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Colombo P, Taveggia G, Chiesa D, Penati R, Tiboni M, De Armas L, Casale R. Lower Tinetti scores can support an early diagnosis of spatial neglect in post-stroke patients. Eur J Phys Rehabil Med 2019; 55:722-727. [PMID: 31274273 DOI: 10.23736/s1973-9087.19.05448-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neglect represents a severe complication of stroke, which impairs patients' daily activities. An early diagnosis of neglect is fundamental for management decisions. AIM The aim of this study is to evaluate the usefulness of the Tinetti Test as an outcome of spatial neglect in post-stroke patients. DESIGN Observational retrospective data analysis. SETTING Rehabilitation Hospital. POPULATION Cohort of post-stroke adults admitted in our Rehabilitation Unit. METHODS One hundred and sixty stroke patients were evaluated between the 1st of January 2015 and the 31st of December 2016 at our Department. Eighty-nine inpatients matched the inclusion criteria. Their scores of the Tinetti Test for balance condition and gait function were compared with Bells Test and line bisection task for spatial neglect. Global independence activity was also assessed using Barthel Index and global cognitive functioning by means of the Mini-Mental State Examination. RESULTS Twenty-two patients between the 89 patients included in this study were affected by spatial neglect at admission. A high statistical significant correlation was observed between lower Tinetti scores and neglect presence (mean Tinetti Score: 2.36 neglect; 7.82 non-neglect; P<0.001). CONCLUSIONS The Tinetti Test is a well-established assessment scale to measure balance ability and gait function in post-stroke patients. Results from this study suggest that Tinetti Test may be considered as an early ecological screening tool for the diagnosis of neglect in post-stroke patients. CLINICAL REHABILITATION IMPACT The alternative use of the Tinetti Test for the diagnosis of spatial neglect.
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Affiliation(s)
- Paola Colombo
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy
| | - Giovanni Taveggia
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy
| | - Deborah Chiesa
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy -
| | - Rachele Penati
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Monica Tiboni
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Liala De Armas
- Unit of Rehabilitation, Faccanoni Hospital, Habilita Care&Research Hospitals, Sarnico, Bergamo, Italy
| | - Roberto Casale
- Istituto di Neuroriabilitazione ad Alta Complessità, Habilita Care&Research Hospitals, Zingonia di Ciserano, Bergamo, Italy
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Bosma MS, Nijboer TCW, Caljouw MAA, Achterberg WP. Impact of visuospatial neglect post-stroke on daily activities, participation and informal caregiver burden: A systematic review. Ann Phys Rehabil Med 2019; 63:344-358. [PMID: 31200080 DOI: 10.1016/j.rehab.2019.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age<65 versus≥65 years. METHODS PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. RESULTS Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age≥65), and 2 on caregiver burden (1 study with mean age≥65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences. CONCLUSIONS AND IMPLICATIONS VSN has a negative impact not only on patients' independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice. SYSTEMATIC REVIEW REGISTRATION NO PROSPERPO Registration No. CRD42018087483.
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Affiliation(s)
- Martine S Bosma
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands; Zorggroep Florence, Laan van Vredenoord 1, 2289 DA, Rijswijk, The Netherlands.
| | - Tanja C W Nijboer
- Center of excellence for rehabilitation medicine, UMC Utrecht brain center, university medical center Utrecht, and De Hoogstraat rehabilitation, Utrecht, The Netherlands; Utrecht university, department of experimental psychology, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Monique A A Caljouw
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Mapping the neuroanatomy of functional decline in Alzheimer’s disease from basic to advanced activities of daily living. J Neurol 2019; 266:1310-1322. [DOI: 10.1007/s00415-019-09260-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/15/2019] [Accepted: 02/26/2019] [Indexed: 11/27/2022]
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Nyffeler T, Vanbellingen T, Kaufmann BC, Pflugshaupt T, Bauer D, Frey J, Chechlacz M, Bohlhalter S, Müri RM, Nef T, Cazzoli D. Theta burst stimulation in neglect after stroke: functional outcome and response variability origins. Brain 2019; 142:992-1008. [DOI: 10.1093/brain/awz029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Tim Vanbellingen
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Brigitte C Kaufmann
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | - Daniel Bauer
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Julia Frey
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | | | - René M Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
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Shea-Shumsky NB, Schoeneberger S, Grigsby J. Executive functioning as a predictor of stroke rehabilitation outcomes. Clin Neuropsychol 2019; 33:854-872. [DOI: 10.1080/13854046.2018.1546905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Jim Grigsby
- Departments of Psychology and Medicine, University of Colorado Denver, Denver, CO, USA
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Bier N, El-Samra A, Bottari C, Vallet G, Carignan M, Paquette G, Brambati S, Demers L, Génier-Marchand D, Rouleau I. Posterior cortical atrophy: Impact on daily living activities and exploration of a cognitive rehabilitation approach. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1634911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- N. Bier
- School of rehabilitation, Université de Montréal, Montréal, Canada
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - A. El-Samra
- School of rehabilitation, Université de Montréal, Montréal, Canada
| | - C. Bottari
- School of rehabilitation, Université de Montréal, Montréal, Canada
- Centre de recherche en réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
| | - G.T. Vallet
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - M. Carignan
- Centre de recherche en réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
- Institut Nazareth et Louis Braille, CISSS de la Montérégie-Centre, Montreal, Canada
| | - G. Paquette
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Centre de recherche en réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
| | - S. Brambati
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Department of psychology, Université de Montréal, Montreal, Canada
| | - L. Demers
- School of rehabilitation, Université de Montréal, Montréal, Canada
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - D. Génier-Marchand
- Department of psychology, Université du Québec à Montréal, Montreal, Canada
| | - I. Rouleau
- Department of psychology, Université du Québec à Montréal, Montreal, Canada
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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.
