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Terruzzi S, Albini F, Massetti G, Etzi R, Gallace A, Vallar G. The Neuropsychological Assessment of Unilateral Spatial Neglect Through Computerized and Virtual Reality Tools: A Scoping Review. Neuropsychol Rev 2024; 34:363-401. [PMID: 36913099 PMCID: PMC10009867 DOI: 10.1007/s11065-023-09586-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 09/28/2022] [Indexed: 03/14/2023]
Abstract
Unilateral Spatial Neglect is a disabling neuropsychological deficit. Patients with spatial neglect fail to detect and report events, and to perform actions in the side of space contralateral to a hemispheric cerebral lesion. Neglect is assessed by evaluating the patients' abilities in daily life activities and by psychometric tests. Computer-based, portable and Virtual Reality technologies may provide more and precise data, and be more sensitive and informative, compared to current paper-and-pencil procedures. Studies since 2010, in which such technologies have been used, are reviewed. Forty-two articles meeting inclusion criteria are categorized according to their technological approaches (computer-, graphics tablet or tablet-, virtual reality-based assessment, and other). The results are promising. However, a definite golden standard, technologically based procedure cannot be still established. Developing technologically based tests is a laborious process, which requires technical and user experience improvements as well as normative data, to increase the evidence of efficacy for clinical evaluation of at least some of the tests considered in this review.
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Affiliation(s)
- Stefano Terruzzi
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy.
- Neurocognitive Rehabilitation Center (CeRiN), University of Trento, Rovereto, Italy.
| | - Federica Albini
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Gemma Massetti
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberta Etzi
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Alberto Gallace
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy.
- Neuropsychological Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Milan, Italy.
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Cai M, Zhang JL, Wang XJ, Cai KR, Li SY, Du XL, Wang LY, Yang RY, Han J, Hu JY, Lyu J. Clinical application of repetitive transcranial magnetic stimulation in improving functional impairments post-stroke: review of the current evidence and potential challenges. Neurol Sci 2024; 45:1419-1428. [PMID: 38102519 DOI: 10.1007/s10072-023-07217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient's rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications.
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Affiliation(s)
- Ming Cai
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jia-Ling Zhang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Xiao-Jun Wang
- Medical Research and Education Department, Shanghai Health Rehabilitation Hospital, Shanghai, 201615, China
| | - Ke-Ren Cai
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Shu-Yao Li
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Xin-Lin Du
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Li-Yan Wang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Ruo-Yu Yang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jing-Yun Hu
- Central Lab, Shanghai Key Laboratory of Pathogenic Fungi Medical Testing, Shanghai Pudong New Area People's Hospital, Shanghai, 201299, China.
| | - Jie Lyu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
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Zhao W, Ye L, Cao L, Song W. A bibliometric review of unilateral neglect: Trends, frontiers, and frameworks. Brain Circ 2024; 10:94-105. [PMID: 39036292 PMCID: PMC11259318 DOI: 10.4103/bc.bc_72_23] [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: 08/26/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Owing to the adverse effects of unilateral neglect (UN) on rehabilitation outcomes, fall risk, and activities of daily living, this field has gradually got considerable interest. Notwithstanding, there is presently an absence of efficient portrayals of the entire research field; hence, the motivation behind this study was to dissect and evaluate the literature published in the field of UN following stroke and other nonprogressive brain injuries to identify hotspots and trends for future research. MATERIALS AND METHODS Original articles and reviews related to UN from 1970 to 2022 were retrieved from the Science Citation Index Expanded of the Web of Science Core Collection. CiteSpace, VOSviewer, and Bibliometrix software were used to observe publication fields, countries, and authors. RESULTS A total of 1,202 publications were incorporated, consisting of 92% of original articles, with an overall fluctuating upward trend in the number of publications. Italy, the United Kingdom, and the United States made critical contributions, with Neuropsychologia being the most persuasive academic journal, and Bartolomeo P. ranked first in both the quantity of publications and co-citations. Keywords were divided into four clusters, and burst keyword detection demonstrated that networks and virtual reality might additionally emerge as frontiers of future development and warrant additional attention. CONCLUSIONS UN is an emerging field, and this study presents the first bibliometric analysis to provide a comprehensive overview of research in the field. The insights and guidance garnered from our research on frontiers, trends, and popular topics could prove highly valuable in facilitating the rapid development of this field while informing future research directions.
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Affiliation(s)
- Wanying Zhao
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Ye
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lei Cao
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation, Xuanwu Hospital, Capital Medical University, Beijing, China
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Zigiotto L, Amorosino G, Saviola F, Jovicich J, Annicchiarico L, Rozzanigo U, Olivetti E, Avesani P, Sarubbo S. Spontaneous unilateral spatial neglect recovery after brain tumour resection: A multimodal diffusion and rs-fMRI case report. J Neuropsychol 2024; 18 Suppl 1:91-114. [PMID: 37431064 DOI: 10.1111/jnp.12339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/25/2023] [Indexed: 07/12/2023]
Abstract
Patients with unilateral spatial neglect (USN) are unable to explore or to report stimuli presented in the left personal and extra-personal space. USN is usually caused by lesion of the right parietal lobe: nowadays, it is also clear the key role of structural connections (the second and the third branch of the right Superior Longitudinal Fasciculus, respectively, SLF II and III) and functional networks (Dorsal and Ventral Attention Network, respectively, DAN and VAN) in USN. In this multimodal case report, we have merged those structural and functional information derived from a patient with a right parietal lobe tumour and USN before surgery. Functional, structural and neuropsychological data were also collected 6 months after surgery, when the USN was spontaneously recovered. Diffusion metrics and Functional Connectivity (FC) of the right SLF and DAN, before and after surgery, were compared with the same data of a patient with a tumour in a similar location, but without USN, and with a control sample. Results indicate an impairment in the right SLF III and a reduction of FC of the right DAN in patients with USN before surgery compared to controls; after surgery, when USN was recovered, patient's diffusion metrics and FC showed no differences compared to the controls. This single case and its multimodal approach reinforce the crucial role of the right SLF III and DAN in the development and recovery of egocentric and allocentric extra-personal USN, highlighting the need to preserve these structural and functional areas during brain surgery.
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Affiliation(s)
- Luca Zigiotto
- Department of Neurosurgery, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Structural and Functional Connectivity Lab Project, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Department of Psychology, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Gabriele Amorosino
- Neuroinformatics Laboratory (NILab), Bruno Kessler Foundation (FBK), Trento, Italy
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Francesca Saviola
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Jorge Jovicich
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Luciano Annicchiarico
- Department of Neurosurgery, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Structural and Functional Connectivity Lab Project, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Umberto Rozzanigo
- Department of Neuroradiology, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Emanuele Olivetti
- Neuroinformatics Laboratory (NILab), Bruno Kessler Foundation (FBK), Trento, Italy
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Paolo Avesani
- Neuroinformatics Laboratory (NILab), Bruno Kessler Foundation (FBK), Trento, Italy
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
- Structural and Functional Connectivity Lab Project, 'S. Chiara' Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
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Stammler B, Flammer K, Schuster T, Lambert M, Neumann O, Lux M, Matuz T, Karnath HO. Spatial Neglect Therapy With the Augmented Reality App "Negami" for Active Exploration Training: A Randomized Controlled Trial on 20 Stroke Patients With Spatial Neglect. Arch Phys Med Rehabil 2023; 104:1987-1994. [PMID: 37582475 DOI: 10.1016/j.apmr.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To investigate the efficacy of the augmented reality (AR) app "Negami" as an active exploration training for the treatment of spatial neglect. Improvements of the ipsilesional attention and orientation bias (and resulting contralesional neglect) will be examined in stroke patients with spatial neglect and compared with a control group. DESIGN Randomized controlled trial with an experimental Negami group, consisting of patients with spatial neglect, and a group of neglect patients receiving standard neglect therapy. SETTING Three rehabilitation hospitals. PARTICIPANTS Twenty right hemispheric stroke patients with spatial neglect (N=20). INTERVENTION Over a period of 2 weeks, both groups received 5 training sessions per week (à 25 minutes). Neglect behavior was assessed weekly over a 5-week period, with the Negami therapy group receiving a second follow-up assessment at 1-to-2-month intervals after completion of training. MAIN OUTCOME MEASURES Letter Cancellation, Bells Test, Copying Task, Line Bisection Task, and a self-developed "Exploration Test". RESULTS Both groups improved significantly. While the Negami therapy group improved in 4 of 5 neglect tests used, the standard therapy group improved in only 1 of these tests. We observed significantly better improvement in the Negami group already after the first week of training. This difference was also significant after the end of the training as well as 1 week after the end of training and remained stable 1-2 months after the end of treatment. CONCLUSION Negami can be used as an effective alternative or addition to current standard neglect therapy, and may even be superior to it.
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Affiliation(s)
- Britta Stammler
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Michael Lux
- Neurological Rehabilitation Center Quellenhof, Sana Kliniken AG, Bad Wildbad, Germany
| | - Tamara Matuz
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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Saj A, Ronchi R. Editorial: Advances in Understanding and Rehabilitating Unilateral Spatial Neglect. Brain Sci 2023; 13:1437. [PMID: 37891806 PMCID: PMC10605040 DOI: 10.3390/brainsci13101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Unilateral Spatial Neglect (USN) is a frequent, very debilitating cognitive syndrome, in which patients fail to pay attention, perceive, and represent a part of the space in the side contralateral to the brain lesion [...].
