001); the rTMS yielded results that were consistent with the overall meta-analysis (SMD -2.82, 95% CI -3.66, -1.98; p = 0.09). The rTMS compared with sham also suggested a benefit in overall USN measured by Motor-Free Visual Perception Test at both 1 Hz (SMD 1.46, 95% CI 0.73, 2.20; p < 0.0001) and 10 Hz (SMD 1.19, 95% CI 0.48, 1.89; p = 0.54). There was also a benefit in overall USN measured by Albert's test and the line crossing test with 1 Hz rTMS compared to sham (SMD 2.04, 95% CI 1.14, 2.95; p < 0.0001). Conclusions The results suggest a benefit of NIBS on overall USN, and we conclude that rTMS is more efficacious compared to sham for USN after stroke.
Collapse
Affiliation(s)
- Flávio Taira Kashiwagi
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Regina El Dib
- Science and Technology Institute, Universidade Estadual Paulista (UNESP), São José dos Campos, SP, Brazil
| | - Huda Gomaa
- Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
| | - Nermeen Gawish
- Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
| | | | - Taís Regina da Silva
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Fernanda Cristina Winckler
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Juli Thomaz de Souza
- Science and Technology Institute, Universidade Estadual Paulista (UNESP), São José dos Campos, SP, Brazil
| | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Rodrigo Bazan
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| |
Collapse
|
57
|
Hreha K, Chaudhari A, Kong Y, Prathusha M, Barrett A. Illustrating where spatial perception versus memory-based representation: spatial neglect in a distinguished artist; a case report. Neurocase 2018; 24:151-155. [PMID: 30035662 PMCID: PMC6162150 DOI: 10.1080/13554794.2018.1495741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
Spatial neglect is a disorder of attention, perception, and processing of stimuli in contralesional space. The heterogeneous behaviors involve diverse neuroanatomical mechanisms. Anecdotal evidence suggests that neural circuitry of active spatial perception may differ from that used to encode spatial memory. These differences can escape detection by conventional assessments, thereby leading to missed diagnoses. We present a case, in an artist who demonstrates selective impairment in a contralesional space during active Where spatial perception. His performance is better when asked to draw entirely from memory. This case highlights the variability in neglect, importance for comprehensive testing, and encourages further investigation.
Collapse
Affiliation(s)
- Kimberly Hreha
- Inpatient Rehabilitation Department, Kessler Institute for
Rehabilitation, West Orange, NJ, USA
- Kessler Foundation, West Orange, NJ, USA
| | | | - Yekyung Kong
- Inpatient Rehabilitation Department, Kessler Institute for
Rehabilitation, West Orange, NJ, USA
- Rutgers – New Jersey Medical School, Newark, NJ,
USA
| | | | - A.M. Barrett
- Inpatient Rehabilitation Department, Kessler Institute for
Rehabilitation, West Orange, NJ, USA
- Kessler Foundation, West Orange, NJ, USA
- Rutgers – New Jersey Medical School, Newark, NJ,
USA
| |
Collapse
|
58
|
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.
Collapse
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
| |
Collapse
|
59
|
Hreha K, Gillen G, Noce N, Nilsen D. The feasibility and effectiveness of using prism adaptation to treat motor and spatial dysfunction in stroke survivors with multiple incidents of stroke. Top Stroke Rehabil 2018; 25:305-311. [DOI: 10.1080/10749357.2018.1437937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kimberly Hreha
- Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Movement Science, Teachers College, Columbia University, New York City, USA
- Occupational Therapy, Kessler Institute for Rehabilitation, West Orange, USA
| | - Glen Gillen
- Occupational Therapy, Columbia University, New York City, USA
- Movement Science, Teachers College, Columbia University, New York City, USA
| | - Natalia Noce
- Occupational Therapy, Kessler Institute for Rehabilitation, West Orange, USA
| | - Dawn Nilsen
- Occupational Therapy, Columbia University, New York City, USA
- Movement Science, Teachers College, Columbia University, New York City, USA
| |
Collapse
|
60
|
Klinke ME, Hjaltason H, Tryggvadóttir GB, Jónsdóttir H. Hemispatial neglect following right hemisphere stroke: clinical course and sensitivity of diagnostic tasks. Top Stroke Rehabil 2017; 25:120-130. [DOI: 10.1080/10749357.2017.1394632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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
| | | | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
61
|
Grech M, Stuart T, Williams L, Chen C, Loetscher T. The Mobility Assessment Course for the Diagnosis of Spatial Neglect: Taking a Step Forward? Front Neurol 2017; 8:563. [PMID: 29163331 PMCID: PMC5671563 DOI: 10.3389/fneur.2017.00563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
Spatial neglect after stroke can be a challenging syndrome to diagnose under standard neuropsychological assessment. There is now sufficient evidence that those affected might demonstrate neglect behavior in everyday settings despite showing no signs of neglect during common neglect tasks. This discrepancy is attributed to the simplified and unrealistic nature of common pen and paper based tasks that do not match the demanding, novel, and complex environment of everyday life. As such, increasing task demands under more ecologically valid scenarios has become an important method of increasing test sensitivity. The main aim of the current study was to evaluate the diagnostic utility of the Mobility Assessment Course (MAC), an ecological task, for the assessment of neglect. If neglect becomes more apparent under more challenging task demands the MAC could prove to be more diagnostically accurate at detecting neglect than conventional methods, particularly as the time from initial brain damage increases. Data collected by Guide Dogs of SA/NT were retrospectively analyzed. The Receiver Operating Characteristic (ROC) curve, a measure of sensitivity and specificity, was used to investigate the diagnostic utility of the MAC and a series of paper and pencil tests in 67 right hemisphere stroke survivors. While the MAC proved to be a more sensitive neglect test (74.2%) when compared to the Star Cancellation (43.3%) and Line Bisection (35.7%) tests, this was at the expense of relatively low specificity. As a result, the ROC curve analysis showed no statistically discernable differences between tasks (p > 0.12), or between subacute and chronic groups for individual tasks (p > 0.45). It is concluded that, while the MAC is an ecologically valid alternative for assessing neglect, regarding its diagnostic accuracy, there is currently not enough evidence to suggest that it is a big step forward in comparison to the accuracy of conventional tests.
Collapse
Affiliation(s)
- Megan Grech
- School of Psychology, Social Work, and Social Policy, University of South Australia, Adelaide, SA, Australia
| | | | - Lindy Williams
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders University, Adelaide, SA, Australia
| | - Tobias Loetscher
- School of Psychology, Social Work, and Social Policy, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
62
|
Chen P, Pitteri M, Gillen G, Ayyala H. Ask the experts how to treat individuals with spatial neglect: a survey study. Disabil Rehabil 2017; 40:2677-2691. [DOI: 10.1080/09638288.2017.1347720] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peii Chen
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, USA
| | - Marco Pitteri
- Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Glen Gillen
- Department of Regenerative and Rehabilitation Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY, USA
| | - Harsha Ayyala
- New Jersey Medical School, Rutgers University, Newark, NJ, USA
| |
Collapse
|
63
|
Donoso Brown EV, Powell JM. Assessment of unilateral neglect in stroke: Simplification and structuring of test items. Br J Occup Ther 2017; 80:448-452. [PMID: 34413568 DOI: 10.1177/0308022616685582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Statement of context Unilateral neglect is a complex impairment that is common after stroke and limits occupational performance. Sensitive assessment of unilateral neglect is critical for planning treatment and ensuring safe community discharge. Critical reflection on practice This reflection describes unexpected findings in the assessment of neglect with two individuals in the acute phase of recovery post stroke. When trialing a new activity based test battery, we observed few neglect behaviors during test tasks despite observation of multiple neglect behaviors outside of the testing situation. Upon reflection, we better understood how simplification and structuring of test items and environments could impact the observation and assessment of neglect behaviors. Implications for practice This practice analysis further supports the use of multiple assessments when evaluating unilateral neglect and specifically encourages the inclusion of assessment methods that maintain the complexity of everyday tasks and environments.
