Neglect following stroke: the role of sensory sensitivity in visuo-spatial performance

Dance after stroke improves motor recovery in the subacute phase: A randomized controlled trial

Purpose

The objective of this study was to investigate the effects of a dance program, combined with conventional treatments, on the motor recovery and quality of life of stroke survivors in comparison with conventional treatments alone.

Materials and methods

A total of 16 subacute stroke survivors were randomized into two groups: a dance group (DG) and a conventional treatments group (CG). Stroke severity, cognitive abilities, and motor capacities were assessed at baseline. For six weeks, all participants underwent standard rehabilitation. However, in the DG, participants attended an additional weekly dance class. In both groups, the Mini-BESTest, Functional Independence Measure (FIM), ABC-Scale, Lower Extremity Motor Coordination Test (LEMOCOT), quadriceps strength, and Stroke-Specific Quality of Life Scale (SS-QOL) were measured at weeks 4 and 6. Nonparametric statistical tests were applied.

Results

Compared to the CG, the DG significantly improved recovery of balance, coordination, and FIM after four or six weeks. No differences were observed for quadriceps strength, SS-QOL, or cognition. Participants were completely satisfied with the dance class, and no adverse effects were observed.

Conclusions

This study was discontinued following the COVID-19 health crisis. However, the analysis revealed numerous beneficial effects of dance practice for subacute stroke survivors. The results contribute significantly to the advancement of artistic practices in stroke rehabilitation.

In Search for the Meaning of Illness: Content of Narrative Discourse Is Related to Cognitive Deficits in Stroke Patients

Stroke survivors undergo a thorough cognitive diagnosis that often involves administration of multiple standardized tests. However, patient’s narrative discourse can provide clinicians with additional knowledge on patient’s subjective experience of illness, attitude toward current situation, and motivation for treatment. We evaluated the methods of analyzing thematic content and story types in relationship to cognitive impairment in stroke survivors with no aphasia (including 9 left hemisphere damage – LHD patients, and 16 right hemisphere damage – RHD patients). Cognitive impairment was evaluated in comparison to a group of 25 patients with orthopaedic injury not involving the brain. Our findings primarily show that higher elaboration on own cognitive problems, physical ailments or coping strategies in LHD patients and cognitive problems, emotional issues and circumstances of illness onset in RHD patients is related to deficits in executive functions and retrieval of information from memory. Furthermore, RHD patients who use more chaos story type show lower executive functioning. However, these results did not survive the significance threshold of p < 0.05 after Bonferroni adjustment for multiple comparisons. In conclusion, this study provides preliminary evidence that stroke survivor’s narrative can constitute an additional source of clinically-relevant information regarding patient’s experience of illness and attitude toward recovery. This knowledge can aid clinicians and nurses in everyday interactions with the patients and support individualized strategy to treatment. Still, the current results need be confirmed with future studies in a larger cohort of stroke patients.

Standing Balance Strategies and Dual-Task Interference Are Differentially Modulated Across Various Sensory Contexts and Cognitive Tests in Individuals With Chronic Stroke

BACKGROUND AND PURPOSE

Mental tracking and verbal fluency tests have been linked to poor mobility and falls; however, no studies have examined the influence of imposing these tests on standing balance post-stroke. The purpose of this study was to investigate standing balance and cognitive performance across sensory conditions and cognitive tests post-stroke.

METHODS

Ninety-two participants with chronic stroke stood on dual-force platforms while performing various sensory conditions (eyes open/fixed surface, eyes closed/fixed surface, eyes open/sway-referenced surface, and eyes closed/sway-referenced surface) and cognitive tests (no cognitive test, serial subtractions, and verbal fluency). Equilibrium scores were computed based on the anterior-posterior sway angle. The number of correct verbal responses was recorded.

RESULTS

Performing serial subtractions during eyes closed/sway-referenced surface revealed the highest equilibrium score (64.0 ± 13.5), followed by the same sensory condition with added verbal fluency test (59.6 ± 15.1), followed by the single-task condition with no cognitive test (52.6 ± 20.9). The number of correct serial subtractions between seated (7.7 ± 3.7) and standing (7.2 ± 3.5) conditions was similar. A trend for more correct verbal fluency responses emerged when seated (8.1 ± 2.9) than the eyes open/sway-referenced surface condition (7.5 ± 2.8). Greater correct verbal fluency responses emerged when seated (8.6 ± 3.1) than the eyes closed/sway-referenced surface condition (7.8 ± 2.7).

DISCUSSION AND CONCLUSIONS

Standing balance enhancement (higher equilibrium score/better balance) depends on the neuropsychological process targeted and the sensory input available post-stroke. Cognitive dual-task interference emerged for the verbal fluency test during the most attention demanding sensory condition. Cognitive tests that enhance standing balance should be considered in assessments and interventions to evaluate and improve dual-tasking post-stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A321).

Direct Gaze Partially Overcomes Hemispatial Neglect and Captures Spatial Attention

Direct gaze has been shown to be a particularly important social cue, being preferentially processed even when unconsciously perceived. Results from several visual search tasks further suggest that direct gaze modulates attention, showing a faster orientation to faces perceived as looking toward us. The present study aimed to analyze putative modulation of spatial attention by eye gaze direction in patients with unilateral neglect. Eight right hemisphere stroke patients with neglect performed a target cancelation paradigm. Patients were instructed to cross all open-eyed pictures amidst closed eyed distractors. Target images were either in direct or averted gaze. Participants performed significantly better when observing targets with direct gaze supporting the hypothesis that this gaze direction captures attention. These findings further suggest that perception of direct gaze is able to diminish the visuospatial impairment seen in neglect patients.

Auditory neglect in children following perinatal stroke

Auditory neglect has been found in adults with right hemisphere focal brain lesions following strokes. Visual and tactile neglect has been found in children following both left and right hemisphere lesions resulting from perinatal strokes. The present cross-sectional study assessed auditory neglect in children with early unilateral brain damage from perinatal stroke. Twenty-six children with perinatal stroke and matched controls participated. All were asked to identify the location of a pure tone presented in left or right auditory fields. We found that children who had experienced left hemisphere perinatal strokes were significantly better at localizing sounds on the left side of space than the right side of space, and that response times improved with age on a normal trajectory relative to controls in left hemispace, while they did not improve normally in right hemispace. Children with right hemisphere perinatal strokes were significantly worse at localizing sounds on the right side of space relative to typically developing controls, and did not follow control trajectories for improvement in response times on the left or the right sides of space. Our preliminary results suggest that left hemisphere perinatal strokes may result in contralateral auditory neglect, while right hemisphere perinatal strokes may result in bilateral auditory neglect. Neglect was more severe in children with parietal lobe involvement, suggesting that the parietal lobe may play a dominant role in auditory attention in the developing brain.

Attentional impairments following right hemisphere damage with and without hemispatial neglect: A comparative study

This study aimed to evaluate the performance of patients with right hemisphere damage (RHD) with or without hemispatial neglect (HN) on a cancellation task. The study involved 31 control participants and 31 patients with RHD, matched by age, education, and frequency of reading and writing habits. The numbers of omission and random errors as well as the mean time to task completion were compared between adults with and without RHD, as well as between patients with and without HN. The latter made more left-sided omission errors, and more overall omission errors, than patients with RHD and no HN. The location of the first target canceled differed between subjects with RHD and control participants, as well as between patients with and without hemineglect. The use of organized vs. disorganized search strategies did not differ between groups. Further studies are required to investigate the performance of patients with HN of different levels of severity.