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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
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58
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Delazer M, Sojer M, Ellmerer P, Boehme C, Benke T. Eye-Tracking Provides a Sensitive Measure of Exploration Deficits After Acute Right MCA Stroke. Front Neurol 2018; 9:359. [PMID: 29942277 PMCID: PMC6004522 DOI: 10.3389/fneur.2018.00359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Abstract
The eye-tracking study aimed at assessing spatial biases in visual exploration in patients after acute right MCA (middle cerebral artery) stroke. Patients affected by unilateral neglect show less functional recovery and experience severe difficulties in everyday life. Thus, accurate diagnosis is essential, and specific treatment is required. Early assessment is of high importance as rehabilitative interventions are more effective when applied soon after stroke. Previous research has shown that deficits may be overlooked when classical paper-and-pencil tasks are used for diagnosis. Conversely, eye-tracking allows direct monitoring of visual exploration patterns. We hypothesized that the analysis of eye-tracking provides more sensitive measures for spatial exploration deficits after right middle cerebral artery stroke. Twenty-two patients with right MCA stroke (median 5 days after stroke) and 28 healthy controls were included. Lesions were confirmed by MRI/CCT. Groups performed comparably in the Mini-Mental State Examination (patients and controls median 29) and in a screening of executive functions. Eleven patients scored at ceiling in neglect screening tasks, 11 showed minimal to severe signs of unilateral visual neglect. An overlap plot based on MRI and CCT imaging showed lesions in the temporo-parieto-frontal cortex, basal ganglia, and adjacent white matter tracts. Visual exploration was evaluated in two eye-tracking tasks, one assessing free visual exploration of photographs, the other visual search using symbols and letters. An index of fixation asymmetries proved to be a sensitive measure of spatial exploration deficits. Both patient groups showed a marked exploration bias to the right when looking at complex photographs. A single case analysis confirmed that also most of those patients who showed no neglect in screening tasks performed outside the range of controls in free exploration. The analysis of patients' scoring at ceiling in neglect screening tasks is of special interest, as possible deficits may be overlooked and thus remain untreated. Our findings are in line with other studies suggesting considerable limitations of laboratory screening procedures to fully appreciate the occurrence of neglect symptoms. Future investigations are needed to explore the predictive value of the eye-tracking index and its validity in everyday situations.
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Affiliation(s)
- Margarete Delazer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Sojer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Philipp Ellmerer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Benke
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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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.
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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
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60
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The Adult Assisting Hand Assessment Stroke: Psychometric Properties of an Observation-Based Bimanual Upper Limb Performance Measurement. Arch Phys Med Rehabil 2018; 99:2513-2522. [PMID: 29807004 DOI: 10.1016/j.apmr.2018.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/28/2018] [Accepted: 04/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate interrater and intrarater reliability, measurement error, and convergent and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke). DESIGN Cross-sectional observational study. SETTING A total of 7 stroke rehabilitation centers. PARTICIPANTS Stroke survivors (reliability sample: n=30; validity sample: N=118) were included (median age 67y; interquartile range [IQR], 59-76); median time poststroke 81 days (IQR 57-117). INTERVENTIONS N/A. MAIN OUTCOME MEASURES Ad-AHA Stroke, Action Research Arm Test (ARAT), upper extremity Fugl-Meyer Assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults poststroke. Reliability of Ad-AHA Stroke was examined using intraclass correlation coefficients (ICCs), Bland-Altman plots, and weighted kappa statistics for reliability on item level. SEM was calculated based on Ad-AHA units. Convergent validity was assessed by calculating Spearman rank correlation coefficients between Ad-AHA Stroke and ARA test and UE-FMA. Comparison of Ad-AHA Stroke scores between subgroups of patients according to hand dominance, neglect, and age evaluated discriminative validity. RESULTS Intrarater and interrater agreement showed an ICC of 0.99 (95% confidence interval, 0.99-0.99), an SEM of 2.15 and 1.64 out of 100, respectively, and weighted kappa for item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was strong (ρ=0.9). Patients with neglect had significantly lower Ad-AHA scores compared to patients without neglect (P=.004). CONCLUSIONS The Ad-AHA Stroke captures actual bimanual performance. Therefore, it provides an additional aspect of upper limb assessment with good to excellent reliability and low SEM for patients with subacute stroke. High convergent validity with the ARA test and UE-FMA and discriminative validity were supported.
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Ten Brink AF, Visser-Meily JMA, Schut MJ, Kouwenhoven M, Eijsackers ALH, Nijboer TCW. Prism Adaptation in Rehabilitation? No Additional Effects of Prism Adaptation on Neglect Recovery in the Subacute Phase Poststroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:1017-1028. [DOI: 10.1177/1545968317744277] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Patients with neglect ignore or respond slower to contralesional stimuli. Neglect negatively influences independence in activities of daily living (ADL). Prism adaptation (PA) is one of the most frequently studied treatments, yet there is little evidence regarding positive effects on neglect behavior in ADL. Objective. To assess whether PA in the subacute phase ameliorates neglect in situations of varying complexity. Methods. A total of 70 neglect patients admitted for inpatient stroke rehabilitation received either PA or sham adaptation (SA) for 2 weeks, with full access to standard treatment. There were 7 time-dependent measurements (baseline and 1-4, 6, and 14 weeks after start of treatment). The primary outcome was change of neglect as observed during basic ADL with the Catherine Bergego Scale (CBS). Secondary outcomes were changes in performance on a dynamic multitask (ie, the Mobility Assessment Course [MAC]) and a static paper-and-pencil task (ie, a shape cancellation task [SC]). Results. In all, 34 patients received PA and 35 SA. There were significant time-dependent improvements in performance as measured with the CBS, MAC, and SC (all F > 15.57; P < .001). There was no significant difference in magnitude of improvement between groups on the CBS, MAC, and SC (all F < 2.54; P > .113]. Conclusions. No beneficial effects of PA over SA in the subacute phase poststroke were observed, which was comparable for situations of varying complexity. Heterogeneity of the syndrome, time post–stroke onset, and the content of treatment as usual are discussed. Basic knowledge on subtypes and recovery patterns would aid the development of tailored treatment.