Collapse
Affiliation(s)
- Elena V Donoso Brown
- Duquesne University, Rangos School of Health Sciences, Department of Occupational Therapy
| | - Janet M Powell
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, Division of Occupational Therapy
| |
Collapse
|
64
|
van der Kemp J, Dorresteijn M, Ten Brink AF, Nijboer TC, Visser-Meily JM. Pharmacological Treatment of Visuospatial Neglect: A Systematic Review. J Stroke Cerebrovasc Dis 2017; 26:686-700. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 11/29/2022] Open
|
65
|
|
66
|
Luvizutto GJ, Rizzati GRS, Fogaroli MO, Rodrigues RT, Ribeiro PW, de Carvalho Nunes HR, Braga GP, da Costa RDM, Bazan SGZ, de Lima Resende LA, Conforto AB, Bazan R. Treatment of unilateral spatial neglect after stroke using transcranial direct current stimulation (ELETRON trial): study protocol for a randomized controlled trial. Trials 2016; 17:479. [PMID: 27716442 PMCID: PMC5048673 DOI: 10.1186/s13063-016-1598-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Unilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects that are presented in the spatial hemisphere that is contralateral to the lesioned hemisphere of the brain. USN has been associated with poor functional outcomes and long stays in hospitals and rehabilitation centers. Noninvasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been used in people who have been affected by USN after stroke. The effects of such treatment could provide new insights for health professionals and policy-makers. The aim of this study will be to evaluate the effectiveness and safety of tDCS for USN after stroke. Methods A prospective randomized controlled trial with two parallel groups will be conducted, which will aim to recruit 60 patients with USN after ischemic or hemorrhagic stroke. Participants will be randomly placed into the following four treatment groups: (1) anodal tDCS over the right parietal lobe (n = 15), (2) cathodal tDCS over the left parietal lobe (n = 15), (3) a sham group of anodal tDCS over the right parietal lobe (n = 15), and (4) a sham group of cathodal tDCS over the left parietal lobe (n = 15). Blinded assessors will conduct two baseline assessments and one post-intervention assessment. The primary outcome measure will be the level of USN as assessed by the conventional Behavioral Inattention Tasks and the Catherine Bergego Scale. Secondary measures will include neurological capacity (based on the Scandinavian Stroke Scale), functional capacity (based on the Functional Independence Measure and Modified Rankin Scale), autonomy (based on the Barthel Index), and quality of life (based on the EuroQol-5D). Group allocation will be concealed, and all analyses will be based on an intention-to-treat principle. Discussion This study will explore the effects of more than 15 sessions of tDCS on the level of USN, functional capacity, autonomy, and quality of life in patients with USN after stroke. This proposed study has the potential to identify a new, evidence-based intervention that can enhance perception and independent living in patients with USN after stroke. Trial registration REBEC - RBR-78jvzx, registered on 13 March 2016.
Collapse
Affiliation(s)
- Gustavo José Luvizutto
- Rehabilitation Department, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil. .,Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, District of Rubião Junior, Botucatu, SP, 18618-970, Brazil.
| | | | | | | | - Priscila Watson Ribeiro
- Rehabilitation Department, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
| | | | - Gabriel Pereira Braga
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
| | | | | | - Luiz Antônio de Lima Resende
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
| | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Professor Montenegro Ave., Botucatu, Brazil
| |
Collapse
|
67
|
Choi YS, Lee KW, Lee JH, Kim SB, Park GT, Lee SJ. The Effect of an Upper Limb Rehabilitation Robot on Hemispatial Neglect in Stroke Patients. Ann Rehabil Med 2016; 40:611-9. [PMID: 27606267 PMCID: PMC5012972 DOI: 10.5535/arm.2016.40.4.611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/28/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of an upper limb rehabilitation robot therapy on hemispatial neglect in stroke patients. METHODS Patients were randomly divided into an upper limb rehabilitation robot treatment group (robot group) and a control group. The patients in the robot group received left upper limb training using an upper limb rehabilitation robot. The patients sat on the right side of the robot, so that the monitor of the robot was located on the patients' left side. In this position, patients could focus continuously on the left side. The control group received conventional neglect treatment, such as visual scanning training and range of motion exercises, administered by occupational therapists. Both groups received their respective therapies for 30 minutes a day, 5 days a week for 3 weeks. Several tests were used to evaluate treatment effects before and after the 3-week treatment. RESULTS In total, 38 patients (20 in the robot group and 18 in the control group) completed the study. After completion of the treatment sessions, both groups showed significant improvements in the Motor-Free Visual Perception Test 3rd edition (MVPT-3), the line bisection test, the star cancellation test, the Albert's test, the Catherine Bergego scale, the Mini-Mental State Examination and the Korean version of Modified Barthel Index. The changes in all measurements showed no significant differences between the two groups. CONCLUSION This present study showed that the upper limb robot treatment had benefits for hemispatial neglect in stroke patients that were similar to conventional neglect treatment. The upper limb robot treatment could be a therapeutic option in the treatment of hemispatial neglect after stroke.
Collapse
Affiliation(s)
- Yoon Sik Choi
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Gyu Tae Park
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| |
Collapse
|
68
|
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.