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Affiliation(s)
- Arnaud Saj
- Department of Psychology, Montréal University, Montréal, QC H3C 3J7, Canada
- CRIR Institute Nazareth Louis-Braille, Longueuil, QC J4K 5G4, Canada
| | - Roberta Ronchi
- Laboratory of Behavioural Neurology and Imagining of Cognition, Department of Fundamental Neurosciences, University of Geneva, 1202 Geneva, Switzerland;
- Neurology Service, Department of Clinical Neurosciences, Geneva University Hospital, 1211 Geneva, Switzerland
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7
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Jang WH, Hwang HM, Kim JY. Effects of Twins Therapy on Egocentric and Allocentric Neglect in Stroke Patients: A Feasibility Study. Brain Sci 2023; 13:952. [PMID: 37371430 DOI: 10.3390/brainsci13060952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/06/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Existing treatment methods for neglect are concentrated on egocentric neglect and may lead to various problems such as cost/space constraints and portability. Therefore, this study seeks to determine how a new treatment (also known as twins therapy, TT) for stroke patients can improve an existing problem associated with neglect. (2) Method: A pre/post-test control group research design was used and both groups continued to receive existing rehabilitation treatment, whilst TT intervention was only added to the experimental group. TT intervention was conducted for a total of 20 sessions (1 session for 30 min/day, 5 days/week, for 4 weeks). (3) Result: There was no significant difference in the manual function test (MFT) and the Korean version of the Modified Barthel Index (K-MBI) items (p > 0.05) before and after the TT intervention. However, the score and execution time of the apple cancellation test showed a significant reduction only in the experimental group (p < 0.05). (4) Conclusion: TT not only improved egocentric neglect, but also allocentric neglect symptoms in stroke patients.
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Affiliation(s)
- Woo-Hyuk Jang
- Department of Occupational Therapy, Kangwon National University, Samcheok 25949, Republic of Korea
| | - Hyeong-Min Hwang
- Department of Occupational Therapy, Kangwon National University, Samcheok 25949, Republic of Korea
| | - Jae-Yeop Kim
- Department of Occupational Therapy, Kangwon National University, Samcheok 25949, Republic of Korea
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Millot S, Beis JM, Pierret J, Badin M, Sabau V, Bensoussan L, Paysant J, Ceyte H. Innovative Therapy Combining Neck Muscle Vibration and Transcranial Direct Current Stimulation in Association with Conventional Rehabilitation in Left Unilateral Spatial Neglect Patients: HEMISTIM Protocol for a Randomized Controlled Trial. Brain Sci 2023; 13:brainsci13040678. [PMID: 37190643 DOI: 10.3390/brainsci13040678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Unilateral spatial neglect (USN) rehabilitation requires the development of new methods that can be easily integrated into conventional practice. The aim of the HEMISTIM protocol is to assess immediate and long-term recovery induced by an innovative association of left-side neck-muscle vibration (NMV) and anodal transcranial Direct Current Stimulation (tDCS) on the ipsilesional posterior parietal cortex during occupational therapy sessions in patients with left USN. Participants will be randomly assigned to four groups: control, Left-NMV, Left-NMV + sham-tDCS or Left-NMV + anodal-tDCS. NMV and tDCS will be applied during the first 15 min of occupational therapy sessions, three days a week for three weeks. USN will be assessed at baseline, just at the end of the first experimental session, after the first and third weeks of the protocol and three weeks after its ending. Our primary outcome will be the evolution of the functional Catherine Bergego Scale score. Secondary outcome measures include five tests that investigate different neuropsychological aspects of USN. Left NMV, by activating multisensory integration neuronal networks, might enhance effects obtained by conventional therapy since post-effects were shown when it was combined with upper limb movements. We expect to reinforce lasting intermodal recalibration through LTP-like plasticity induced by anodal tDCS.
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Affiliation(s)
- Sarah Millot
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
| | - Jean-Marie Beis
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
| | - Jonathan Pierret
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
| | - Marina Badin
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
| | - Verginia Sabau
- UGECAM PACA-Corse, Centre Helio Marin, Vallauris, France
| | - Laurent Bensoussan
- Aix Marseille Univ, CNRS, INT, Marseille, France
- UGECAM PACA, Institut Universitaire de Réadaptation de Valmante Sud, Marseille, France
| | - Jean Paysant
- UGECAM Nord-Est, Institut Régional de Médecine Physique et de Réadaptation, Centre de Médecine Physique et de Réadaptation, Lay Saint-Christophe, France
- Université de Lorraine, DevAH, Nancy, France
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Bode LKG, Sprenger A, Helmchen C, Hauptmann B, Münte TF, Machner B. Combined optokinetic stimulation and cueing-assisted reading therapy to treat hemispatial neglect: A randomized controlled crossover trial. Ann Phys Rehabil Med 2023; 66:101713. [PMID: 36645965 DOI: 10.1016/j.rehab.2022.101713] [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: 06/09/2022] [Revised: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hemispatial neglect is a disabling cognitive disorder following stroke and effective therapies are required. OBJECTIVES To evaluate the effects of combined optokinetic stimulation (OKS) and cueing-assisted reading therapy (READ) on the remission of hemispatial neglect following stroke. METHODS Randomized, controlled, two-period, crossover trial conducted at a German neurorehabilitation center. Twenty participants with left neglect following right hemispheric stroke (mean age 66 years (SD 11), mean time since stroke 50 days (SD 33)) finished the trial (12 received OKSREAD first, 8 CONTROL first). The intervention consisted of 15 daily sessions of OKS (20 min) and text reading assisted by a therapist providing cues (20 min). The control treatment was a same-number, same-length neuropsychological treatment not targeting visuospatial attention. Primary outcomes were the change in performance of a customized neuropsychological test battery for neglect (0% worst - 100% best) and a test of neglect-related functional disability (Catherine Bergego Scale, 0 no impairment - 30 severest impairment), assessed before and after each treatment period. Secondary outcomes were performance in the 6 single tests composing the battery (e.g., omissions in text reading, center of cancellation in the Bells test, spatial bias of fixations when freely viewing photographs) and a clinical test of anosognosia. RESULTS Overall performance in the neglect test battery improved slightly more after OKSREAD than after CONTROL (d=6%; p=0.002). The remission of neglect-related functional disability did not differ between treatments (d=-2; p=0.291). Ipsilesional fixation bias during free viewing was the only secondary outcome that was improved by OKSREAD as compared to CONTROL (d= -2.8°; p=0.005). CONCLUSION At the applied intensity, the combined OKSREAD intervention slightly attenuated the ipsilesional attention bias in persons with neglect, but it did not improve neglect-related functional disability, anosognosia, or other neglect symptoms to a clinically meaningful degree. CLINICAL TRIAL REGISTRATION URL: http://www. CLINICALTRIALS gov. Unique identifier: NCT04273620.
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Affiliation(s)
- Lisa Kunkel Genannt Bode
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany; Neurological Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Andreas Sprenger
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany; Department of Psychology II, University of Lübeck, Germany
| | - Christoph Helmchen
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany
| | - Björn Hauptmann
- Neurological Center Segeberger Kliniken, Bad Segeberg, Germany; Department Performance, Neuroscience, Therapy and Health, Medical School Hamburg, Germany
| | - Thomas F Münte
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany
| | - Björn Machner
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany.
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10
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Yang YX, Wang LL, Du J, Luo YM, Xie YL, Zhang B, Zhang H. Prism adaptation combined with eye movement training for unilateral spatial neglect after stroke: Study protocol for a single-blind prospective, randomized controlled trial. Front Neurol 2023; 13:1081895. [PMID: 36686538 PMCID: PMC9849677 DOI: 10.3389/fneur.2022.1081895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Background Unilateral spatial neglect (USN) is a complex neurological syndrome that often reduces rehabilitation outcomes, prolongs patients' hospital stays, and decreases their quality of life. However, the current therapies for USN have varying efficacy. We will explore a new treatment option that combines prism adaptation (PA) with eye movement training (EMT) for the treatment of USN after stroke. Methods We will conduct a single-blind, prospective, randomized controlled trial to assess the efficacy of the combined intervention (PA & EMT) on USN in an inpatient rehabilitation setting. The study aims to recruit 88 patients with USN after an ischemic or hemorrhagic stroke. Participants will be randomly assigned to the following four groups: (1) PA group (n = 22), (2) EMT group (n = 22), (3) PA and EMT group (n = 22), and (4) control group (n = 22). All groups will receive 10 sessions of interventions over 2 weeks, 5 times per week. Blinded assessors will conduct a baseline assessment, a post-intervention assessment, and a follow-up assessment (2 weeks post-intervention). The primary outcome measure will use the Behavioral Inattention Test-Conventional Subset (BIT-C) and Catherine Bergego Scale (CBS) to assess the levels of USN. Secondary outcome measures will assess the patient's ability to perform activities of daily living using the Modified Barthel Index (MBI). Patients who completed all treatment and assessment sessions will be included in the final analysis. Discussion This study will explore the effects of 10 sessions of combined interventions (PA & EMT) on USN and functional capacity. This study has the potential to identify a new, evidence-based treatment option and provide new ideas for the treatment of USN. Ethics and dissemination The study protocol has been approved by the Nanchong Central Hospital. Written informed consent will be obtained from all the participants. The results of this study will be disseminated to the public through scientific conferences and a peer-reviewed journal. Trial registration ChiCTR, ChiCTR2100049482. Registered on 2 August 2021, http://www.chictr.org.cn/showproj.aspx?proj=130823.