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Affiliation(s)
- Antonia F. Ten Brink
- University Medical Center Utrecht, Netherlands
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | | | | | | | | | - Tanja C. W. Nijboer
- University Medical Center Utrecht, Netherlands
- Utrecht University, Netherlands
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Yoshihiro N, Ito E. Effect of Passive Limb Activation by Functional Electrical Stimulation on Wheelchair Driving in Patients with Unilateral Spatial Neglect: A Case Study. Hong Kong J Occup Ther 2017; 30:14-21. [PMID: 30186076 PMCID: PMC6092007 DOI: 10.1016/j.hkjot.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/16/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background/Objective Limb activation is one of the behavioural interventions to improve unilateral
spatial neglect (USN). However, the effect of passive limb activation on
activities of daily living (ADL) is not clear. This study examined the
effect of passive limb activation by functional electrical stimulation (FES)
on wheelchair driving for patients with USN, and to discuss the possibility
of application of this treatment to occupational therapy. Methods A single subject design-baseline-intervention-baseline (ABA), was applied to
2 stroke patients with USN. Phase A' and A consisted of the wheelchair
driving task only. Phase B consisted of the wheelchair driving task with
FES. Each phase lasted for 2 weeks. The wheelchair driving task was
maneuvering on a square passage in the clockwise and counter clockwise
conditions for 8 minutes respectively, and four obstacles were set at each
side. FES was applied to the affected forearm extensor muscles. Assessor
recorded: 1) The distance participants drove wheelchair for 8 minutes, and
2) The number of collisions with obstacles and the wall, for 10 days. Results For one participant, the distance of maneuvering significantly increased in
phase B (p < .05.), and USN on the cognitive test in the extrapersonal
space indicated a tendency to improve after phase B. Conclusion Passive limb activation by FES improved wheelchair driving and cognitive
performance for patients with USN. It can be used with instruction from
occupational therapists to enhance the performance on ADL.
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Affiliation(s)
- Nao Yoshihiro
- Department of Rehabilitation (Occupational Therapy), Tango Central Hospital, Kyoto, Japan
| | - Emi Ito
- Department of Physical and Occupational Therapy, Graduate School of Medicine, Nagoya University, Aichi, Japan
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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
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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.
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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
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65
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Patients’ characteristics and outcomes depending on complete or incomplete unilateral spatial neglect. Neurosurg Rev 2017; 40:643-646. [DOI: 10.1007/s10143-017-0821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
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66
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Hadid V, Lepore F. From Cortical Blindness to Conscious Visual Perception: Theories on Neuronal Networks and Visual Training Strategies. Front Syst Neurosci 2017; 11:64. [PMID: 28912694 PMCID: PMC5583595 DOI: 10.3389/fnsys.2017.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/11/2017] [Indexed: 12/13/2022] Open
Abstract
Homonymous hemianopia (HH) is the most common cortical visual impairment leading to blindness in the contralateral hemifield. It is associated with many inconveniences and daily restrictions such as exploration and visual orientation difficulties. However, patients with HH can preserve the remarkable ability to unconsciously perceive visual stimuli presented in their blindfield, a phenomenon known as blindsight. Unfortunately, the nature of this captivating residual ability is still misunderstood and the rehabilitation strategies in terms of visual training have been insufficiently exploited. This article discusses type I and type II blindsight in a neuronal framework of altered global workspace, resulting from inefficient perception, attention and conscious networks. To enhance synchronization and create global availability for residual abilities to reach visual consciousness, rehabilitation tools need to stimulate subcortical extrastriate pathways through V5/MT. Multisensory bottom-up compensation combined with top-down restitution training could target pre-existing and new neuronal mechanisms to recreate a framework for potential functionality.
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Affiliation(s)
- Vanessa Hadid
- Département de Sciences Biomédicales, Université de MontréalMontréal, QC, Canada
| | - Franco Lepore
- Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Département de Psychologie, Université de MontréalMontréal, QC, Canada
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67
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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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68
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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
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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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70
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Ten Brink AF, Visser-Meily JMA, Nijboer TCW. Dynamic assessment of visual neglect: The Mobility Assessment Course as a diagnostic tool. J Clin Exp Neuropsychol 2017; 40:161-172. [DOI: 10.1080/13803395.2017.1324562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antonia F. Ten Brink
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus,University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M. A. Visser-Meily
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus,University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tanja C. W. Nijboer
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus,University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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71
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Increased Alpha-Rhythm Dynamic Range Promotes Recovery from Visuospatial Neglect: A Neurofeedback Study. Neural Plast 2017; 2017:7407241. [PMID: 28529806 PMCID: PMC5424484 DOI: 10.1155/2017/7407241] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/08/2017] [Indexed: 11/22/2022] Open
Abstract
Despite recent attempts to use electroencephalogram (EEG) neurofeedback (NFB) as a tool for rehabilitation of motor stroke, its potential for improving neurological impairments of attention—such as visuospatial neglect—remains underexplored. It is also unclear to what extent changes in cortical oscillations contribute to the pathophysiology of neglect, or its recovery. Utilizing EEG-NFB, we sought to causally manipulate alpha oscillations in 5 right-hemisphere stroke patients in order to explore their role in visuospatial neglect. Patients trained to reduce alpha oscillations from their right posterior parietal cortex (rPPC) for 20 minutes daily, over 6 days. Patients demonstrated successful NFB learning between training sessions, denoted by improved regulation of alpha oscillations from rPPC. We observed a significant negative correlation between visuospatial search deficits (i.e., cancellation test) and reestablishment of spontaneous alpha-rhythm dynamic range (i.e., its amplitude variability). Our findings support the use of NFB as a tool for investigating neuroplastic recovery after stroke and suggest reinstatement of intact parietal alpha oscillations as a promising target for reversing attentional deficits. Specifically, we demonstrate for the first time the feasibility of EEG-NFB in neglect patients and provide evidence that targeting alpha amplitude variability might constitute a valuable marker for clinical symptoms and self-regulation.