Collapse
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
| |
Collapse
|
69
|
Facchin A, Beschin N, Pisano A, Reverberi C. Normative data for distal line bisection and baking tray task. Neurol Sci 2016; 37:1531-6. [DOI: 10.1007/s10072-016-2626-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/28/2016] [Indexed: 11/30/2022]
|
70
|
Azouvi P. The ecological assessment of unilateral neglect. Ann Phys Rehabil Med 2016; 60:186-190. [PMID: 26830087 DOI: 10.1016/j.rehab.2015.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
Conventional paper-and-pencil tests of unilateral neglect are of limited ecological validity. To address this issue, a number of assessment procedures have been proposed to provide clinicians and researchers with more ecologically valid assessments of unilateral neglect, which may be useful to plan rehabilitation and to measure the generalization of the effects of rehabilitation to daily life. We present here an overview of the different assessment measures available in the literature. The most widely used scales are the Behavioural Inattention Test (BIT), the semi-structured scales for assessment of personal and extra-personal neglect, the Subjective Neglect Questionnaire, the Baking Tray Task, the wheelchair obstacle course, the ADL-based neglect battery, and the Catherine Bergego Scale (CBS). The CBS is probably, to date, the most widely used behavioural assessment instrument for unilateral neglect. It has been found to be reliable, valid, and sensitive to change during rehabilitation. It also enables the assessment of awareness of the consequences of unilateral neglect in daily life skills.
Collapse
Affiliation(s)
- Philippe Azouvi
- AP-HP, hôpital Raymond-Poincaré, service de médecine physique et de réadaptation, 92380 Garches, France; EA 4047 HANDIReSP, université Versailles - Saint-Quentin, UFR des sciences de la santé - Simone-Veil, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France.
| |
Collapse
|
71
|
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
| |
Collapse
|
72
|
Jeong EH, Kim BR, Lee J. Relationship between Comorbid Cognitive Impairment and Functional Outcomes in Stroke Patients with Spatial Neglect. BRAIN & NEUROREHABILITATION 2016. [DOI: 10.12786/bn.2016.9.1.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Eun Hwa Jeong
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Korea
| | - Bo-Ram Kim
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Korea
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Korea
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| |
Collapse
|
73
|
Luvizutto GJ, Bazan R, Braga GP, Resende LADL, Bazan SGZ, El Dib R. Pharmacological interventions for unilateral spatial neglect after stroke. Cochrane Database Syst Rev 2015; 2015:CD010882. [PMID: 26544542 PMCID: PMC6465189 DOI: 10.1002/14651858.cd010882.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Unilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects presented on the side contralateral to the lesioned side of the brain and has been associated with poor functional outcomes and long stays in hospitals and rehabilitation centers. Pharmacological interventions (medical interventions only, use of drugs to improve the health condition), such as dopamine and noradrenergic agonists or pro-cholinergic treatment, have been used in people affected by USN after stroke, and effects of these treatments could provide new insights for health professionals and policy makers. OBJECTIVES To evaluate the effectiveness and safety of pharmacological interventions for USN after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2015), the Cochrane Central Register of Controlled Trials (April 2015), MEDLINE (1946 to April 2015), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to April 2015), EMBASE (1980 to April 2015), PsycINFO (1806 to April 2015) and Latin American Caribbean Health Sciences Literature (LILACS) (1982 to April 2015). We also searched trials and research registers, screened reference lists, and contacted study authors and pharmaceutical companies (April 2015). SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) of pharmacological interventions for USN after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias in the included studies and extracted data. MAIN RESULTS We included in the review two studies with a total of 30 randomly assigned participants. We rated the quality of the evidence as very low as the result of study limitations, small numbers of events, and small sample sizes, with imprecision in the confidence interval (CI). We were not able to perform meta-analysis because of heterogeneity related to the different interventions evaluated between included studies. Very low-quality evidence from one trial (20 participants) comparing effects of rivastigmine plus rehabilitation versus rehabilitation on overall USN at discharge showed the following: Barrage (mean difference (MD) 0.30, 95% confidence interval (CI) -0.18 to 0.78); Letter Cancellation (MD 10.60, 95% CI 2.07 to 19.13); Sentence Reading (MD 0.20, 95% CI -0.69 to 1.09), and the Wundt-Jastrow Area Illusion Test (MD -4.40, 95% CI -8.28 to -0.52); no statistical significance was observed for the same outcomes at 30 days' follow-up. In another trial (10 participants), study authors showed statistically significant reduction in omissions in the three cancellation tasks under transdermal nicotine treatment (mean number of omissions 2.93 ± 0.5) compared with both baseline (4.95 ± 0.8) and placebo (5.14 ± 0.9) (main effect of treatment condition: F (2.23) = 11.06; P value < 0.0001). One major adverse event occurred in the transdermal nicotine treatment group, and treatment was discontinued in the affected participant. None of the included trials reported data on several of the prespecified outcomes (falls, balance, depression or anxiety, poststroke fatigue, and quality of life). AUTHORS' CONCLUSIONS The quality of the evidence from available RCTs was very low. The effectiveness and safety of pharmacological interventions for USN after stroke are therefore uncertain. Additional large RCTs are needed to evaluate these treatments.