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Affiliation(s)
- Yu-xuan Yang
- Department of Rehabilitation Medicine, The Second Clinical Medical School of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Ling-ling Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Juan Du
- Department of Rehabilitation Medicine, The Second Clinical Medical School of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yao-min Luo
- Department of Rehabilitation Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yu-lei Xie
- School of Rehabilitation, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Bo Zhang
- Department of Rehabilitation Medicine, The Second Clinical Medical School of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China,*Correspondence: Bo Zhang ✉ :
| | - Han Zhang
- Department of Rehabilitation Medicine, The Second Clinical Medical School of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China,Han Zhang ✉
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11
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Melnikova EA, Starkova EY, Razumov AN. [Modern view on upper limb physical rehabilitation after stroke. Literature review]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:42-53. [PMID: 36971671 DOI: 10.17116/kurort202310001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Stroke is the world's second leading cause of death and the first cause of disability among all diseases. The most common complication of a stroke is a violation of the motor function of the limbs, which significantly worsens the quality of life and the level of self-care and independence of patients. Restoring the function of the upper limb is one of the priority tasks of rehabilitation after a stroke. A large number of factors, such as the location and size of the primary brain lesion, the presence of complications in the form of spasticity, impaired skin and proprioceptive sensitivity, and comorbidities, determine the patient's rehabilitation potential and the prognosis of ongoing rehabilitation measures. Of particular note are the timing of the start of rehabilitation measures, the duration and regularity of the treatment methods. A number of authors propose scales for assessing the rehabilitation prognosis, as well as algorithms for compiling rehabilitation programs for restoring the function of the upper limb. A fairly large number of rehabilitation methods and their combinations have been proposed, including special methods of kinesitherapy, robotic mechanotherapy with biofeedback, the use of physiotherapeutic factors, manual and reflex effects, as well as ready-made programs that include sequential and combined use of various methods. Dozens of studies have been devoted to comparative analysis and evaluation of the effectiveness of these methods. The purpose of this work is to review current research on a given topic and draw up our own conclusion on the appropriateness of using and combining these methods at various stages of rehabilitation in stroke patients.
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Affiliation(s)
- E A Melnikova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - E Yu Starkova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A N Razumov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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12
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Abstract
Unilateral spatial neglect (USN) is a common and disabling cognitive consequence of stroke wherein individuals demonstrate decreased response to contralesional information. Here, we provide an updated narrative review of studies that shed light on the neural mechanisms and predictors of recovery of USN. Additionally, we report a rapid review of randomized controlled trials focusing on USN intervention, both nonpharmacological and pharmacological, published in the last 5 years. Randomized controlled trials are reviewed within the context of systematic reviews and meta-analyses of USN interventions published within the same time frame. The quality of randomized controlled trials of treatment is higher compared to quality reported in previous reviews and meta-analyses. However, remaining weaknesses in participant demographic reporting, as well as small, heterogenous samples, render generalizability and cross-study interpretation a challenge. Nevertheless, evidence regarding neural mechanisms underlying USN recovery and regarding the effectiveness of targeted USN interventions is accumulating and strengthening, setting the foundation for future investigations into patient-specific factors that may influence treatment response. We identify gaps and provide suggestions for future USN intervention research.
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Affiliation(s)
- Alexandra Zezinka Durfee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (A.Z.D., A.E.H.)
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (A.Z.D., A.E.H.).,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD (A.E.H.).,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD (A.E.H.)
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13
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Middag-van Spanje M, Schuhmann T, Nijboer T, van der Werf O, Sack AT, van Heugten C. Study protocol of transcranial electrical stimulation at alpha frequency applied during rehabilitation: A randomized controlled trial in chronic stroke patients with visuospatial neglect. BMC Neurol 2022; 22:402. [PMID: 36324088 PMCID: PMC9628038 DOI: 10.1186/s12883-022-02932-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND A frequent post stroke disorder in lateralized attention is visuospatial neglect (VSN). As VSN has a strong negative impact on recovery in general and independence during daily life, optimal treatment is deemed urgent. Next to traditional stroke treatment, non-invasive brain stimulation offers the potential to facilitate stroke recovery as a complementary approach. In the present study, visual scanning training (VST; the current conventional treatment) will be combined with transcranial alternating current stimulation (tACS) to evaluate the additive effects of repeated sessions of tACS in combination with six-weeks VST rehabilitation. METHODS In this double-blind randomized placebo-controlled intervention study (RCT), we will compare the effects of active tACS plus VST to sham (placebo) tACS plus VST, both encompassing 18 VST training sessions, 40 minutes each, during 6 weeks. Chronic stroke patients with VSN (> 6 months post-stroke onset) are considered eligible for study participation. In total 22 patients are needed for the study. The primary outcome is change in performance on a cancellation task. Secondary outcomes are changes in performance on a visual detection task, two line bisection tasks, and three measures to assess changes in activities of daily living. Assessment is at baseline, directly after the first and ninth training session, after the last training session (post training), and 1 week and 3 months after termination of the training (follow-up). DISCUSSION If effective, a tACS-VST rehabilitation program could be implemented as a treatment option for VSN. TRIAL REGISTRATION ClinicalTrials.gov ; registration number: NCT05466487; registration date: July 18, 2022 retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT05466487.
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Affiliation(s)
- Marij Middag-van Spanje
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,InteraktContour, Nunspeet, The Netherlands
| | - Teresa Schuhmann
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht Brain Imaging Centre, Maastricht University, Maastricht, The Netherlands
| | - Tanja Nijboer
- grid.5477.10000000120346234Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands ,grid.7692.a0000000090126352Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Olof van der Werf
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht Brain Imaging Centre, Maastricht University, Maastricht, The Netherlands
| | - Alexander T. Sack
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht Brain Imaging Centre, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Centre for Integrative Neuroscience, Faculty of Psychology and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Caroline van Heugten
- Limburg Brain Injury Center, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382School for Mental Health and Neuroscience, Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
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14
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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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15
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Schuhmann T, Duecker F, Middag-van Spanje M, Gallotto S, van Heugten C, Schrijnemaekers AC, van Oostenbrugge R, Sack AT. Transcranial alternating brain stimulation at alpha frequency reduces hemispatial neglect symptoms in stroke patients. Int J Clin Health Psychol 2022; 22:100326. [PMID: 35990733 PMCID: PMC9364103 DOI: 10.1016/j.ijchp.2022.100326] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background/Objective Non-invasive brain stimulation techniques such as transcranial alternating current stimulation (tACS) may help alleviate attention deficits in stroke patients with hemispatial neglect by modulating oscillatory brain activity. We applied high-definition (HD)-tACS at alpha frequency over the contralesional hemisphere to support unilateral oscillatory alpha activity and correct for the pathologically altered attention bias in neglect patients. Methods We performed a within-subject, placebo-controlled study in which sixteen stroke patients with hemispatial neglect underwent 10 Hz (alpha) as well as sham (placebo) stimulation targeting the contralesional posterior parietal cortex. Attentional bias was measured with a computerized visual detection paradigm and two standard paper-and-pencil neglect tests. Results We revealed a significant shift of attentional resources after alpha-HD-tACS, but not sham tACS, toward the ipsilateral and thus contralesional hemifield leading to a reduction in neglect symptoms, measured with a computerized visual detection paradigm and a widely used standard paper and pencil neglect tests. Conclusions We showed a significant alpha-HD-tACS-induced shift of attentional resources toward the contralesional hemifield, thus leading to a reduction in neglect symptoms. Importantly, HD-tACS effects persisted after the stimulation itself had ended. This tACS protocol, based on intrinsic oscillatory processes, may be an effective and well-tolerated treatment option for neglect.
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Affiliation(s)
- Teresa Schuhmann
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands
| | - Felix Duecker
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands
| | - Marij Middag-van Spanje
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands.,InteraktContour, Nunspeet, the Netherlands
| | - Stefano Gallotto
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands.,EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine of Geneva, University of Geneva, Geneva, Switzerland
| | - Caroline van Heugten
- Limburg Brain Injury Center, the Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience (FPN), Maastricht University, the Netherlands.,School for Mental Health and Neuroscience, Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University Medical Center, the Netherlands
| | - Anne-Claire Schrijnemaekers
- Adelante Rehabilitation Centre, Department of Brain Injury, Hoensbroek, the Netherlands.,Mondriaan Mental Health Centre, Department of Adult Psychiatry, Heerlen, the Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alexander T Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands.,Centre for Integrative Neuroscience, Faculty of Psychology and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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16
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The unilateral hemispatial neglect phenomenon in right hemiplegia. Turk J Phys Med Rehabil 2022; 68:426-429. [DOI: 10.5606/tftrd.2022.6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
One of the most important perceptual function disorders following a cerebrovascular accident (CVA) is the unilateral hemispatial neglect phenomenon (UHNP). In this case report, we present a 73-year-old male patient with UHNP accompanying right hemiplegia, which was identified with detailed examination. Clinical picture was characterized by right-sided hemiparesis in the upper right shoulder and relative weakness in the right leg. Patient was tested on hemineglect (HN) with star cancellation test and detailed neuropsychological evaluation. This article highlight the latest findings regarding the cognitive–behavioral syndrome of neglect for hemiplegia that occur following left hemisphere stroke.