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72
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Abstract
BACKGROUND Many stroke patients are clinically dehydrated at the time of hospital presentation, which could lead to an increase in blood viscosity and alteration in cerebral perfusion. Impaired cerebral perfusion can cause hemispheric dysfunction, which can be rapidly quantified with bedside tests of hemispatial neglect. We hypothesized that hospitalized patients with laboratory markers consistent with dehydration or a volume contracted state (VCS) would have more severe cerebral dysfunction defined by greater degree of neglect. METHODS Subjects were a consecutive series of right-handed patients with acute right hemispheric stroke admitted within the Johns Hopkins Health System. All participants had clinical syndrome and magnetic resonance imaging consistent with acute infarction. The primary definition of a VCS was a urea/creatinine ratio >15, with secondary definition including urine specific gravity over 1.010. Acute infarct volume was measured on magnetic resonance imaging. Neglect was evaluated using a standardized battery of bedside tests. RESULTS Of 201 patients meeting inclusion criteria, 131/201 (65%) had elevated BUN/creatinine ratios at admission. Approximately 61% (122/201) had some degree of neglect. Elevated BUN/creatinine ratio was associated with an increased odds of severe neglect in unadjusted models (OR=4.1; 95% CI, 1.2, 14.4), with loss of significance in adjusted models (OR=4.43; 95% CI, 0.99, 19.8) after adjustment for age, infarct volume, sex, and NIHSS score. CONCLUSIONS Our data suggest that patients who are in a VCS at the time of stroke may have more frequent and severe neglect, with attenuation of results after adjustment for factors related to stroke size and age. If proven clinically relevant, a formalized rehydration strategy based on objective lab markers may represent an opportunity for improvement in outcome with low-cost, broadly available treatment for acute stroke patients.
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73
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Caulfield MD, Chen P, Barry MM, Barrett AM. Which perseverative behaviors are symptoms of spatial neglect? Brain Cogn 2017; 113:93-101. [PMID: 28167411 DOI: 10.1016/j.bandc.2016.11.002] [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] [Received: 01/12/2016] [Revised: 10/31/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
Abstract
Spatial neglect is a characterized by a failure to attend or make movements towards left-sided stimuli. Common paper-and-pencil tasks to diagnose spatial neglect are sensitive to perseverative errors, including additional marks over already cancelled targets and "scribbling" out a target. Here, we examine whether functionally distinct perseverative behaviors are related to spatial neglect. Line cancellation tasks of 45 healthy controls and 220 right-hemisphere stroke survivors were examined for recurrent marks (RM) and continuous marks (CM) perseverations. We found that RM perseveration correlated with neglect severity, while CM perseveration did not. Examination of lesion profiles for the two groups indicated distinct anatomical correlates, with RM lesions overlapping regions implicated in spatial neglect including the rolandic operculum, superior temporal gyrus, and inferior parietal lobule.
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Affiliation(s)
- Meghan D Caulfield
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA; Department of Psychology, Lafayette College, Easton, PA, USA.
| | - Peii Chen
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Michele M Barry
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA
| | - A M Barrett
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA; Kessler Institute for Rehabilitation, West Orange, NJ, USA
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74
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Ten Brink AF, Verwer JH, Biesbroek JM, Visser-Meily JMA, Nijboer TCW. Differences between left- and right-sided neglect revisited: A large cohort study across multiple domains. J Clin Exp Neuropsychol 2016; 39:707-723. [DOI: 10.1080/13803395.2016.1262333] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Antonia F. Ten Brink
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Jurre H. Verwer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J. Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M. A. Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tanja C. W. Nijboer
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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Abstract
In a cancellation task, a participant is required to search for and cross out (“cancel”) targets, which are usually embedded among distractor stimuli. The number of cancelled targets and their location can be used to diagnose the neglect syndrome after stroke. In addition, the organization of search provides a potentially useful way to measure executive control over multitarget search. Although many useful cancellation measures have been introduced, most fail to make their way into research studies and clinical practice due to the practical difficulty of acquiring such parameters from traditional pen-and-paper measures. Here we present new, open-source software that is freely available to all. It allows researchers and clinicians to flexibly administer computerized cancellation tasks using stimuli of their choice, and to directly analyze the data in a convenient manner. The automated analysis suite provides output that includes almost all of the currently existing measures, as well as several new ones introduced here. All tasks can be performed using either a computer mouse or a touchscreen as an input device, and an online version of the task runtime is available for tablet devices. A summary of the results is produced in a single A4-sized PDF document, including high quality data visualizations. For research purposes, batch analysis of large datasets is possible. In sum, CancellationTools allows users to employ a flexible, computerized cancellation task, which provides extensive benefits and ease of use.
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76
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Chen P, Fyffe DC, Hreha K. Informal caregivers' burden and stress in caring for stroke survivors with spatial neglect: an exploratory mixed-method study. Top Stroke Rehabil 2016; 24:24-33. [PMID: 27216085 DOI: 10.1080/10749357.2016.1186373] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Spatial neglect prolongs stroke survivors' recovery to independence. However, little is known about the impact of spatial neglect on caregivers of stroke survivors. OBJECTIVE To explore the factors associated with burden and stress among informal caregivers of stroke survivors with spatial neglect. METHODS Following the previous study of 108 stroke survivors, we reached 24 stroke survivors' caregivers, and 20 caregivers (age: M±SD=56.9±12.7 years; 12 females) completed the study. 10 survivors had symptoms of spatial neglect, and 10 did not (i.e., SN+ or SN-, respectively) at the time when discharged from inpatient rehabilitation, which was 9.3±6.2 months before the present study. Via a semi-structured telephone interview, we assessed caregivers' burden and stress qualitatively and quantitatively. RESULTS No difference was observed across caregiver groups in cognitive function, depressive mood, or community mobility. In comparison, caregivers of the SN+ group allocated more time to care, controlling for survivors' disability (adjusted effective size d = 1.80). Their self-perceived burden and stress were more severe than the other group (adjusted d = .99). Qualitative analysis indicated caregivers of the SN+ group were more likely to describe economic stressors and undesirable changes in career and vacation planning. While 80% of participants preferred their care recipients to receive additional motor or mobility therapy, caregivers of the SN+ group were more likely to suggest additional therapy for cognitive impairment. CONCLUSIONS This exploratory study suggests that spatial neglect may heighten caregivers' burden and stress levels. Future studies with a large sample size are required.