Collapse
Affiliation(s)
- Gustavo José Luvizutto
- Botucatu Medical School, Universidade Estadual Paulista (UNESP)Department of NeurologyDistrict of Rubiao JuniorBotucatu, São PauloBrazil
| | - Rodrigo Bazan
- Botucatu Medical School, Universidade Estadual Paulista (UNESP)Department of NeurologyDistrict of Rubiao JuniorBotucatu, São PauloBrazil
| | - Gabriel Pereira Braga
- Botucatu Medical School, Universidade Estadual Paulista (UNESP)Department of NeurologyDistrict of Rubiao JuniorBotucatu, São PauloBrazil
| | - Luiz Antônio de Lima Resende
- Botucatu Medical School, Universidade Estadual Paulista (UNESP)Department of NeurologyDistrict of Rubiao JuniorBotucatu, São PauloBrazil
| | - Silméia Garcia Z Bazan
- Botucatu Medical School, Universidade Estadual Paulista (UNESP)Department of Internal MedicineBotucatu, São PauloBrazil18618‐970
| | - Regina El Dib
- Botucatu Medical School, Universidade Estadual Paulista (UNESP)Department of AnaesthesiologyDistrito de Rubião Júnior, s/nBotucatu, São PauloBrazil18603‐970
| | | |
Collapse
|
74
|
Chen P, Ward I, Khan U, Liu Y, Hreha K. Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury: A Retrospective Study. Neurorehabil Neural Repair 2015; 30:451-60. [PMID: 26338431 DOI: 10.1177/1545968315604397] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury-induced mass effect predicted left-sided neglect. Conclusions Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment.
Collapse
Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, NJ, USA Rutgers University, Newark, NJ, USA
| | - Irene Ward
- Rutgers University, Newark, NJ, USA Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | | | - Yan Liu
- Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Kessler Institute for Rehabilitation, West Orange, NJ, USA Columbia University, New York, NY, USA
| |
Collapse
|
75
|
Chen P, Goedert KM, Shah P, Foundas AL, Barrett AM. Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment. Brain Imaging Behav 2015; 8:346-58. [PMID: 22941243 DOI: 10.1007/s11682-012-9200-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prism adaptation treatment (PAT) is a promising rehabilitative method for functional recovery in persons with spatial neglect. Previous research suggests that PAT improves motor-intentional "aiming" deficits that frequently occur with frontal lesions. To test whether presence of frontal lesions predicted better improvement of spatial neglect after PAT, the current study evaluated neglect-specific improvement in functional activities (assessment with the Catherine Bergego Scale) over time in 21 right-brain-damaged stroke survivors with left-sided spatial neglect. The results demonstrated that neglect patients' functional activities improved after two weeks of PAT and continued improving for four weeks. Such functional improvement did not occur equally in all of the participants: Neglect patients with lesions involving the frontal cortex (n = 13) experienced significantly better functional improvement than did those without frontal lesions (n = 8). More importantly, voxel-based lesion-behavior mapping (VLBM) revealed that in comparison to the group of patients without frontal lesions, the frontal-lesioned neglect patients had intact regions in the medial temporal areas, the superior temporal areas, and the inferior longitudinal fasciculus. The medial cortical and subcortical areas in the temporal lobe were especially distinguished in the "frontal lesion" group. The findings suggest that the integrity of medial temporal structures may play an important role in supporting functional improvement after PAT.
Collapse
Affiliation(s)
- Peii Chen
- Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA,
| | | | | | | | | |
Collapse
|
76
|
Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility. Arch Phys Med Rehabil 2015; 96:1458-66. [PMID: 25862254 DOI: 10.1016/j.apmr.2015.03.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. DESIGN Inception cohort. SETTING Inpatient rehabilitation facility (IRF). PARTICIPANTS Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP). INTERVENTIONS Usual and standard IRF care. MAIN OUTCOME MEASURES The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition. RESULTS The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. CONCLUSIONS Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS.