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17
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Maurer-Karattup P, Neumann O, Danneil W, Thöne-Otto AIT. Leitlinienbasierte Standards zur Struktur- und Prozessqualität neuropsychologischer Diagnostik und Therapie. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2022. [DOI: 10.1024/1016-264x/a000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Zusammenfassung: Die vorliegende Arbeit untersucht die aktuelle wissenschaftliche Evidenz zur Diagnostik und Therapie neuropsychologischer Störungen nach Hirnschädigung, wie sie bis 2020 in Leitlinien publiziert wurde. Deren Umsetzung ist nur möglich, wenn die institutionellen Rahmenbedingungen dies erlauben. Unter Einbezug der klinischen Erfahrung wurden daher auf Basis der Leitlinien Standards für eine wissenschaftlich fundierte neuropsychologische Diagnostik und Therapie erarbeitet. Es entstanden Best-Practice-Empfehlungen zu Struktur- und Prozessqualität, insbesondere zu Intensität und Häufigkeit der Interventionen. Diese werden für die wichtigsten neuropsychologischen Funktionsbereiche vorgestellt. Sowohl die Deutsche Gesellschaft für Neuropsychologie e. V. (GNP) als auch die Deutsche Gesellschaft für Neurologie e. V. (DGN) unterstützen diese Empfehlungen. Sie richten sich an Neuropsycholog_innen sowie an Einrichtungsleitende und Sozialversicherungsträger und definieren die Rahmenbedingungen für eine auf den individuellen Fall angepasste leitliniengerechte neuropsychologische Behandlung.
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Affiliation(s)
| | | | - Wolfgang Danneil
- Waldklinik Jesteburg & Neuropsychologische Praxis Nordheide, Jesteburg, Deutschland
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18
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Giannakou I, Lin D, Punt D. Computer-based assessment of unilateral spatial neglect: A systematic review. Front Neurosci 2022; 16:912626. [PMID: 36061603 PMCID: PMC9437703 DOI: 10.3389/fnins.2022.912626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background To date, no gold standard exists for the assessment of unilateral spatial neglect (USN), a common post-stroke cognitive impairment, with limited sensitivity provided by currently used clinical assessments. Extensive research has shown that computer-based (CB) assessment can be more sensitive, but these have not been adopted by stroke services yet. Objective We conducted a systematic review providing an overview of existing CB tests for USN to identify knowledge gaps and positive/negative aspects of different methods. This review also investigated the benefits and barriers of introducing CB assessment tasks to clinical settings and explored practical implications for optimizing future designs. Methodology We included studies that investigated the efficacy of CB neglect assessment tasks compared to conventional methods in detecting USN for adults with brain damage. Study identification was conducted through electronic database searches (e.g., Scopus), using keywords and standardized terms combinations, without date limitation (last search: 08/06/2022). Literature review and study selection were based on prespecified inclusion criteria. The quality of studies was assessed with the quality assessment of diagnostic accuracy studies tool (Quadas-2). Data synthesis included a narrative synthesis, a table summarizing the evidence, and vote counting analysis based on a direction of effect plot. Results A total of 28 studies met the eligibility criteria and were included in the review. According to our results, 13/28 studies explored CB versions of conventional tasks, 11/28 involved visual search tasks, and 5/28 other types of tasks. The vote counting analysis revealed that 17/28 studies found CB tasks had either equal or higher sensitivity than conventional methods and positive correlation with conventional methods (15/28 studies). Finally, 20/28 studies showed CB tasks effectively detected patients with USN within different patient groups and control groups (17/28). Conclusions The findings of this review provide practical implications for the implementation of CB assessment in the future, offering important information to enhance a variety of methodological issues. The study adds to our understanding of using CB tasks for USN assessment, exploring their efficacy and benefits compared to conventional methods, and considers their adoption in clinical environments.
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Affiliation(s)
- Ioanna Giannakou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Dan Lin
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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19
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Bazan R, Fonseca BHDS, Miranda JMDA, Nunes HRDC, Bazan SGZ, Luvizutto GJ. Effect of Robot-Assisted Training on Unilateral Spatial Neglect After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Neurorehabil Neural Repair 2022; 36:545-556. [PMID: 35880666 DOI: 10.1177/15459683221110894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have shown that robotic devices can effectively improve motor function in stroke patients through limb activation. However, the effects of robot-assisted therapy on perceptual deficits after stroke is unclear. OBJECTIVE This review aimed to evaluate the effectiveness of robotic limb activation in patients with unilateral spatial neglect (USN) after stroke. METHODS In this systematic review, a literature search was performed using MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS databases without language restrictions. Randomized controlled trials (RCTs) and quasi-RCTs of robot-assisted therapy for USN after stroke were selected. Two reviewers independently assessed the risk of bias and certainty of the evidence of the included studies. RESULTS A total of 630 studies were identified, including five studies for qualitative synthesis and four meta-analyses. The results of RCTs comparing robotic limb activation with a control group suggested an improvement in the degree of USN measured by the line bisection test (standardized mean difference [SMD], -0.64; 95% confidence interval [CI], -1.13 to -0.15; P = .01). There were no differences between the groups in the motor-free visual perception test 3rd edition (SMD, 0.27; 95% CI, -0.25-0.79; P = .31), star cancellation test (SMD, 0.26; 95% CI, -0.42-0.94; P = .54), Albert's test (SMD, -0.67; 95% CI, -2.01-0.66; P = .32), and Catherine Bergego Scale (SMD, -0.81; 95% CI, -2.07-0.45; P = .21). CONCLUSION The study demonstrated that limb activation through robotic therapy can improve midline perception. However, there was no impact on tasks assessing visual scanning, functionality, or activities of daily living.
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Affiliation(s)
- Rodrigo Bazan
- Department of Neurology, Psychology, and Psychiatry at Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
| | | | | | | | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy-Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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20
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da Silva TR, de Carvalho Nunes HR, Martins LG, da Costa RDM, de Souza JT, Winckler FC, Sartor LCA, Modolo GP, Ferreira NC, da Silva Rodrigues JC, Kanda R, Fogarolli MO, Borges GF, Rizzatti GRS, Ribeiro PW, Favoretto DB, Aguiar L, Zanati Bazan SG, Betting LEG, de Oliveira Antunes LC, Mendes Pereira V, Santos TEG, Pontes-Neto O, Conforto AB, Bazan R, Luvizutto GJ. Brain stimulation can reduce unilateral spatial neglect after stroke: ELETRON trial. Ann Neurol 2022; 92:400-410. [PMID: 35688801 DOI: 10.1002/ana.26430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. METHODS This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to Behavior Inattention Test Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 min of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity [National Institutes of Health Stroke Scale (NIHSS)], disability [modified Rankin Scale (mRS)], autonomy [Barthel Index (BI), functional independence measure (FIM)], and quality of life (EQ-5D). Outcomes were analyzed using ANCOVA model corrected by age, baseline NIHSS and baseline BIT-C. Pairwise posthoc comparisons were performed using Bonferroni correction. RESULTS In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (MD: 18.4; 95%CI: 3.9-32.8; p=0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD: 13.9; 95%CI: -0.3-28.1; p=0.057), or C-tDCS and sham (MD: 4.5; 95%CI: -9.7-18.8; p=0.99). There were no significant differences between groups in terms of secondary outcomes. CONCLUSIONS A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase III trial. REGISTRATION URL: https://ensaiosclinicos.gov.br/; Unique Identifier RBR-78jvzx This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Rafael Kanda
- Department of Neurology, Psychology and Psychiatry at Botucatu Medical School (UNESP)
| | | | | | | | | | - Diandra B Favoretto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Luan Aguiar
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | - Taiza E Grespan Santos
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octávio Pontes-Neto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Adriana Bastos Conforto
- Hospital das Clínicas São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry at Botucatu Medical School (UNESP)
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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21
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Meidian AC, Wahyuddin, Amimoto K. Rehabilitation interventions of unilateral spatial neglect based on the functional outcome measure: A systematic review and meta-analysis. Neuropsychol Rehabil 2022; 32:764-793. [PMID: 33106080 DOI: 10.1080/09602011.2020.1831554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
ABSTRACTThis review aimed to examine the bottom-up and top-down rehabilitation intervention effectiveness based on the functional outcome measure as immediate effect and long-term effect for unilateral spatial neglect conditions. The RCT studies were collected by searching in three databases J-Stage, PubMed, and PEDro from 2008 through 2018. The studies which used the following instruments: BI, CBS, FMA, and FIM, as the functional outcome with the PEDro score of six and above, were eligible for inclusion. A total of 492 participants in 13 studies included from 291 studies initially identified. The meta-analysis for overall ES revealed that BI and CBS had a significant mean of SMD = 0.65 (95% CI, 0.23-1.07; p = 0.003; I2 = 65%), and SMD = -0.23 (95% CI, -0.45 to -0.01; p = 0.04; I2 = 35%) respectively, while FMA and FIM had an insignificant mean of SMD = 0.14 (95% CI, -0.08-0.37; p = 0.22; I2 = 0%), and SMD = -0.22 (95% CI, -0.69-0.25; p = 0.37; I2 = 0%) respectively. Based on the results, although indicated the heterogeneity representation across studies, it showed that the top-down intervention approach of high-frequency rTMS was more effective in enhancing the functional abilities and ADL of unilateral spatial neglect patients on the immediate effects but not necessarily in the long-term effects.
