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Wheeler C, Smith LJ, Sakel M, Wilkinson D. A systematic review of vestibular stimulation in post-stroke visual neglect. Neuropsychol Rehabil 2024:1-33. [PMID: 38605647 DOI: 10.1080/09602011.2024.2338603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
Unilateral visual neglect is a condition that negatively impacts the lives of many stroke survivors. Studies have investigated different forms of vestibular stimulation as a potential therapy, but evidence is yet to be systematically reviewed. We therefore reviewed the effects of vestibular stimulation on outcomes of neglect and activities of daily living (ADL) for people with visual neglect. We searched relevant databases up until September 2022. Eligible articles included any form of vestibular stimulation, study design, or control condition. Included participants were 18 years or older, presenting with neglect following a haemorrhagic or ischaemic stroke. Relevant outcomes were clinically validated measures of neglect and ADL. Cochrane risk of bias tools were used to assess study quality. Meta-analyses and narrative methods were used to synthesize the data. Our search returned 17 relevant studies comprising 180 participants. Meta-analyses showed no difference between galvanic vestibular stimulation and sham conditions on outcomes, whereas caloric vestibular stimulation led to improvement compared to pre-stimulation scores. Narrative syntheses showed mixed results. Clinical and methodological heterogeneity was found both within and between studies. Overall, results were inconsistent regarding the effects of vestibular stimulation as a treatment for neglect. Further trials are warranted but require more careful methodological planning.
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Affiliation(s)
- Charlotte Wheeler
- School of Psychology, Keynes College, University of Kent, Kent, UK
- Norfolk and Suffolk NHS Foundation Trust, Norfolk, UK
| | - Laura J Smith
- School of Psychology, Keynes College, University of Kent, Kent, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Mohamed Sakel
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - David Wilkinson
- School of Psychology, Keynes College, University of Kent, Kent, UK
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2
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Shi S, Qie S, Wang H, Wang J, Liu T. Recombination of the right cerebral cortex in patients with left side USN after stroke: fNIRS evidence from resting state. Front Neurol 2023; 14:1178087. [PMID: 37545727 PMCID: PMC10400010 DOI: 10.3389/fneur.2023.1178087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Unilateral spatial neglect (USN) is an impaired contralesional stimulus detection, response, or action, causing functional disability. After a stroke, the right hemisphere experiences USN more noticeably, severely, and persistently than the left. However, few studies using fNIRS have been reported in cases of USN. This study aimed to confirm weaker RSFC in USN and investigate the potential inherent features in hemodynamic fluctuations that may be associated with USN. Furthermore, these features were combined into a mathematical model for more accurate classification. Methods A total of 33 stroke patients with right-sided brain damage were chosen, of whom 12 had non-USN after stroke, and 21 had USN after stroke (the USN group). Graph theory was used to evaluate the hemodynamic signals of the brain's right cerebral cortex during rest. Furthermore, a support vector machine model was built to categorize the subjects into two groups based on the chosen network properties. Results First, mean functional connectivity was lower in the USN group (0.745 ± 0.239) than in the non-USN group (0.843 ± 0.254) (t = -4.300, p < 0.001). Second, compared with the non-USN group, USN patients had a larger clustering coefficient (C) (t = 3.145, p < 0.001), local efficiency (LE) (t = 3.189, p < 0.001), and smaller global efficiency (GE) (t = 3.047, p < 0.001). Notably, there were differences in characteristic path length (L) and small worldness (σ) values between the two groups at certain thresholds, mainly as higher L (t = 3.074, p < 0.001) and lower small worldness (σ) values (t = 2.998, p < 0.001) in USN patients compared with non-USN patients. Finally, the classification accuracy of the SVM model based on AUC aC (t = -2.259, p = 0.031) and AUC aLE (t = -2.063, p = 0.048) was 85%, the sensitivity was 75%, and the specificity was 89%. Conclusion The functional network architecture of the right cerebral cortex exhibits significant topological alterations in individuals with USN following stroke, and the sensitivity index based on the small-world property AUC may be utilized to identify these patients accurately.