Collapse
|
77
|
Aparicio-López C, García-Molina A, García-Fernández J, Lopez-Blazquez R, Enseñat-Cantallops A, Sánchez-Carrión R, Muriel V, Tormos JM, Roig-Rovira T. Cognitive rehabilitation with right hemifield eye-patching for patients with sub-acute stroke and visuo-spatial neglect: a randomized controlled trial. Brain Inj 2015; 29:501-7. [PMID: 25565480 DOI: 10.3109/02699052.2014.995230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess whether, following a right-hemisphere stroke, the combined administration of computer-based cognitive rehabilitation and right hemifield eye-patching in patients with visuo-spatial neglect is more effective than computer-based cognitive rehabilitation alone. METHODS Twelve patients were randomized into two treatment groups: a single treatment group (n = 7) and a combination treatment group (n = 5). In both cases, the treatment consisted of a mean number of 15 sessions, each lasting 1 hour. Visuo-spatial neglect was assessed using a specific exploration protocol (Bell Cancellation Test, Figure Copying of Odgen, Line Bisection, Baking Tray Task and Reading Task). The functional effects of the treatment were assessed using the Catherine Bergego Scale. RESULTS Significant between-group differences were observed when comparing the pre- and post-treatment scores for the Reading Task. No differences were observed in either group in the Catherine Bergego Scale administered at baseline and at the final intervention. CONCLUSION The results obtained do not allow one to conclude that the combination treatment with cognitive rehabilitation and right hemifield eye-patching is more effective than cognitive rehabilitation alone. Although partial improvement in the performance of neuropsychological tests was observed, this improvement is not present at functional level.
Collapse
Affiliation(s)
- Celeste Aparicio-López
- Institut Guttmann, Institut Universitari de Neurorehabilitació , adscrit UAB, Badalona, Barcelona , Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Chen P, Chen CC, Hreha K, Goedert KM, Barrett AM. Kessler Foundation Neglect Assessment Process uniquely measures spatial neglect during activities of daily living. Arch Phys Med Rehabil 2014; 96:869-876.e1. [PMID: 25461827 DOI: 10.1016/j.apmr.2014.10.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore the factor structure of the Kessler Foundation Neglect Assessment Process (KF-NAP), and evaluate the prevalence and clinical significance of spatial neglect among stroke survivors. DESIGN Inception cohort. SETTING Inpatient rehabilitation facility (IRF). PARTICIPANTS Participants (N=121) with unilateral brain damage from their first stroke were assessed within 72 hours of admission to an IRF, and 108 were assessed again within 72 hours before IRF discharge. INTERVENTIONS Usual and standard IRF care. MAIN OUTCOME MEASURES During each assessment session, occupational therapists measured patients' functions with the KF-NAP, FIM, and Barthel Index (BI). RESULTS The KF-NAP showed excellent internal consistency with a single-factor structure. The exploratory factor analysis revealed the KF-NAP to be unique from both the FIM and BI even though all 3 scales were correlated. Symptoms of spatial neglect (KF-NAP>0) were present in 67.8% of the participants at admission and 47.2% at discharge. Participants showing the disorder at IRF admission were hospitalized longer than those showing no symptoms. Among those presenting with symptoms, the regression analysis showed that the KF-NAP scores at admission negatively predicted FIM scores at discharge, after controlling for age, FIM at admission, and length of stay. CONCLUSIONS The KF-NAP uniquely quantifies symptoms of spatial neglect by measuring functional difficulties that are not captured by the FIM or BI. Using the KF-NAP to measure spatial neglect, we found the disorder persistent after inpatient rehabilitation, and replicated previous findings showing that spatial neglect adversely affects rehabilitation outcome even after prolonged IRF care.
Collapse
Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ.
| | - Christine C Chen
- Department of Rehabilitation Sciences, University of Texas, El Paso, TX
| | - Kimberly Hreha
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY; Kessler Institute for Rehabilitation, West Orange, NJ
| | - Kelly M Goedert
- Department of Psychology, Seton Hall University, South Orange, NJ
| | - A M Barrett
- Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ
| |
Collapse
|
79
|
Galletta EE, Campanelli L, Maul KK, Barrett AM. Assessment of neglect dyslexia with functional reading materials. Top Stroke Rehabil 2014; 21:75-86. [PMID: 24521842 DOI: 10.1310/tsr2101-75] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spatial neglect is a neurocognitive disorder that affects perception, representation, and/or motor planning. Neglect dyslexia in spatial neglect after right hemisphere damage may co-occur with, or be dissociated from, other spatial neglect signs. Previous neglect dyslexia research focused on word-level stimuli and reading errors. Using single words for assessment may leave some people with neglect dyslexia undiagnosed, and assessment materials that are closer to texts read in real life may better capture neglect dyslexia. METHOD The authors tested reading in 67 right hemisphere stroke survivors with 4 types of text materials: words, phrases, an article, and a menu. RESULTS Accuracy on reading the menu and article texts was significantly poorer than reading the words and phrases. The hypothesis that assessment materials with ecological validity such as reading a menu and reading an article may be more challenging than reading single words and phrases was supported. CONCLUSION Results suggest that neglect dyslexia assessment after stroke should include text materials comparable to those read in everyday life. Increasing the spatial extent of training materials in future research might also yield better functional generalization after right brain stroke.