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Affiliation(s)
- Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Faculty of Physiotherapy, Esa Unggul University, Jakarta, Indonesia
| | - Wahyuddin
- Faculty of Physiotherapy, Esa Unggul University, Jakarta, Indonesia
| | - Kazu Amimoto
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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22
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Cavedoni S, Cipresso P, Mancuso V, Bruni F, Pedroli E. Virtual reality for the assessment and rehabilitation of neglect: where are we now? A 6-year review update. VIRTUAL REALITY 2022; 26:1663-1704. [PMID: 35669614 PMCID: PMC9148943 DOI: 10.1007/s10055-022-00648-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/24/2022] [Indexed: 06/13/2023]
Abstract
Unilateral spatial neglect (USN) is a frequent repercussion of a cerebrovascular accident, typically a stroke. USN patients fail to orient their attention to the contralesional side to detect auditory, visual, and somatosensory stimuli, as well as to collect and purposely use this information. Traditional methods for USN assessment and rehabilitation include paper-and-pencil procedures, which address cognitive functions as isolated from other aspects of patients' functioning within a real-life context. This might compromise the ecological validity of these procedures and limit their generalizability; moreover, USN evaluation and treatment currently lacks a gold standard. The field of technology has provided several promising tools that have been integrated within the clinical practice; over the years, a "first wave" has promoted computerized methods, which cannot provide an ecological and realistic environment and tasks. Thus, a "second wave" has fostered the implementation of virtual reality (VR) devices that, with different degrees of immersiveness, induce a sense of presence and allow patients to actively interact within the life-like setting. The present paper provides an updated, comprehensive picture of VR devices in the assessment and rehabilitation of USN, building on the review of Pedroli et al. (2015). The present paper analyzes the methodological and technological aspects of the studies selected, considering the issue of usability and ecological validity of virtual environments and tasks. Despite the technological advancement, the studies in this field lack methodological rigor as well as a proper evaluation of VR usability and should improve the ecological validity of VR-based assessment and rehabilitation of USN.
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Affiliation(s)
- S. Cavedoni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - P. Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, TO Italy
| | - V. Mancuso
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - F. Bruni
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - E. Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, eCampus University, Novedrate, Italy
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23
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Kaiser AP, Villadsen KW, Samani A, Knoche H, Evald L. Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects. Front Psychol 2022; 13:787382. [PMID: 35391965 PMCID: PMC8982678 DOI: 10.3389/fpsyg.2022.787382] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.
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Affiliation(s)
- Alexander Pilgaard Kaiser
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Westergaard Villadsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark,*Correspondence: Lars Evald,
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24
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Facchin A, Figliano G, Daini R. Prism Adaptation and Optokinetic Stimulation Comparison in the Rehabilitation of Unilateral Spatial Neglect. Brain Sci 2021; 11:brainsci11111488. [PMID: 34827487 PMCID: PMC8615435 DOI: 10.3390/brainsci11111488] [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: 10/04/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Prism adaptation (PA) is one of the most effective treatments for the rehabilitation of unilateral spatial neglect. Optokinetic stimulation (OKS) has also been demonstrated to be effective in ameliorating symptoms of neglect. The aim of this study is to compare the effectiveness of these two methods in a group of neglect patients using a crossover design. A group of 13 post-acute brain-damaged patients with unilateral spatial neglect, who had never been rehabilitated, were treated using PA and OKS. Each treatment was applied for 10 sessions, twice a day, to all patients with both treatments in crossed order (i.e., PA followed by OKS or vice versa). Neuropsychological assessments were performed: before the first (T1), at the end of the first/beginning of the second (T2) and at the end of the second training sessions (T3), and two weeks after the end of treatment (T4). Both procedures produced a significant improvement in clinical tests at T2, independent of the type of training. The results suggest that either PA or OKS induces a significant amelioration of neglect in right brain-damaged patients, mainly in the first block of treatment. Since no differences between treatments were found, they could be applied in clinical practice, according to the requirements of the individual patient.
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Affiliation(s)
- Alessio Facchin
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (G.F.); (R.D.)
- COMiB—Optics and Optometry Research Center, Università Degli Studi di Milano-Bicocca & NeuroMI—Milan Center for Neuroscience, 20126 Milan, Italy
- Correspondence:
| | - Giusi Figliano
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (G.F.); (R.D.)
| | - Roberta Daini
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (G.F.); (R.D.)
- COMiB—Optics and Optometry Research Center, Università Degli Studi di Milano-Bicocca & NeuroMI—Milan Center for Neuroscience, 20126 Milan, Italy
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25
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Meidian AC, Yige S, Irfan M, Rahayu UB, Amimoto K. Immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the unilateral spatial neglect model. J Phys Ther Sci 2021; 33:809-817. [PMID: 34776614 PMCID: PMC8575481 DOI: 10.1589/jpts.33.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study aimed to clarify the immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the left unilateral spatial neglect model. [Participants and Methods] We included 64 healthy participants to create left unilateral spatial neglect models and divided them into four subgroups. Each subgroup received opposite lateral weight-shifting training with or without mirror visual feedback. We then evaluated the static and dynamic standing balance by measuring the center of pressure point alterations in the medial-lateral and anterior-posterior planes. We further evaluated the center of pressure length and bilateral load ratio. [Results] The center of pressure was significantly stable upon performing the eyes-open static standing balance test in the left weight-shifting training subgroup with mirror visual feedback. When participants performed the left dynamic standing balance test, the center of pressure moved significantly rightward and became significantly stable in the right weight-shifting training subgroup with mirror visual feedback. The left load ratio significantly decreased in the right weight-shifting training of subgroups that either did or did not receive mirror visual feedback upon performing the left dynamic standing balance test. [Conclusion] We concluded that adding mirror visual feedback to lateral weight-shifting training affected some measurements of standing balance control of the left unilateral spatial neglect model.
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Affiliation(s)
- Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
- Faculty of Physiotherapy, Esa Unggul University,
Indonesia
| | - Song Yige
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
| | - Muhammad Irfan
- Department of Physiotherapy, Faculty of Health Sciences,
Universitas Aisyiyah Yogyakarta, Indonesia
| | - Umi Budi Rahayu
- Department of Physiotherapy, Faculty of Health Sciences,
Universitas Muhammadiyah Surakarta, Indonesia
| | - Kazu Amimoto
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
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26
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Edwards G, Berestova A, Battelli L. Behavioral gain following isolation of attention. Sci Rep 2021; 11:19329. [PMID: 34588526 PMCID: PMC8481494 DOI: 10.1038/s41598-021-98670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
Stable sensory perception is achieved through balanced excitatory-inhibitory interactions of lateralized sensory processing. In real world experience, sensory processing is rarely equal across lateralized processing regions, resulting in continuous rebalancing. Using lateralized attention as a case study, we predicted rebalancing lateralized processing following prolonged spatial attention imbalance could cause a gain in attention in the opposite direction. In neurotypical human adults, we isolated covert attention to one visual field with a 30-min attention-demanding task and found an increase in attention in the opposite visual field after manipulation. We suggest a gain in lateralized attention in the previously unattended visual field is due to an overshoot through attention rebalancing. The offline post-manipulation effect is suggestive of long-term potentiation affecting behavior. Our finding of visual field specific attention increase could be critical for the development of clinical rehabilitation for patients with a unilateral lesion and lateralized attention deficits. This proof-of-concept study initiates the examination of overshoot following the release of imbalance in other lateralized control and sensory domains, important in our basic understanding of lateralized processing.
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Affiliation(s)
- Grace Edwards
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy. .,Department of Psychology, Harvard University, Cambridge, MA, 02138, USA.
| | - Anna Berestova
- Lesley University, 29 Everett St, Cambridge, MA, 02138, USA
| | - Lorella Battelli
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di Tecnologia, 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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27
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Zhang Y, Xing Y, Li C, Hua Y, Hu J, Wang Y, Ya R, Meng Q, Bai Y. Mirror therapy for unilateral neglect after stroke: A systematic review. Eur J Neurol 2021; 29:358-371. [PMID: 34558762 DOI: 10.1111/ene.15122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE The effect of mirror therapy for unilateral neglect after stroke currently remains uncertain. METHODS This systematic review investigated the effect of mirror therapy on neglect and daily living activities in patients with unilateral neglect after stroke when compared with no treatment, sham mirror therapy, or routinely applied therapies only. We performed a systematic electronic search of PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data to identify relevant randomized control trials (RCTs). RESULTS We included five RCTs in the data synthesis. Mirror therapy (combined or not with other treatments) was more effective in improving neglect as compared with sham mirror therapy or no treatment (combined or not with the other therapies; standard mean difference [SMD] = 1.62, 95% confidence interval [CI] = 1.03-2.21, p < 0.00001). Mirror therapy (combined or not with other therapies) was effective in improving daily living activities as compared with sham mirror therapy or no treatment (combined or not with the other therapies; SMD = 2.09, 95% CI = 0.63-3.56, p = 0.005). CONCLUSIONS Our results show that mirror therapy effectively improves neglect and daily living activities in patients with unilateral neglect after stroke. Future trials with high methodological quality and larger sample sizes are needed to determine the immediate and long-term effect of appropriate mirror therapy protocol for unilateral neglect.