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Affiliation(s)
- Shanshan Shi
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shuyan Qie
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Hujun Wang
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jie Wang
- Rehabilitation Clinic, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Tiejun Liu
- Department of General Surgery, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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3
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González-Rodriguez B, Serradell-Ribé N, Viejo-Sobera R, Romero-Muñoz JP, Marron EM. Transcranial direct current stimulation in neglect rehabilitation after stroke: a systematic review. J Neurol 2022; 269:6310-6329. [PMID: 36138161 PMCID: PMC9618519 DOI: 10.1007/s00415-022-11338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022]
Abstract
Hemispatial neglect is one of the most frequent attention disorders after stroke. The presence of neglect is associated with longer hospital stays, extended rehabilitation periods, and poorer functional recovery. Transcranial direct current stimulation (tDCS) is a new technique with promising results in neglect rehabilitation; therefore, the objective of this systematic review, performed following the PRISMA guidelines, is to evaluate the effectiveness of tDCS on neglect recovery after stroke. The search was done in MEDLINE (PubMed), Web of Science, Scopus, Cochrane Library, and BioMed Central databases. A total of 311 articles were found; only 11 met the inclusion criteria, including 152 post-stroke patients in total. Methodological quality and risk of bias were assessed for all the studies, and methodological characteristics of the studies, sample sizes, methods, main results, and other relevant data were extracted. tDCS intervention ranged from one to twenty sessions distributed in 1 day to 4 weeks, with intensity ranged from 1 to 2 mA. We found moderate evidence for the efficacy of tDCS in the rehabilitation of hemispatial neglect after a stroke, being more effective in combination with other interventions. Nonetheless, the limited number of studies and some studies' design characteristics makes it risky to draw categorical conclusions. Since scientific evidence is still scarce, further research is needed to determine the advantage of this treatment in acute, sub-acute and chronic stroke patients. Future studies should include larger samples, longer follow-ups, and broader neurophysiological assessments, with the final aim of establishing the appropriate use of tDCS as an adjuvant intervention in neurorehabilitation settings.
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Affiliation(s)
- B González-Rodriguez
- Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain.,Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - N Serradell-Ribé
- Faculty of Health Sciences, Cognitive NeuroLab, Universitat Oberta de Catalunya, Madrid, Barcelona, Spain
| | - R Viejo-Sobera
- Faculty of Health Sciences, Cognitive NeuroLab, Universitat Oberta de Catalunya, Madrid, Barcelona, Spain
| | - J P Romero-Muñoz
- Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain.,Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Elena M Marron
- Faculty of Health Sciences, Cognitive NeuroLab, Universitat Oberta de Catalunya, Madrid, Barcelona, Spain.
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Wissel J, Ri S. Assessment, goal setting, and botulinum neurotoxin a therapy in the management of post-stroke spastic movement disorder: updated perspectives on best practice. Expert Rev Neurother 2021; 22:27-42. [PMID: 34933648 DOI: 10.1080/14737175.2021.2021072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Post-stroke spastic movement disorder (PS-SMD) appears up to 20% in the first week following stroke and 40% in the chronic phase. It may create major hurdles to overcome in early stroke rehabilitation and as one relevant factor that reduces quality of life to a major degree in the chronic phase. AREAS COVERED In this review, we discuss predictors,early identification, clinical assessments, goal setting, and management in multiprofessional team, including Botulinum neurotoxin A (BoNT-A) injection for early and chronic management of PS-SMD. EXPERT OPINION The earlier PS-SMD is recognized and managed, the better the outcome will be. The comprehensive management in the subacute or chronic phase of PS-SMD with BoNT-A injections requires detailed assessment, patient-centered goal setting, technical-guided injection, effective dosing of BoNT-A per site, muscle, and session and timed adjunctive treatment, delivered in a multi-professional team approach in conjunction with physical treatment. Evidence-based data showed BoNT-A injections are safe and effective in managing focal, multifocal, segmental PS-SMD and its complications. If indicated, BoNT-A therapy should be accompanied with adjunctive treatment in adequate time slots. BoNT-A could be added to oral, intrathecal, and surgical treatment in severe multisegmental or generalized PS-SMD to reach patient/caregiver's goals, especially in chronic PS-SMD.