Collapse
Affiliation(s)
- Elizabeth E Galletta
- Hunter College, The City University of New York, New York, New York The Graduate School and University Center, The City University of New York, New York, New York Kessler Foundation Research Center, West Orange, New Jersey
| | - Luca Campanelli
- The Graduate School and University Center, The City University of New York, New York, New York
| | - Kristen K Maul
- Kessler Foundation Research Center, West Orange, New Jersey
| | - A M Barrett
- Kessler Foundation Research Center, West Orange, New Jersey New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
80
|
Vleet TV, DeGutis J, Dabit S, Chiu C. Randomized control trial of computer-based rehabilitation of spatial neglect syndrome: the RESPONSE trial protocol. BMC Neurol 2014; 14:25. [PMID: 24502769 PMCID: PMC3922254 DOI: 10.1186/1471-2377-14-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 01/28/2014] [Indexed: 11/17/2022] Open
Abstract
Background Spatial neglect is a frequent and debilitating consequence of acquired brain injury and currently has no widely accepted standard of care. While previous interventions for spatial neglect have targeted patients’ overt spatial deficits (e.g., reduced contralesional visual scanning), far fewer have directly targeted patients’ non-spatial deficits (e.g., sustained attention deficits). Considering that non-spatial deficits have shown to be highly predictive of long-term disability, we developed a novel computer based training program that targets both sustained (tonic) and moment-to-moment (phasic) aspects of non-spatial attention (Tonic and Phasic Alertness Training, TAPAT). Preliminary studies demonstrate that TAPAT is safe and effective in improving both spatial and non-spatial attention deficits in the post-acute recovery phase in neglect patients. The purpose of the current trial (referred to as the REmediation of SPatial Neglect or RESPONSE trial) is to compare TAPAT to an active control training condition, include a larger sample of patients, and assess both cognitive and functional outcomes. Methods/Design We will employ a multi-site, longitudinal, blinded randomized controlled trial (RCT) design with a target sample of 114 patients with spatial neglect. Patients will either perform, at their home, the experimental TAPAT training program or an active control computer games condition for thirty minutes/day, five days a week, over three months. Patients will be assessed on a battery of cognitive and functional outcomes on three occasions: a) immediately before training, b) within forty-eight hours post completion of total training, and c) after a three-month no-contact period post completion of total training, to assess the longevity of potential training effects. Discussion The strengths of this protocol are that it tests an innovative, in-home administered treatment that targets a fundamental deficit in neglect, employs highly sensitive computer-based assessments of cognition as well as functional outcomes, and incorporates a large sample size (relative to other neglect treatment studies) in an RCT design. Trial registration ClinicalTrials.gov identifier, NCT01965951
Collapse
Affiliation(s)
- Thomas Van Vleet
- Brain Plasticity Institute, 77 Geary Street, San Francisco, CA 94108, USA.
| | | | | | | |
Collapse
|
81
|
Oh-Park M, Hung C, Chen P, Barrett AM. Severity of spatial neglect during acute inpatient rehabilitation predicts community mobility after stroke. PM R 2014; 6:716-22. [PMID: 24412266 DOI: 10.1016/j.pmrj.2014.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/25/2013] [Accepted: 01/06/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine whether stroke survivors with more severe spatial neglect during their acute inpatient rehabilitation had poorer mobility after returning to their communities. DESIGN A prospective observational study. SETTING Acute inpatient rehabilitation and follow-up in the community. PARTICIPANTS Thirty-one consecutive stroke survivors with right-brain damage (women, n = 15 [48.4%]), with the mean (standard deviation) age of 60 ± 11.5 years, were included in the study if they demonstrated spatial neglect within 2 months after stroke. METHODS Spatial neglect was assessed with the Behavioral Inattention Test (BIT) (range, 0-146 [a lower score indicates more severity]) and the Catherine Bergego Scale (range, 0-30 [a higher score indicates more severity]). A score of the Behavioral Inattention Test <129 or of the Catherine Bergego Scale >0 defined the presence of spatial neglect. MAIN OUTCOME MEASUREMENTS The outcome measure is community mobility, defined by the extent and frequency of traveling within the home and in the community, and is assessed with the University of Alabama at Birmingham Study of Aging Life-Space Assessment (range, 0-120 [a lower score indicates less mobile]). This measure was assessed after participants returned home ≥6 months after stroke. The covariates were age, gender, functional independence at baseline; follow-up interval; and depressed mood, which may affect the relationship between spatial neglect and community mobility. RESULTS A lower Behavioral Inattention Test score was a significant predictor of a lower Life-Space Assessment score after controlling for all the covariates (β = 0.009 [95% confidence interval, 0.008-0.017]); P = .020). The proportion of participants unable to travel independently beyond their homes was 0%, 27.3%, and 72.7% for those with mild, moderate, and severe acute neglect, respectively (Catherine Bergego Scale range, 1-10, 11-20, and 21-30, respectively). CONCLUSIONS Our result indicates that acute spatial neglect has a negative impact on regaining of functional mobility in the community. Specific screening and treatment of spatial neglect during acute stroke care may be necessary to improve long-term mobility recovery.
