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Rich TJ, Williams LJ, Bowen A, Eskes GA, Hreha K, Checketts M, Mancuso M, Fordell H, Chen P. An International and Multidisciplinary Consensus on the Labeling of Spatial Neglect Using a Modified Delphi Method. Arch Rehabil Res Clin Transl 2024; 6:100343. [PMID: 39006109 PMCID: PMC11240031 DOI: 10.1016/j.arrct.2024.100343] [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] [Indexed: 07/16/2024] Open
Abstract
Survivors of neurologic injury (most commonly stroke or traumatic brain injury) frequently experience a disorder in which contralesionally positioned objects or the contralesional features of individual objects are often left unattended or underappreciated. The disorder is known by >200 unique labels in the literature, which potentially causes confusion for patients and their families, complicates literature searches for researchers and clinicians, and promotes a fractionated conceptualization of the disorder. The objective of this Delphi was to determine if consensus (≥75% agreement) could be reached by an international and multidisciplinary panel of researchers and clinicians with expertise on the topic. To accomplish this aim, we used a modified Delphi method in which 66 researchers and/or clinicians with expertise on the topic completed at least 1 of 4 iterative rounds of surveys. Per the Delphi method, panelists were provided with results from each round prior to responding to the survey in the subsequent round with the explicit intention of achieving consensus. The panel ultimately reached consensus that the disorder should be consistently labeled spatial neglect. Based on the consensus reached by our expert panel, we recommend that researchers and clinicians use the label spatial neglect when describing the disorder in general and more specific labels pertaining to subtypes of the disorder when appropriate.
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Affiliation(s)
- Timothy J. Rich
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Lindy J. Williams
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia, Australia
| | - Audrey Bowen
- Manchester Centre for Health Psychology, and the Geoffrey Jefferson Brain Research Centre, University of Manchester, Salford, United Kingdom
| | - Gail A. Eskes
- Departments of Psychiatry and Psychology & Neuroscience, Life Sciences Centre - Oceanography, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberly Hreha
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, Duke University School of Medicine, Durham, NC, United States
| | - Matthew Checketts
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Salford, United Kingdom
| | - Mauro Mancuso
- Physical and Rehabilitative Medicine Unit, Italian National Health Service Az-Azienda, USL, Tuscany, Italy
| | - Helena Fordell
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
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Edwards G, Contò F, Bucci LK, Battelli L. Controlling Brain State Prior to Stimulation of Parietal Cortex Prevents Deterioration of Sustained Attention. Cereb Cortex Commun 2020; 1:tgaa069. [PMID: 34296130 PMCID: PMC8152938 DOI: 10.1093/texcom/tgaa069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/25/2020] [Accepted: 09/19/2020] [Indexed: 11/13/2022] Open
Abstract
Sustained attention is a limited resource which declines during daily tasks. Such decay is exacerbated in clinical and aging populations. Inhibition of the intraparietal sulcus (IPS), using low-frequency repetitive transcranial magnetic stimulation (LF-rTMS), can lead to an upregulation of functional communication within the attention network. Attributed to functional compensation for the inhibited node, this boost lasts for tens of minutes poststimulation. Despite the neural change, no behavioral correlate has been found in healthy subjects, a necessary direct evidence of functional compensation. To understand the functional significance of neuromodulatory induced fluctuations on attention, we sought to boost the impact of LF-rTMS to impact behavior. We controlled brain state prior to LF-rTMS using high-frequency transcranial random noise stimulation (HF-tRNS), shown to increase and stabilize neuronal excitability. Using fMRI-guided stimulation protocols combining HF-tRNS and LF-rTMS, we tested the poststimulation impact on sustained attention with multiple object tracking (MOT). While attention deteriorated across time in control conditions, HF-tRNS followed by LF-rTMS doubled sustained attention capacity to 94 min. Multimethod stimulation was more effective when targeting right IPS, supporting specialized attention processing in the right hemisphere. Used in cognitive domains dependent on network-wide neural activity, this tool may cause lasting neural compensation useful for clinical rehabilitation.
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Affiliation(s)
- Grace Edwards
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di Tecnologia, 38068 Rovereto, Italy
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
| | - Federica Contò
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di Tecnologia, 38068 Rovereto, Italy
- Center for Mind/Brain Sciences – CIMeC, University of Trento, 38122 Trento, Italy
| | - Loryn K Bucci
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lorella Battelli
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di Tecnologia, 38068 Rovereto, Italy
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation and Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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