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Affiliation(s)
- Peii Chen
- a Kessler Foundation , 1199 Pleasant Valley Way, West Orange, New Jersey , 07052 , USA.,b Department of Physical Medicine and Rehabilitation , Rutgers University , USA
| | - Denise C Fyffe
- a Kessler Foundation , 1199 Pleasant Valley Way, West Orange, New Jersey , 07052 , USA.,b Department of Physical Medicine and Rehabilitation , Rutgers University , USA
| | - Kimberly Hreha
- c Department of Biobehavioral Sciences , Teachers College, Columbia University , USA.,d Kessler Institute for Rehabilitation , USA
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Sugihara S, Tanaka T, Miyasaka T, Izumi T, Shimizu K. Assessment of visual space recognition of patients with unilateral spatial neglect and visual field defects using a head mounted display system. J Phys Ther Sci 2016; 28:332-8. [PMID: 27065515 PMCID: PMC4792969 DOI: 10.1589/jpts.28.332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/30/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was the development of a method for presenting diverse visual information and assessing visual space recognition using a new head mounted display (HMD) system. [Subjects] Eight patients: four with unilateral spatial neglect (USN) and four with visual field defects (VFD). [Methods] A test sheet was placed on a desk, and its image was projected on the display of the HMD. Then, space recognition assessment was conducted using a cancellation test and motion analysis of the eyeballs and head under four conditions with images reduced in size and shifted. [Results] Leftward visual search was dominant in VFD patients, while rightward visual search was dominant in USN patients. The angular velocity of leftward eye movement during visual search of the right sheet decreased in both patient types. Motion analysis revealed a tendency of VFD patients to rotate the head in the affected direction under the left reduction condition, whereas USN patients rotated it in the opposite direction of the neglect. [Conclusion] A new HMD system was developed for presenting diverse visual information and assessing visual space recognition which identified the differences in the disturbance of visual space recognition of VFD and USN patients were indicated.
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Affiliation(s)
- Shunichi Sugihara
- The Graduate School of Information Science and Technology, Hokkaido University: N14, W9, Kita-ku, Sapporo 060-0814, Japan; Department of Rehabilitation, Sapporo Shuyukai Hospital, Japan
| | - Toshiaki Tanaka
- Department of Physical Therapy, Faculty of Health Sciences, Hokkaido University of Science, Japan
| | - Tomoya Miyasaka
- Department of Physical Therapy, Faculty of Health Sciences, Hokkaido University of Science, Japan
| | - Takashi Izumi
- Department of Human Science and Informatics, School of Biological Science and Engineering, Tokai University, Japan
| | - Koichi Shimizu
- The Graduate School of Information Science and Technology, Hokkaido University: N14, W9, Kita-ku, Sapporo 060-0814, Japan
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Fordell H, Bodin K, Eklund A, Malm J. RehAtt – scanning training for neglect enhanced by multi-sensory stimulation in Virtual Reality. Top Stroke Rehabil 2016; 23:191-9. [DOI: 10.1080/10749357.2016.1138670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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79
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De Wit L, Ten Brink AF, Visser-Meily JMA, Nijboer TCW. Does prism adaptation affect visual search in spatial neglect patients: A systematic review. J Neuropsychol 2016; 12:53-77. [DOI: 10.1111/jnp.12100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Liselotte De Wit
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine; University Medical Center Utrecht and De Hoogstraat Rehabilitation; The Netherlands
| | - Antonia F. Ten Brink
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine; University Medical Center Utrecht and De Hoogstraat Rehabilitation; The Netherlands
| | - Johanna M. A. Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine; University Medical Center Utrecht and De Hoogstraat Rehabilitation; The Netherlands
| | - Tanja C. W. Nijboer
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine; University Medical Center Utrecht and De Hoogstraat Rehabilitation; The Netherlands
- Department of Experimental Psychology; Helmholtz Institute; Utrecht University; The Netherlands
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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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Meyer S, De Bruyn N, Lafosse C, Van Dijk M, Michielsen M, Thijs L, Truyens V, Oostra K, Krumlinde-Sundholm L, Peeters A, Thijs V, Feys H, Verheyden G. Somatosensory Impairments in the Upper Limb Poststroke: Distribution and Association With Motor Function and Visuospatial Neglect. Neurorehabil Neural Repair 2015; 30:731-42. [PMID: 26719352 DOI: 10.1177/1545968315624779] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A thorough understanding of the presence of different upper-limb somatosensory deficits poststroke and the relation with motor performance remains unclear. Additionally, knowledge about the relation between somatosensory deficits and visuospatial neglect is limited. OBJECTIVE To investigate the distribution of upper-limb somatosensory impairments and the association with unimanual and bimanual motor outcomes and visuospatial neglect. METHODS A cross-sectional observational study was conducted, including 122 patients within 6 months after stroke (median = 82 days; interquartile range = 57-133 days). Somatosensory measurement included the Erasmus MC modification of the (revised) Nottingham Sensory Assessment (Em-NSA), Perceptual Threshold of Touch (PTT), thumb finding test, 2-point discrimination, and stereognosis subscale of the NSA. Upper-limb motor assessment comprised the Fugl-Meyer assessment, motricity index, Action Research Arm Test, and Adult-Assisting Hand Assessment Stroke. Screening for visuospatial neglect was performed using the Star Cancellation Test. RESULTS Upper-limb somatosensory impairments were common, with prevalence rates ranging from 21% to 54%. Low to moderate Spearman ρ correlations were found between somatosensory and motor deficits (r = 0.22-0.61), with the strongest associations for PTT (r = 0.56-0.61) and stereognosis (r = 0.51-0.60). Visuospatial neglect was present in 27 patients (22%). Between-group analysis revealed somatosensory deficits that occurred significantly more often and more severely in patients with visuospatial neglect (P < .05). Results showed consistently stronger correlations between motor and somatosensory deficits in patients with visuospatial neglect (r = 0.44-0.78) compared with patients without neglect (r = 0.08-0.59). CONCLUSIONS Somatosensory impairments are common in subacute patients poststroke and are related to motor outcome. Visuospatial neglect was associated with more severe upper-limb somatosensory impairments.