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Affiliation(s)
- Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Vivantes Klinikum Spandau, Neue Bergstrasse 6, 13585 Berlin, Germany.,Neurology and Psychosomatics at Wittenbergplatz, Out-Patient-Clinic, Ansbacher straße 17-19, 10787 Berlin, Germany
| | - Songjin Ri
- Neurology and Psychosomatics at Wittenbergplatz, Out-Patient-Clinic, Ansbacher straße 17-19, 10787 Berlin, Germany.,Department of Neurology, Charité University Hospital (CBS), Hindenburgdamm 30, Berlin 12203, Germany
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5
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Bavikatte G, Subramanian G, Ashford S, Allison R, Hicklin D. Early Identification, Intervention and Management of Post-stroke Spasticity: Expert Consensus Recommendations. J Cent Nerv Syst Dis 2021; 13:11795735211036576. [PMID: 34566442 PMCID: PMC8461119 DOI: 10.1177/11795735211036576] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/27/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke patients with spasticity usually require long-lasting care and interventions but frequently report that outpatient and community treatment is limited, reflecting a significant unmet need in health and social care provision. Rehabilitation and spasticity management services are essential for patient recovery, with improvements in both activity and participation reducing the burden on patients, family and society. Current clinical guidance provides scope for improvements in both post-stroke management and spasticity prevention. However, access to specialist services can be limited and the patient journey does not always match national recommendations. Identification of spasticity and its predictors and lack of subsequent referral to rehabilitation or specialist spasticity services are key issues in the management of post-stroke spasticity. Implementation of a traffic light classification system prioritises patients at an increased risk of spasticity and promotes early and consistent management across the spectrum of primary and secondary care. The proposed system is based on clinical evidence, expert consensus and recent clinical guidelines. It provides simple and straightforward criteria for management, multidisciplinary consultation and referral to specialist spasticity services, with patients allocated by monitoring requirements and a low (green/periodic monitoring), medium (amber/routine referral) or high risk (red/urgent referral) of spasticity.
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Affiliation(s)
- Ganesh Bavikatte
- Neuro-Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ganesh Subramanian
- Department of Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust; King’s College London & Centre for Nursing Midwifery and Allied Health Research, University College London Hospitals/University College London, London, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torbay, Devon, UK
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Chen P, Zanca J, Esposito E, Barrett AM. Barriers and Facilitators to Rehabilitation Care of Individuals With Spatial Neglect: A Qualitative Study of Professional Views. Arch Rehabil Res Clin Transl 2021; 3:100122. [PMID: 34179758 PMCID: PMC8212009 DOI: 10.1016/j.arrct.2021.100122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify barriers and facilitators to achieving optimal inpatient rehabilitation outcome among individuals with spatial neglect (SN). Design Cross-sectional, semistructured focus group discussions. Setting Rehabilitation hospitals. Participants A total of 15 occupational therapists and 14 physical therapists treating patients with SN on 3 campuses of a rehabilitation hospital system (N=29). Six focus group sessions were conducted and audio-recorded for transcription. Interventions Not applicable. Main Outcome Measures Not applicable. Results Participants identified several patient-related characteristics that posed barriers to treatment, including the symptoms of SN itself, cognitive issues, physical weakness, comorbidities, and reduced therapy engagement. Supportive family members were considered a key facilitator, but lack of preparedness to assume caregiving roles, poor understanding of SN and rehabilitation goals, and inadequate levels of involvement were family-related barriers to successful treatment. Participants expressed that having resources and technologies available at their center to support SN treatment facilitated positive outcomes and perceived limited staff knowledge and skills and poor interclinician communication as barriers to treatment. At the health care system level, barriers included a lack of responsive measures of SN progress and insurer-related issues. Strong continuity of care between transitions was considered an important factor for enabling effective treatment. Conclusions Barriers and facilitators to the current practice of SN care were identified from occupational and physical therapists’ point of view. Opportunities exist to promote identified facilitators and minimize barriers to improve SN rehabilitation. The present study makes a unique contribution in identifying specific needs for innovative interventions that involve family support and training, promotion of interdisciplinary collaboration, development of interprofessional vocabulary, and continuous treatment and follow-up assessment for SN through care transitions.