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Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Xing
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Congqin Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Ru Ya
- Department of Rehabilitation Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Qiong Meng
- Department of Internal Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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28
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Saj A, Pierce JE, Ronchi R, Ros T, Thomasson M, Bernati T, Van De Ville D, Serino A, Vuilleumier P. Real-time fMRI and EEG neurofeedback: A perspective on applications for the rehabilitation of spatial neglect. Ann Phys Rehabil Med 2021; 64:101561. [PMID: 34311120 DOI: 10.1016/j.rehab.2021.101561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 01/20/2023]
Abstract
Spatial neglect is a neuropsychological syndrome characterized by a failure to orient, perceive, and act toward the contralesional side of the space after brain injury. Neglect is one of the most frequent and disabling neuropsychological syndromes following right-hemisphere damage, often persisting in the chronic phase and responsible for a poor functional outcome at hospital discharge. Different rehabilitation approaches have been proposed over the past 60 years, with a variable degree of effectiveness. In this point-of-view article, we describe a new rehabilitation technique for spatial neglect that directly targets brain activity and pathological physiological processes: namely, neurofeedback (NFB) with real-time brain imaging methodologies. In recent proof-of-principle studies, we have demonstrated the potential of this rehabilitation technique. Using real-time functional MRI (rt-fMRI) NFB in chronic neglect, we demonstrated that patients are able to upregulate their right visual cortex activity, a response that is otherwise reduced due to losses in top-down attentional signals. Using real-time electroencephalography NFB in patients with acute or chronic condition, we showed successful regulation with partial restoration of brain rhythm dynamics over the damaged hemisphere. Both approaches were followed by mild, but encouraging, improvement in neglect symptoms. NFB techniques, by training endogenous top-down modulation of attentional control on sensory processing, might induce sustained changes at both the neural and behavioral levels, while being non-invasive and safe. However, more properly powered clinical studies with control groups and longer follow-up are needed to fully establish the effectiveness of the techniques, identify the most suitable candidates, and determine how the techniques can be optimized or combined in the context of rehabilitation.
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Affiliation(s)
- Arnaud Saj
- University of Montreal, Psychology Department, Montreal, QC, Canada; University Hospital of Geneva, Neuropsychology Unit, Geneva, Switzerland.
| | - Jordan E Pierce
- Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, Geneva, Switzerland
| | - Roberta Ronchi
- University Hospital of Geneva, Neuropsychology Unit, Geneva, Switzerland; Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, Geneva, Switzerland
| | - Tomas Ros
- Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, Geneva, Switzerland
| | - Marine Thomasson
- Clinical and Experimental Neuropsychology Laboratory, Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Thérèse Bernati
- University Hospital of Geneva, Neuropsychology Unit, Geneva, Switzerland
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Andrea Serino
- Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland; Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Patrik Vuilleumier
- Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, Geneva, Switzerland
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29
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Dozio N, Maggioni E, Pittera D, Gallace A, Obrist M. May I Smell Your Attention: Exploration of Smell and Sound for Visuospatial Attention in Virtual Reality. Front Psychol 2021; 12:671470. [PMID: 34366990 PMCID: PMC8339311 DOI: 10.3389/fpsyg.2021.671470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
When interacting with technology, attention is mainly driven by audiovisual and increasingly haptic stimulation. Olfactory stimuli are widely neglected, although the sense of smell influences many of our daily life choices, affects our behavior, and can catch and direct our attention. In this study, we investigated the effect of smell and sound on visuospatial attention in a virtual environment. We implemented the Bells Test, an established neuropsychological test to assess attentional and visuospatial disorders, in virtual reality (VR). We conducted an experiment with 24 participants comparing the performance of users under three experimental conditions (smell, sound, and smell and sound). The results show that multisensory stimuli play a key role in driving the attention of the participants and highlight asymmetries in directing spatial attention. We discuss the relevance of the results within and beyond human-computer interaction (HCI), particularly with regard to the opportunity of using VR for rehabilitation and assessment procedures for patients with spatial attention deficits.
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Affiliation(s)
- Nicolò Dozio
- Politecnico di Milano, Department of Mechanical Engineering, Milan, Italy
- Sussex Computer-Human Interaction Lab, Department of Informatics, University of Sussex, Brighton, United Kingdom
| | - Emanuela Maggioni
- Sussex Computer-Human Interaction Lab, Department of Informatics, University of Sussex, Brighton, United Kingdom
- Department of Computer Science, University College London, London, United Kingdom
| | - Dario Pittera
- Sussex Computer-Human Interaction Lab, Department of Informatics, University of Sussex, Brighton, United Kingdom
- Ultraleap Ltd., Bristol, United Kingdom
| | - Alberto Gallace
- Mind and Behavior Technological Center - MibTec, University of Milano-Bicocca, Milan, Italy
| | - Marianna Obrist
- Sussex Computer-Human Interaction Lab, Department of Informatics, University of Sussex, Brighton, United Kingdom
- Department of Computer Science, University College London, London, United Kingdom
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30
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Di Gregorio F, La Porta F, Lullini G, Casanova E, Petrone V, Simoncini L, Ferrucci E, Piperno R. Efficacy of Repetitive Transcranial Magnetic Stimulation Combined With Visual Scanning Treatment on Cognitive-Behavioral Symptoms of Unilateral Spatial Neglect in Patients With Traumatic Brain Injury: Study Protocol for a Randomized Controlled Trial. Front Neurol 2021; 12:702649. [PMID: 34335455 PMCID: PMC8317998 DOI: 10.3389/fneur.2021.702649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
Left hemispatial neglect (LHSN) is a frequent and disabling condition affecting patients who suffered from traumatic brain injury (TBI). LHSN is a neuropsychological syndrome characterized clinically by difficulties in attending, responding, and consciously representing the right side of space. Despite its frequency, scientific evidence on effective treatments for this condition in TBI patients is still low. According to existing literature, we hypothesize that in TBI, LHSN is caused by an imbalance in inter-hemispheric activity due to hyperactivity of the left hemisphere, as observed in LHSN after right strokes. Thus, by inhibiting this left hyperactivity, repetitive Transcranial Magnetic Stimulation (rTMS) would have a rebalancing effect, reducing LHSN symptoms in TBI patients. We plan to test this hypothesis within a single-blind, randomized SHAM controlled trial in which TBI patients will receive inhibitory i-rTMS followed by cognitive treatment for 15 days. Neurophysiological and clinical measures will be collected before, afterward, and in the follow-up. This study will give the first empirical evidence about the efficacy of a novel approach to treating LHSN in TBI patients. Clinical Trial Registration:https://www.clinicaltrials.gov/ct2/show/NCT04573413?cond=Neglect%2C+Hemispatial&cntry=IT&city=Bologna&draw=2&rank=2, identifier: NCT04573413.
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Affiliation(s)
- Francesco Di Gregorio
- Azienda Unità Sanitaria Locale, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Fabio La Porta
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Giada Lullini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Emanuela Casanova
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Valeria Petrone
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Loredana Simoncini
- Azienda Unità Sanitaria Locale, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Enrico Ferrucci
- Azienda Unità Sanitaria Locale, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Roberto Piperno
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
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31
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Chen ZJ, Gu MH, He C, Xiong CH, Xu J, Huang XL. Robot-Assisted Arm Training in Stroke Individuals With Unilateral Spatial Neglect: A Pilot Study. Front Neurol 2021; 12:691444. [PMID: 34305798 PMCID: PMC8297561 DOI: 10.3389/fneur.2021.691444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Robot-assisted arm training (RAT) is an innovative exercise-based therapy that provides highly intensive, adaptive, and task-specific training, yet its effects for stroke individuals with unilateral spatial neglect remain to be explored. The study was aimed to investigate the effects of RAT on unilateral spatial neglect, arm motor function, activities of daily living, and social participation after stroke. Methods: In a pilot randomized controlled trial, individuals with unilateral spatial neglect after right hemisphere stroke were equally allocated to intervention group and control group, 45-min training daily, 5 days/week, for 4 weeks. Outcome measures included the Behavioral Inattention Test-conventional section (BIT-C), Catherine Bergego Scale (CBS), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Modified Barthel Index (MBI), and World Health Organization Disability Assessment Schedule Version 2.0 (WHODAS 2.0). Results: From November 2018 to February 2021, 20 stroke patients (mean age 47.40 ± 8.47) were enrolled in the study. Robot-assisted arm training was feasible and safe for individuals with unilateral spatial neglect. Both groups had significant improvements in all outcome measures. Participants assigned to RAT therapy had significantly greater improvements in BIT-C (difference, 7.70; 95% CI, 0.55–14.85, P = 0.04), FMA-UE (difference, 5.10; 95% CI, 1.52–8.68, P = 0.01), and WHODAS 2.0 (difference, −7.30; 95% CI, −12.50 to −2.10, P = 0.01). However, the change scores on CBS and MBI demonstrated no significance between the groups. Conclusion: Our findings provide preliminary support for introducing robot-assisted arm training to remediate unilateral spatial neglect after stroke. The training program focusing on neglect of contralateral space and affected upper extremity may be effective in neglect symptoms, motor function recovery, and social participation, while not generalizing into improvements in activities of daily living. Clinical Trial Registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/) on 17 October 2019, identifier: ChiCTR1900026656.