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Affiliation(s)
- Sarah Meyer
- KU Leuven-University of Leuven, Leuven, Belgium
| | | | | | | | - Marc Michielsen
- Jessa Hospital - Rehabilitation Centre Sint Ursula, Herk-de-stad, Belgium
| | - Liselot Thijs
- Jessa Hospital - Rehabilitation Centre Sint Ursula, Herk-de-stad, Belgium
| | | | | | | | - Andre Peeters
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vincent Thijs
- KU Leuven-University of Leuven, Leuven, Belgium University Hospitals Leuven, Leuven, Belgium Vesalius Research Center - VIB, Leuven, Belgium
| | - Hilde Feys
- KU Leuven-University of Leuven, Leuven, Belgium
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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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Pedroli E, Serino S, Cipresso P, Pallavicini F, Riva G. Assessment and rehabilitation of neglect using virtual reality: a systematic review. Front Behav Neurosci 2015; 9:226. [PMID: 26379519 PMCID: PMC4548208 DOI: 10.3389/fnbeh.2015.00226] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/10/2015] [Indexed: 12/13/2022] Open
Abstract
After experiencing a stroke in the right hemisphere, almost 50% of patients showed Unilateral Spatial Neglect (USN). In recent decades, Virtual Reality (VR) has been used as an effective tool both for the assessment and rehabilitation of USN. Indeed, this advanced technology allows post-stroke patients to interact with ecological and engaging environments similar to real ones, but in a safe and controlled way. To provide an overview of the most recent VR applications for the assessment and rehabilitation of USN, a systematic review has been carried out. Since 2010, 13 studies have proposed and tested innovative VR tools for USN. After a wide description of the selected studies, we discuss the main features of these VR tools in order to provide crucial indications for future studies, neurorehabilitation interventions, and clinical practice.
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Affiliation(s)
- Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Silvia Serino
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Federica Pallavicini
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano Milan, Italy ; Department of Psycholgy, Università Cattolica del Sacro Cuore Milan, Italy
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Rangaraju S, Streib C, Aghaebrahim A, Jadhav A, Frankel M, Jovin TG. Relationship Between Lesion Topology and Clinical Outcome in Anterior Circulation Large Vessel Occlusions. Stroke 2015; 46:1787-92. [PMID: 26060248 DOI: 10.1161/strokeaha.115.009908] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/12/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS), a surrogate of infarct volume, predicts outcome in anterior large vessel occlusion strokes. We aim to determine whether topological information captured by DWI ASPECTS contributes additional prognostic value. METHODS Adults with intracranial internal carotid artery, M1 or M2 middle carotid artery occlusions who underwent endovascular therapy were included. The primary outcome measure was poor clinical outcome (3-month modified Rankin Scale score, 3-6). Prognostic value of the 10 DWI ASPECTS regions in predicting poor outcome was determined by multivariable logistic regression, controlling for final infarct volume, age, and laterality. RESULTS Two hundred and thirteen patients (mean age, 66.1±14.5 years; median National Institutes of Health Stroke Scale, 15) were included. Inter-rater reliability was good for DWI ASPECTS (deep regions, κ=0.72; cortical regions, κ=0.63). All DWI ASPECTS regions with the exception of the putamen were significant predictors (P<0.05) of poor outcome in univariate analyses. Statistical collinearity among ASPECTS regions was not observed. Using penalized multivariable logistic regression, only M4 (odds ratio, 2.82; 95% confidence interval, 1.39-5.76) and M6 (odds ratio, 2.45; 95% confidence interval, 1.15-5.3) involvement were associated with poor outcome. M6 involvement independently predicted poor outcome in right hemispheric strokes (odds ratio, 5.8; 95% confidence interval, 1.9-20.3), whereas M4 (odds ratio, 4.3; 95% confidence interval, 1.3-15.0) involvement predicted poor outcome in left hemispheric strokes adjusting for infarct volume. Topologic information modestly improved the predictive ability of a prognostic score that incorporates age, infarct volume, and hemorrhagic transformation. CONCLUSIONS Involvement of the right parieto-occipital (M6) and left superior frontal (M4) regions affect clinical outcome in anterior large vessel occlusions over and above the effect of infarct volume and should be considered during prognostication.
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Affiliation(s)
- Srikant Rangaraju
- From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.)
| | - Christopher Streib
- From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.)
| | - Amin Aghaebrahim
- From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.)
| | - Ashutosh Jadhav
- From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.)
| | - Michael Frankel
- From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.)
| | - Tudor G Jovin
- From the Emory University, Atlanta, GA (S.R., M.F.); and University of Pittsburgh Medical Center, PA (C.S., A.A., A.J., T.G.J.).
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Smit M, Schutter DJLG, Nijboer TCW, Visser-Meily JMA, Kappelle LJ, Kant N, Penninx J, Dijkerman HC. Transcranial direct current stimulation to the parietal cortex in hemispatial neglect: A feasibility study. Neuropsychologia 2015; 74:152-61. [PMID: 25940097 DOI: 10.1016/j.neuropsychologia.2015.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 04/04/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Prior research suggests that dampening neural activity of the intact, presumably overactive hemisphere, combined with increasing neural activity in the damaged hemisphere, might restore cortical interhemispheric balance and reduce neglect. In the present study we repeatedly applied a relatively new technique, transcranial direct current stimulation (tDCS), to the posterior parietal cortex to modulate spontaneous neural activity levels in a polarity dependent fashion to find evidence for improvements in severe hemispatial neglect in chronic patients. METHODS Eighty-nine patients were initially identified from our databases as having neglect, after thoroughly screening databases, consulting medical practitioners and baseline testing, only five met our inclusion criteria and agreed to participate. Sixty-five patients were excluded as they did not meet safety criteria for tDCS (epilepsy, metal implants), suffered from other medical conditions (i.e., heart disease, epilepsy, current psychiatric disorder) or displayed only mild neglect at baseline testing. Five patients with severe chronic hemispatial neglect were enrolled in a double-blind, placebo-controlled treatment program. TDCS or placebo was applied for 20 minutes over the left (cathodal) and right (anodal) posterior parietal cortex at an intensity of 2 mA on five consecutive days. Treatment conditions were separated by a four week wash-out period. Baseline corrected change in performance on the conventional subtests of the Behavioral Inattention Test (BIT) was our primary endpoint. RESULTS No treatment-related effects were observed for the BIT change scores and performance on individual subtests. Moreover, patients' performance somewhat improved only during the stimulation period (day one vs day five, irrespective of whether it was placebo or tDCS), but not thirty days later, indicating a practice effect. DISCUSSION The present study does not provide evidence that tDCS to the posterior parietal cortex improves chronic hemispatial neglect. As a result of in- and exclusion health and safety criteria the majority of patients were excluded, which indicates that performing large randomized controlled trials is not feasible in chronic neglect patients.