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Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Jeanne Zanca
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Emily Esposito
- Department of Psychology, University of California, Riverside, California, United States
| | - A M Barrett
- Department of Neurology, Emory University, Atlanta, Georgia, United States.,Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Decatur, Georgia, United States
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Checketts M, Mancuso M, Fordell H, Chen P, Hreha K, Eskes GA, Vuilleumier P, Vail A, Bowen A. Current clinical practice in the screening and diagnosis of spatial neglect post-stroke: Findings from a multidisciplinary international survey. Neuropsychol Rehabil 2020; 31:1495-1526. [PMID: 32691688 DOI: 10.1080/09602011.2020.1782946] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spatial neglect has profound implications for quality of life after stroke, yet we lack consensus for screening/diagnosing this heterogeneous syndrome. Our first step in a multi-stage research programme aimed to determine which neglect tests are used (within four categories: cognitive, functional, neurological and neuroimaging/neuromodulation), by which stroke clinicians, in which countries, and whether choice is by professional autonomy or institutional policy. 454 clinicians responded to an online survey: 12 professions (e.g., 39% were occupational therapists) from 33 countries (e.g., 38% from the UK). Multifactorial logistic regression suggested inter-professional differences but fewer differences between countries (Italy was an outlier). Cognitive tests were used by 82% (particularly by psychologists, cancellation and drawing were most popular); 80% used functional assessments (physiotherapists were most likely). 20% (mainly physicians, from Italy) used neuroimaging/ neuromodulation. Professionals largely reported clinical autonomy in their choices. Respondents agreed on the need for a combined approach to screening and further training. This study raises awareness of the translation gap between theory and practice. These findings lay an important foundation to subsequent collaborative action between clinicians, researchers and stroke survivors to reach consensus on screening and diagnostic measures. The immediate next step is a review of the measures' psychometric properties.
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Affiliation(s)
- Matthew Checketts
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
| | - Mauro Mancuso
- Physical and Rehabilitative Medicine Unit, National Health Service, Grosseto, Italy
| | - Helena Fordell
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Division for Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Gail A Eskes
- Department of Psychology and Neuroscience & Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Patrik Vuilleumier
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Fundamental Neurosciences & Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Andy Vail
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
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8
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Effects of Prism Adaptation on Reference Systems for Extrapersonal Space in Neglect Patients. Brain Sci 2019; 9:brainsci9110327. [PMID: 31744104 PMCID: PMC6896101 DOI: 10.3390/brainsci9110327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 11/21/2022] Open
Abstract
Up to now, rehabilitation of unilateral spatial neglect has focused on egocentric forms of neglect, whereas less is known about the possibility to improve allocentric deficits. The present study aimed to examine the efficacy of prism adaptation (PA) training on patients with different forms of neglect: egocentric, allocentric, or mixed. Twenty-eight patients were assessed with specific neglect tests before (T0) and after (T1) 10 sessions of PA training. Performance in the Apples Cancellation test was used to identify patients with egocentric (n = 6), allocentric (n = 5), or mixed (n = 17) forms of neglect. In the overall group of patients, PA training produced significant improvements in performance across different neglect tests. In terms of the egocentric–allocentric distinction, the training was effective in reducing omissions in the left part of space in the Apples Cancellation test both for patients with egocentric neglect and mixed neglect. By contrast, errors of commissions (marking the inability to detect the left part of the target stimulus, i.e., allocentric neglect) remained unchanged after PA in patients with allocentric neglect and actually increased marginally in patients with mixed neglect. The PA training is effective in improving egocentric neglect, while it is ineffective on the allocentric form of the disturbance. Notably, the allocentric component of neglect is frequently impaired, although this is most often in conjunction with the egocentric impairment, yielding the mixed form of neglect. This stresses the importance of developing exercises tuned to improving allocentric neglect.
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Choi HS, Kim DJ, Yang YA. The Effect of a Complex Intervention Program for Unilateral Neglect in Patients with Acute-Phase Stroke: A Randomized Controlled Trial. Osong Public Health Res Perspect 2019; 10:265-273. [PMID: 31673487 PMCID: PMC6816354 DOI: 10.24171/j.phrp.2019.10.5.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to examine the combined effects of Prism Adaptation (PA) plus functional electrical stimulation (FES) on stroke patients with unilateral neglect, and suggest a new intervention method for acute-phase stroke patients. Methods There were 30 patients included in this study from April to October 2016 that had unilateral neglect whilst hospitalized following a stroke (diagnosed by a professional). The participants, who were patients receiving occupational therapy, understood the purpose of the study and agreed to participate. The patients were randomly divided into 3 groups: PA plus FES group (Group A), PA group (Group B), and FES group (Group C). Treatments lasted for 50 minutes per day, 5 times per week, for 3 weeks in total. Reevaluation was conducted after 3 weeks of intervention. Results All 3 groups showed unilateral neglect reduction after the intervention, but PA plus FES (complex intervention method) was more effective than PA or FES alone [effect size: Motor-free Visual Perception Test (0.80), Albert test (0.98), CBS (0.92)]. Conclusion The results of this study support further studies to examine complex intervention for the treatment of unilateral neglect.