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Affiliation(s)
- Ze-Jian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Ming-Hui Gu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Chang He
- State Key Lab of Digital Manufacturing Equipment and Technology, Institute of Rehabilitation and Medical Robotics, Huazhong University of Science and Technology, Wuhan, China
| | - Cai-Hua Xiong
- State Key Lab of Digital Manufacturing Equipment and Technology, Institute of Rehabilitation and Medical Robotics, Huazhong University of Science and Technology, Wuhan, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Xiao-Lin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
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32
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Leitner MC, Hawelka S. Visual field improvement in neglect after virtual reality intervention: a single-case study. Neurocase 2021; 27:308-318. [PMID: 34278959 DOI: 10.1080/13554794.2021.1951302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A patient suffering from visuo-spatial neglect was investigated as a special interest case during a study on the effectiveness of "restorative approaches" after visual field loss. This patient trained with our newly developed Virtual Reality (VR) system "Salzburg Visual Field Trainer" for 254 days. Perimetric results show a visual field expansion of 48.8% (left eye) and 36.8% (right eye) translating to an improvement of approximately 5.5° to 10.5° of visual angle. Further, subjective self-report shows improvements of up to 317% in visual field functionality. Our results indicate that patients suffering from visuo-spatial neglect could benefit from a VR-based restorative intervention.
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Affiliation(s)
- Michael Christian Leitner
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria.,Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Stefan Hawelka
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria.,Department of Psychology, University of Salzburg, Salzburg, Austria
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BULBOACA AE, STANESCU I, NICULA C, BULBOACA A. Neuroplasticity pathophysiological mechanisms underlying neuro-optometric rehabilitation in ischemic stroke – a brief review. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neuroplasticity is an essential phenomenon underlying on neurorehabilitation process, by which the brain can remodel the dysfunction consequent to a lesion. Ischemic brain lesions are the most frequent brain lesions often associated with visual function disability. Experimental and clinical studies established that visual function disability can impede the neurorehabilitation therapy efficiency. Neuro-optometric therapy has been proved to significantly improve the patient outcome after brain lesions. The pathophysiological mechanisms underlying this process are yet to be deciphered. Current knowledge regarding the pathophysiological mechanisms involved in ischemic lesions and neuroplasticity as a reparation process offers real support to a more efficient neurorehabilitation therapy that can contribute to the improvement of life quality in stroke patients.
Keywords: neuroplasticity, neuro-optometric rehabilitation, ischemic stroke,
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Affiliation(s)
- Adriana Elena BULBOACA
- Functional Biosciences Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Ioana STANESCU
- Neurosciences Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Cristina NICULA
- Neurosciences Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Angelo BULBOACA
- Neurosciences Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
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34
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Vestito L, Trombini M, Mori L, Dellepiane S, Trompetto C, Morando M, Bandini F. Improved visuospatial neglect after tDCS and computer-assisted cognitive training in Posterior Cortical Atrophy: a single-case study. Neurocase 2021; 27:57-63. [PMID: 33332244 DOI: 10.1080/13554794.2020.1862242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Visuospatial neglect (VN) frequently occurs in Posterior Cortical Atrophy (PCA) and requires specific rehabilitation. In this single-case study, we investigated the efficacy of a computer-assisted cognitive training (CCT) alone or coupled with multiple sessions of anodal transcranial direct-current stimulation (A-tDCS) over the right posterior parietal cortex in improving left VN symptoms in a patient with PCA. The digital ReMoVES platform was used for both VN assessment and training. We found a significant improvement after CCT combined with A-tDCS within the limits of a single-case, our results suggest, for the first time, the usefulness of this combined approach in a neurodegenerative disorder.
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Affiliation(s)
| | - Marco Trombini
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Laura Mori
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Silvana Dellepiane
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Morando
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Fabio Bandini
- Department of Neurology, San Paolo Hospital, Savona, Italy
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35
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Wang T, Peeters R, Mantini D, Gillebert CR. Modulating the interhemispheric activity balance in the intraparietal sulcus using real-time fMRI neurofeedback: Development and proof-of-concept. NEUROIMAGE-CLINICAL 2021; 28:102513. [PMID: 33396000 PMCID: PMC7941162 DOI: 10.1016/j.nicl.2020.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/15/2020] [Accepted: 11/20/2020] [Indexed: 10/31/2022]
Abstract
The intraparietal sulcus (IPS) plays a key role in the distribution of attention across the visual field. In stroke patients, an imbalance between left and right IPS activity has been related to a spatial bias in visual attention characteristic of hemispatial neglect. In this study, we describe the development and implementation of a real-time functional magnetic resonance imaging neurofeedback protocol to noninvasively and volitionally control the interhemispheric IPS activity balance in neurologically healthy participants. Six participants performed three neurofeedback training sessions across three weeks. Half of them trained to voluntarily increase brain activity in left relative to right IPS, while the other half trained to regulate the IPS activity balance in the opposite direction. Before and after the training, we estimated the distribution of attention across the visual field using a whole and partial report task. Over the course of the training, two of the three participants in the left-IPS group increased the activity in the left relative to the right IPS, while the participants in the right-IPS group were not able to regulate the interhemispheric IPS activity balance. We found no evidence for a decrease in resting-state functional connectivity between left and right IPS, and the spatial distribution of attention did not change over the course of the experiment. This study indicates the possibility to voluntarily modulate the interhemispheric IPS activity balance. Further research is warranted to examine the effectiveness of this technique in the rehabilitation of post-stroke hemispatial neglect.
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Affiliation(s)
- Tianlu Wang
- Brain and Cognition, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Ronald Peeters
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Dante Mantini
- Research Centre for Motor Control and Neuroplasticity, KU Leuven, Leuven, Belgium; Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, Italy
| | - Céline R Gillebert
- Brain and Cognition, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium.
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Di Gregorio F, La Porta F, Casanova E, Magni E, Bonora R, Ercolino MG, Petrone V, Leo MR, Piperno R. Efficacy of repetitive transcranial magnetic stimulation combined with visual scanning treatment on cognitive and behavioral symptoms of left hemispatial neglect in right hemispheric stroke patients: study protocol for a randomized controlled trial. Trials 2021; 22:24. [PMID: 33407787 PMCID: PMC7789759 DOI: 10.1186/s13063-020-04943-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left hemispatial neglect (LHN) is a neuropsychological syndrome often associated with right hemispheric stroke. Patients with LHN have difficulties in attending, responding, and consciously representing the right side of space. Various rehabilitation protocols have been proposed to reduce clinical symptoms related to LHN, using cognitive treatments, or on non-invasive brain stimulation. However, evidence of their benefit is still lacking; in particular, only a few studies focused on the efficacy of combining different approaches in the same patient. METHODS In the present study, we present the SMART ATLAS trial (Stimolazione MAgnetica Ripetitiva Transcranica nell'ATtenzione LAteralizzata dopo Stroke), a multicenter, randomized, controlled trial with pre-test (baseline), post-test, and 12 weeks follow-up assessments based on a novel rehabilitation protocol based on the combination of brain stimulation and standard cognitive treatment. In particular, we will compare the efficacy of inhibitory repetitive-transcranial magnetic stimulation (r-TMS), applied over the left intact parietal cortex of LHN patients, followed by visual scanning treatment, in comparison with a placebo stimulation (SHAM control) followed by the same visual scanning treatment, on visuospatial symptoms and neurophysiological parameters of LHN in a population of stroke patients. DISCUSSION Our trial results may provide scientific evidence of a new, relatively low-cost rehabilitation protocol for the treatment of LHN. TRIAL REGISTRATION ClinicalTrials.gov NCT04080999 . Registered on September 2019.
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Affiliation(s)
- Francesco Di Gregorio
- Azienda Unità Sanitaria Locale, UOC di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy.
| | - Emanuela Casanova
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Elisabetta Magni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Roberta Bonora
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Maria Grazia Ercolino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Valeria Petrone
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | | | - Roberto Piperno
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
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37
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Ceyte H, Beis JM, Ceyte G, Caudron S. Perceptual post-effects of left neck muscle vibration with visuo-haptic feedback in healthy individuals: A potential approach for treating spatial neglect. Neurosci Lett 2020; 743:135557. [PMID: 33352280 DOI: 10.1016/j.neulet.2020.135557] [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: 10/03/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Among the techniques used to reduce spatial neglect's symptoms, left neck muscle vibration (NMV) is alluring because it does not require the patient's attentional co-operation. The aim of this study was to determine the type of NMV-associated feedback that induced the most intense and longest-lasting egocentric post-effects. Eighty-seven healthy individuals were randomly assigned to four intervention groups: "neck muscle vibration, blindfolded" (NMV), "neck muscle vibration with vision" (NMV + V), "neck muscle vibration and visual finger-pointing" (NMV + P), and "visual finger-pointing" (P). An eyes-closed finger-pointing subjective straight-ahead (SSA) test was carried out before the intervention, immediately afterwards, and 30 min afterwards. The results showed that only the NMV + P intervention induced a lasting leftward bias of SSA. In addition, the deviation reported in this intervention group differed significantly from those observed in the other interventions. The combination of visuo-haptic feedback and neck-somatosensory stimulation may enable a full, lasting intermodal recalibration, which could be potentiated by the attention level engaged during voluntary pointing. These outcomes highlighted that the NMV technique could easily integrate into routine occupational therapy sessions for treating various aspects of neglect disorders.