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Affiliation(s)
- Miranda Smit
- Utrecht University, Department of Experimental Psychology, Helmholtz Institute, Utrecht, The Netherlands; Nieuw Unicum, Zandvoort, The Netherlands.
| | - Dennis J L G Schutter
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tanja C W Nijboer
- Utrecht University, Department of Experimental Psychology, Helmholtz Institute, Utrecht, The Netherlands; University Medical Center Utrecht, Department of Neurology, Rudolf Magnus Institute of Neuroscience, The Netherlands; Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - L Jaap Kappelle
- University Medical Center Utrecht, Department of Neurology, Rudolf Magnus Institute of Neuroscience, The Netherlands
| | - Neeltje Kant
- Utrecht University, Department of Experimental Psychology, Helmholtz Institute, Utrecht, The Netherlands; Nieuw Unicum, Zandvoort, The Netherlands
| | - Janne Penninx
- Stichting Zorggroep Noordwest-Veluwe, Sonnevanck, Harderwijk, The Netherlands
| | - H Chris Dijkerman
- Utrecht University, Department of Experimental Psychology, Helmholtz Institute, Utrecht, The Netherlands; University Medical Center Utrecht, Department of Neurology, Rudolf Magnus Institute of Neuroscience, The Netherlands
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86
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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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87
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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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Fujita T, Sato A, Togashi Y, Kasahara R, Ohashi T, Yamamoto Y. Contribution of abdominal muscle strength to various activities of daily living of stroke patients with mild paralysis. J Phys Ther Sci 2015; 27:815-8. [PMID: 25931737 PMCID: PMC4395721 DOI: 10.1589/jpts.27.815] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/24/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The trunk muscles frequently become weak after stroke, thus impacting overall
activities of daily living. However, activities of daily living items closely related with
trunk strength remain unclear. This study aimed to clarify the influence of trunk muscle
weakness on activities of daily living items. [Subjects] The subjects were 24 stroke
patients who fulfilled the following inclusion criteria: first stroke and the absence of
severe paralysis, marked cognitive function deterioration, unilateral spatial neglect or
apathy. [Methods] According to abdominal strength, the 24 patients were divided into a
nonweakness group and a weakness group. For the assessment, we used the stroke impairment
assessment set, the Berg balance scale, a simple test for evaluating hand function, grip
strength, and functional independence measure scale scores and the results were compared
between the groups. [Results] The Berg balance scale score and scores for dressing, toilet
use, transfer to bed, and walk items of the functional independence measure were
significantly lower in the weakness group than in the nonweakness group. [Conclusion] Our
results suggest that weakness of the abdominal muscles adversely impacts the balance of
patients with mild stroke as well as their ability to dress, use a toilet, transfer, and
walk. Trunk training, including abdominal muscle exercises, can effectively improve the
performance of these activities of daily living items.
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Affiliation(s)
- Takaaki Fujita
- Department of Rehabilitation, Faculty of Health Sciences, Tohoku Fukushi University, Japan
| | - Atsushi Sato
- Department of Rehabilitation, Northern Fukushima Medical Center, Japan
| | - Yui Togashi
- Department of Rehabilitation, Northern Fukushima Medical Center, Japan
| | - Ryuichi Kasahara
- Department of Rehabilitation, Northern Fukushima Medical Center, Japan
| | - Takuro Ohashi
- Department of Rehabilitation, Northern Fukushima Medical Center, Japan
| | - Yuichi Yamamoto
- Department of Rehabilitation, Northern Fukushima Medical Center, Japan
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90
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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.
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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
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Abstract
Given the increasing rates of stroke and our aging population, it is critical that we continue to foster innovation in stroke rehabilitation. Although there is evidence supporting cognitive rehabilitation in stroke, the set of cognitive domains effectively addressed to date represents only a small subset of the problems experienced by stroke survivors. Further, a gap remains between investigational treatments and our evolving theories of brain function. These limitations present opportunities for improving the functional impact of stroke rehabilitation. The authors use a case example to encourage the reader to consider the evidence base for cognitive rehabilitation in stroke, focusing on four domains critical to daily life function: (1) speech and language, (2) functional memory, (3) executive function and skilled learned purposive movements, and (4) spatial-motor systems. Ultimately, they attempt to draw neuroscience and practice closer together by using translational reasoning to suggest possible new avenues for treating these disorders.
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Affiliation(s)
- Cheryl L Shigaki
- Department of Health Psychology, University of Missouri, Columbia, Missouri
| | - Scott H Frey
- Department of Psychological Sciences and Brain Imaging Center, University of Missouri, Columbia, Missouri
| | - A M Barrett
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, New Jersey
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Neglect following stroke: the role of sensory sensitivity in visuo-spatial performance. Neurosci Lett 2014; 583:98-102. [PMID: 25240591 DOI: 10.1016/j.neulet.2014.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 11/21/2022]
Abstract
Both proprioceptive and visual manipulations have led to some improvement of the spatial neglect syndrome. Until now, their effects on visuo-spatial behaviour have never been compared simultaneously. The objective of this study was to determine their influence, as a function of the presence of neglect and the side of the brain damage. 19 stroke patients with right and 14 with left brain damage, without or with neglect; realized the Bells test in 5 conditions: a reference condition and 4 sensory conditions, defined according to the side of application (contralesional vs ipsilesional) and the type of perturbation (visual vs proprioceptive). The visuo-spatial behaviour was analyzed for global and spatial aspects and for individual extreme performances. For the neglect group, the restriction of the visual field to the ipsilesional hemi-field significantly diverted the centre of exploration towards the ipsilesional side compared to all other conditions. The weighting of visual cues from the ipsilesional hemi-field seems to be increased in sensory-motor integration processes in neglect patients. In all the groups, although some improvements in performance did occur with sensory manipulation, they were dependent on the individual, particularly for neglect patients. A same performance can be achieved through the use of different sensory-motor strategies, which are individual-related. It is thus important to consider the sensory sensitivity and the responsiveness of each patient before beginning any sensory therapies.