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Affiliation(s)
- Hyun-Se Choi
- Department of Occupational Therapy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Deok-Ju Kim
- Department of Occupational Therapy, College of Health & Medical Sciences, Cheongju University, Cheongju, Korea
| | - Yeong-Ae Yang
- Department of Occupational Therapy, College of Biomedical Sciences and Engineering, Inje University, Gimhae, Korea
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Abstract
PURPOSE Patching for double vision is a common palliative treatment for head-trauma patients with acquired strabismus when prisms are not feasible. METHODS We review literature on spatial neglect and discuss possible effects of monocular occlusion on spatial attention. RESULTS Patching the left eye has been shown to worsen spatial judgments in some brain-injured patients with left neglect by inhibiting the right superior colliculus further impairing contralateral leftward orienting (the Sprague Effect). CONCLUSIONS Because more peripheral parts of the visual field increasingly project to the contralateral superior colliculus with the temporal crescent being entirely contralateral, avoiding patching of the temporal crescent was advised, and in most cases can be achieved by taping off the spectacle lens and avoiding an elastic eye patch.
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Kim BR, Jeong EH, Oh-Park M, Lee K, Kim H, Yoo SD, Yi T, Kim M, Lee J. Reliability and Validity of the Korean Kessler Foundation Neglect Assessment Process. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bo-Ram Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Eun Hwa Jeong
- Department of Occupational Therapy, Far East University, Eumseong, Korea
| | - Mooyeon Oh-Park
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Kyungjae Lee
- Department of Audiology and Speech-Language Pathology, Catholic University of Daegu, Daegu, Korea
| | - Hyuntae Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Taeim Yi
- Deptment of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
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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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Chen P, Ward I, Khan U, Liu Y, Hreha K. Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury: A Retrospective Study. Neurorehabil Neural Repair 2015; 30:451-60. [PMID: 26338431 DOI: 10.1177/1545968315604397] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury-induced mass effect predicted left-sided neglect. Conclusions Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment.
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Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, NJ, USA Rutgers University, Newark, NJ, USA
| | - Irene Ward
- Rutgers University, Newark, NJ, USA Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | | | - Yan Liu
- Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Kessler Institute for Rehabilitation, West Orange, NJ, USA Columbia University, New York, NY, USA
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14
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Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility. Arch Phys Med Rehabil 2015; 96:1458-66. [PMID: 25862254 DOI: 10.1016/j.apmr.2015.03.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. DESIGN Inception cohort. SETTING Inpatient rehabilitation facility (IRF). PARTICIPANTS Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP). INTERVENTIONS Usual and standard IRF care. MAIN OUTCOME MEASURES The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition. RESULTS The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. CONCLUSIONS Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS.
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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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Gallagher M, Wilkinson D, Sakel M. Hemispatial neglect: clinical features, assessment and treatment. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/bjnn.2013.9.6.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Mohamed Sakel
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust, UK
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Zubko O, Wilkinson D, Langston D, Sakel M. The effect of repeated sessions of galvanic vestibular stimulation on target cancellation in visuo-spatial neglect: preliminary evidence from two cases. Brain Inj 2013; 27:613-9. [PMID: 23473288 DOI: 10.3109/02699052.2013.767938] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In recent years it has emerged that the attentional disorder of visuo-spatial neglect can be overcome via artificial stimulation of the balance system. One means of achieving this is via galvanic vestibular stimulation (GVS), a simple procedure in which tiny, electrical currents are discharged to the part of the scalp overlying the vestibular nerves. Attempts to remediate neglect with GVS have utilized only a single session of stimulation and, although this can induce spontaneous recovery, symptoms resurface soon after stimulation. This study assessed whether repeated sessions induce longer carry-over. METHODS Two individuals diagnosed with neglect post-stroke received 5 days of sub-sensory, left anodal GVS. Performance was assessed via the letter and star cancellation tasks of the Behavioural Inattention Test on four occasions; 3 days before the start of stimulation, on the first and last day of stimulation and 3-days after stimulation. RESULTS Analyses of variance indicated that both participants missed significantly fewer targets in both tasks on the fifth day of stimulation compared to baseline. More so, this improvement was still evident at follow-up 3 days later. CONCLUSION The results strengthen the need for a larger, sham-controlled trial to establish whether repeated GVS provides lasting relief from neglect.
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Affiliation(s)
- Olga Zubko
- School of Psychology, University of Kent, UK
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