Collapse
Affiliation(s)
- Mooyeon Oh-Park
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ; Stroke Rehabilitation Research Laboratory, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052(∗).
| | - Cynthia Hung
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ(†)
| | - Peii Chen
- Stroke Rehabilitation Research Laboratory, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ(‡)
| | - A M Barrett
- Stroke Rehabilitation Research Laboratory, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ(§)
| |
Collapse
|
82
|
Goedert KM, Chen P, Boston RC, Foundas AL, Barrett AM. Presence of Motor-Intentional Aiming Deficit Predicts Functional Improvement of Spatial Neglect With Prism Adaptation. Neurorehabil Neural Repair 2013; 28:483-93. [PMID: 24376064 DOI: 10.1177/1545968313516872] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Background Spatial neglect is a debilitating disorder for which there is no agreed on course of rehabilitation. The lack of consensus on treatment may result from systematic differences in the syndrome's characteristics, with spatial cognitive deficits potentially affecting perceptual-attentional "Where" or motor-intentional "Aiming" spatial processing. Heterogeneity of response to treatment might be explained by different treatment impacts on these dissociated deficits: prism adaptation, for example, might reduce Aiming deficits without affecting Where spatial deficits. OBJECTIVE Here, we tested the hypothesis that classifying patients by their profile of Where-versus-Aiming spatial deficit would predict response to prism adaptation and specifically that patients with Aiming bias would have better recovery than those with isolated Where bias. Methods We classified the spatial errors of 24 subacute right stroke survivors with left spatial neglect as (1) isolated Where bias, (2) isolated Aiming bias, or (3) both. Participants then completed 2 weeks of prism adaptation treatment. They also completed the Behavioral Inattention Test and Catherine Bergego Scale (CBS) tests of neglect recovery weekly for 6 weeks. Results As hypothesized, participants with only Aiming deficits improved on the CBS, whereas those with only Where deficits did not improve. Participants with both deficits demonstrated intermediate improvement. Conclusion These results support behavioral classification of spatial neglect patients as a potential valuable tool for assigning targeted, effective early rehabilitation.
Collapse
Affiliation(s)
| | - Peii Chen
- Kessler Foundation, West Orange, NJ, USA Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | | | - A M Barrett
- Kessler Foundation, West Orange, NJ, USA Rutgers New Jersey Medical School, Newark, NJ, USA Kessler Institute for Rehabilitation, West Orange, NJ, USA
| |
Collapse
|
83
|
Shah PP, Spaldo N, Barrett AM, Chen P. Assessment and functional impact of allocentric neglect: a reminder from a case study. Clin Neuropsychol 2013; 27:840-63. [PMID: 23560431 DOI: 10.1080/13854046.2013.783120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
SR suffered a right hemispheric stroke more than 3 years ago, and now lives with left-sided hemiparesis and chronic spatial neglect due to damaged white matter pathways connecting the frontal, temporal and parietal regions. We report here that SR suffers from both viewer-centered (i.e., egocentric) and object-centered (i.e., allocentric) spatial neglect. Notably, unlike most neuropsychological and functional assessments that focus on egocentric deficits, a specialized neuropsychological figurative discrimination test (the Apples test) revealed SR's allocentric neglect. Further, using assessments sensitive to detect functional deficits related to allocentric neglect, we observed SR's difficulty in reading and using clocks, reflecting his object-centered errors in these everyday activities. SR's case suggests that allocentric-specific assessments, both neuropsychological and functional, are valuable in standard neglect examinations, particularly to predict daily function after stroke. We recommend that neglect-related functional disability be distinguished further with respect to allocentric spatial deficits, and functional assessments for allocentric neglect should be validated in future large sample studies. Identifying allocentric neglect early, and learning about its influence on daily function, may enhance care quality and facilitate effective rehabilitation planning for stroke recovery.
Collapse
Affiliation(s)
- Priyanka P Shah
- Department of Neurology, Center for Cognitive Neuroscience, University of Pennsylvania, Philadelphia, PA 19104-6241, USA.
| | | | | | | |
Collapse
|