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Huddleston W, Keenan K, Ernest B. Relations among visual strategies, force fluctuations, and attention during a force-matching task. Percept Mot Skills 2014; 117:775-800. [PMID: 24665797 DOI: 10.2466/22.24.pms.117x29z6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Greater understanding of how people use visual information to minimize force fluctuations provides critical insight into visuomotor processing. Visual strategies were examined during a force-matching task with different feedback displays. When only vertical feedback was provided, young healthy participants (N = 20, 9 men) fixated their gaze centrally. When vertical and horizontal visual feedback was provided, participants performed saccades to maintain gaze near the leading edge of the force trace. Performance on a separate attention task assessed visual and motor attention capabilities in the same participants. Selecting the correct saccade trajectory on the attention task was positively correlated with measures predicting performance on the force-matching task. Optimal visual strategies, combined with motor attention, may contribute to minimizing pinch force variability at low force.
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Van der Stigchel S, Nijboer TCW. Introduction to the research topic novel insights in rehabilitation of neglect. Front Hum Neurosci 2014; 8:233. [PMID: 24782747 PMCID: PMC3995039 DOI: 10.3389/fnhum.2014.00233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/01/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefan Van der Stigchel
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University , Utrecht , Netherlands
| | - Tanja C W Nijboer
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University , Utrecht , Netherlands ; Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation Center , Utrecht , Netherlands
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95
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Stöttinger E, Filipowicz A, Marandi E, Quehl N, Danckert J, Anderson B. Statistical and perceptual updating: correlated impairments in right brain injury. Exp Brain Res 2014; 232:1971-87. [DOI: 10.1007/s00221-014-3887-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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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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97
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Wilkinson D, Zubko O, Sakel M, Coulton S, Higgins T, Pullicino P. Galvanic vestibular stimulation in hemi-spatial neglect. Front Integr Neurosci 2014; 8:4. [PMID: 24523679 PMCID: PMC3905204 DOI: 10.3389/fnint.2014.00004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/09/2014] [Indexed: 11/24/2022] Open
Abstract
Hemi-spatial neglect is an attentional disorder in which the sufferer fails to acknowledge or respond to stimuli appearing in contralesional space. In recent years, it has become clear that a measurable reduction in contralesional neglect can occur during galvanic vestibular stimulation, a technique by which transmastoid, small amplitude current induces lateral, attentional shifts via asymmetric modulation of the left and right vestibular nerves. However, it remains unclear whether this reduction persists after stimulation is stopped. To estimate longevity of effect, we therefore conducted a double-blind, randomized, dose-response trial involving a group of stroke patients suffering from left-sided neglect (n = 52, mean age = 66 years). To determine whether repeated sessions of galvanic vestibular stimulation more effectively induce lasting relief than a single session, participants received 1, 5, or 10 sessions, each lasting 25 min, of sub-sensory, left-anodal right-cathodal noisy direct current (mean amplitude = 1 mA). Ninety five percent confidence intervals indicated that all three treatment arms showed a statistically significant improvement between the pre-stimulation baseline and the final day of stimulation on the primary outcome measure, the conventional tests of the Behavioral Inattention Test. More remarkably, this change (mean change = 28%, SD = 18) was still evident 1 month later. Secondary analyses indicated an allied increase of 20% in median Barthel Index (BI) score, a measure of functional capacity, in the absence of any adverse events or instances of participant non-compliance. Together these data suggest that galvanic vestibular stimulation, a simple, cheap technique suitable for home-based administration, may produce lasting reductions in neglect that are clinically important. Further protocol optimization is now needed ahead of a larger effectiveness study.
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Affiliation(s)
| | - Olga Zubko
- School of Psychology, University of Kent Canterbury, UK
| | - Mohamed Sakel
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust Canterbury, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent Canterbury, UK
| | - Tracy Higgins
- Centre for Health Services Studies, University of Kent Canterbury, UK
| | - Patrick Pullicino
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust Canterbury, UK
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98
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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.
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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(§)
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99
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Rabuffetti M, Folegatti A, Spinazzola L, Ricci R, Ferrarin M, Berti A, Neppi-Modona M. Long-lasting amelioration of walking trajectory in neglect after prismatic adaptation. Front Hum Neurosci 2013; 7:382. [PMID: 23882208 PMCID: PMC3711059 DOI: 10.3389/fnhum.2013.00382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/02/2013] [Indexed: 11/13/2022] Open
Abstract
In the present study we explored the effect of prismatic adaptation (PA) applied to the upper right limb on the walking trajectory of a neglect patient with more severe neglect in far than in near space. The patient was asked to bisect a line fixed to the floor by walking across it before and after four sessions of PA distributed over a time frame of 67 days. Gait path was analyzed by means of an optoelectronic motion analysis system. The walking trajectory improved following PA and the result was maintained at follow-up, 15 months after treatment. The improvement was greater for the predicted bisection error (estimated on the basis of the trajectory extrapolated from the first walking step) than for the observed bisection error (measured at line bisection). These results show that PA may act on high level spatial representation of gait trajectory rather than on lower level sensory-motor gait components and suggest that PA may have a long-lasting rehabilitative effect on neglect patients showing a deviated walking trajectory.
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Affiliation(s)
- Marco Rabuffetti
- Biomedical Technology Department, Fondazione Don Carlo Gnocchi ONLUS IRCCS, Milano, Italy
| | | | - Lucia Spinazzola
- Department of Rehabilitation, Ospedale A. Bellini, Somma Lombardo, Italy
| | - Raffaella Ricci
- Department of Psychology, University of Torino, Torino, Italy
| | - Maurizio Ferrarin
- Biomedical Technology Department, Fondazione Don Carlo Gnocchi ONLUS IRCCS, Milano, Italy
| | - Anna Berti
- Department of Psychology, University of Torino, Torino, Italy
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