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Affiliation(s)
- Hadrien Ceyte
- Université de Lorraine, DevAH, F-54000, Nancy, France.
| | - Jean-Marie Beis
- Université de Lorraine, DevAH, F-54000, Nancy, France; Institut Régional de Médecine Physique et de Réadaptation de Nancy, Centre de Médecine Physique et de Réadaptation, F-54690, Lay-Saint-Christophe, France
| | | | - Sébastien Caudron
- Université de Lorraine, DevAH, F-54000, Nancy, France; Univ. Grenoble Alpes, CNRS, LPNC, 38000 Grenoble, France
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38
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Zhang Y, Hua Y, Bai Y. Applications of Functional Magnetic Resonance Imaging in Determining the Pathophysiological Mechanisms and Rehabilitation of Spatial Neglect. Front Neurol 2020; 11:548568. [PMID: 33281698 PMCID: PMC7688780 DOI: 10.3389/fneur.2020.548568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a neuroimaging tool which has been applied extensively to explore the pathophysiological mechanisms of neurological disorders. Spatial neglect is considered to be the failure to attend or respond to stimuli on the side of the space or body opposite a cerebral lesion. In this review, we summarize and analyze fMRI studies focused specifically on spatial neglect. Evidence from fMRI studies have highlighted the role of dorsal and ventral attention networks in the pathophysiological mechanisms of spatial neglect, and also support the concept of interhemispheric rivalry as an explanatory model. fMRI studies have shown that several rehabilitation methods can induce activity changes in brain regions implicated in the control of spatial attention. Future investigations with large study cohorts and appropriate subgroup analyses should be conducted to confirm the possibility that fMRI might offer an objective standard for predicting spatial neglect and tracking the response of brain activity to clinical treatment, as well as provide biomarkers to guide rehabilitation for patients with SN.
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Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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39
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Trombini M, Vestito L, Morando M, Mori L, Trompetto C, Bandini F, Dellepiane S. Unilateral spatial neglect rehabilitation supported by a digital solution: two case-studies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3670-3675. [PMID: 33018797 DOI: 10.1109/embc44109.2020.9175834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Digital solutions for unilateral spatial neglect (USN) assessment and treatment are nowadays of great interest, because of both the possibility of combining them with other rehabilitation practices, and the easy-to-understand data and indicators they collect. The ReMoVES platform, developed in DITEN laboratories, is conceived in the Assistive Technologies framework and provides motor and cognitive exergames and activities to be performed in conjunction with traditional rehabilitation. In this work, two case-studies, related to the USN rehabilitation, are presented. The combination of cognitive therapy, delivered by the ReMoVES platform, and transcranial direct-current stimulation (tDCS) technique was used as rehabilitation treatment for both the patients. Data collected at the beginning or at the end of the rehabilitation process, or also during the treatment sessions, are shown and discussed in this paper. This work is a preliminary part of a wider one, that will be conducted involving many different rehabilitation centers, aimed at proving the validity of such an approach to USN treatments.
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40
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Cohen-Dallal H, Soroker N, Pertzov Y. Working Memory in Unilateral Spatial Neglect: Evidence for Impaired Binding of Object Identity and Object Location. J Cogn Neurosci 2020; 33:46-62. [PMID: 32985947 DOI: 10.1162/jocn_a_01631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Working memory (WM) is known to be impaired in patients with stroke experiencing unilateral spatial neglect (USN). Here, we examined in a systematic manner three WM components: memory of object identity, memory of object location, and binding between object identity and location. Moreover, we used two different retention intervals to isolate maintenance from other mnemonic and perceptual processes. Fourteen USN first-event stroke patients with right-hemisphere damage were tested in two different WM experiments using long and short retention intervals and an analog response scale. Patients exhibited more identification errors for items displayed on the contralesional side. Localization errors were also more prominent in the contralesional side, especially after a long retention interval. These localization errors were often a result of swap errors, that is, erroneous localizations of correctly identified contralesional objects in correctly memorized locations of ipsilesional objects. We conclude that a key WM deficit in USN is a lateralized impairment in binding between the identity of an object and its spatial tag.
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Affiliation(s)
| | - Nachum Soroker
- Loewenstein Hospital, Raanana, Israel.,Tel-Aviv University
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41
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Balan PF, Gerits A, Zhu Q, Kolster H, Orban GA, Wardak C, Vanduffel W. Fast Compensatory Functional Network Changes Caused by Reversible Inactivation of Monkey Parietal Cortex. Cereb Cortex 2020; 29:2588-2606. [PMID: 29901747 DOI: 10.1093/cercor/bhy128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 11/13/2022] Open
Abstract
The brain has a remarkable capacity to recover after lesions. However, little is known about compensatory neural adaptations at the systems level. We addressed this question by investigating behavioral and (correlated) functional changes throughout the cortex that are induced by focal, reversible inactivations. Specifically, monkeys performed a demanding covert spatial attention task while the lateral intraparietal area (LIP) was inactivated with muscimol and whole-brain fMRI activity was recorded. The inactivation caused LIP-specific decreases in task-related fMRI activity. In addition, these local effects triggered large-scale network changes. Unlike most studies in which animals were mainly passive relative to the stimuli, we observed heterogeneous effects with more profound muscimol-induced increases of task-related fMRI activity in areas connected to LIP, especially FEF. Furthermore, in areas such as FEF and V4, muscimol-induced changes in fMRI activity correlated with changes in behavioral performance. Notably, the activity changes in remote areas did not correlate with the decreased activity at the site of the inactivation, suggesting that such changes arise via neuronal mechanisms lying in the intact portion of the functional task network, with FEF a likely key player. The excitation-inhibition dynamics unmasking existing excitatory connections across the functional network might initiate these rapid adaptive changes.
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Affiliation(s)
- Puiu F Balan
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Annelies Gerits
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Qi Zhu
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Hauke Kolster
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Guy A Orban
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Department of Medicine and Surgery, University of Parma, via Volturno, 39E Parma, Italy
| | - Claire Wardak
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium
| | - Wim Vanduffel
- Laboratorium voor Neuro- en Psychofysiologie, KU Leuven Medical School, Campus Gasthuisberg, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Harvard Medical School, Charlestown, MA, USA
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42
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Morse H, Biggart L, Pomeroy V, Rossit S. Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke. Neuropsychol Rehabil 2020; 32:707-731. [PMID: 32942950 DOI: 10.1080/09602011.2020.1819827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable therapies and remotely monitor adherence without the presence of a therapist at all times. Researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and, ultimately, optimize adherence and efficacy. This study aims to explore end-user perspectives on the use of self-administered VR for spatial neglect in a university environment to identify barriers and facilitators prior to extending its use remotely as a telerehabilitation tool. We used a mixed-method design including focus groups, self-administered questionnaires and interviews with stroke survivors (N = 7), their carers (N = 3) and stroke clinicians (N = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators were performance feedback, engagement and enjoyment, and psychological benefits associated with self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform development, enhance engagement and uptake of VR telerehabilitation and inform future studies.
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Affiliation(s)
- Helen Morse
- School of Psychology, University of East Anglia, Norwich, UK.,Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK
| | - Laura Biggart
- School of Psychology, University of East Anglia, Norwich, UK
| | - Valerie Pomeroy
- Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK.,School of Health Sciences, University of East Anglia, Norwich, UK.,National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative, Cambridge, UK
| | - Stéphanie Rossit
- School of Psychology, University of East Anglia, Norwich, UK.,Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK
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43
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Fisher G, Quel de Oliveira C, Verhagen A, Gandevia S, Kennedy D. Proprioceptive impairment in unilateral neglect after stroke: A systematic review. SAGE Open Med 2020; 8:2050312120951073. [PMID: 32913649 PMCID: PMC7444113 DOI: 10.1177/2050312120951073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/24/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Unilateral neglect is a debilitating condition that can occur after stroke and can affect a variety of domains and modalities, including proprioception. Proprioception is a sensorimotor process essential to motor function and is thus important to consider in unilateral neglect. To date, there has not been a comprehensive review of studies examining the various aspects of proprioceptive impairment in unilateral neglect after stroke. This review aimed to determine if people with unilateral neglect have more severe proprioceptive impairments than those without unilateral neglect after stroke. Methods: The MEDLINE, Embase, Scopus, CINAHL and Web of Science databases were searched from inception to September 2019 using an a priori search strategy. Two independent reviewers screened abstracts and full texts, and extracted data from the included full texts. A third reviewer resolved disagreements at each step. Risk of bias was assessed using the AXIS Quality Assessment tool. Results: A total of 191 abstracts were identified, with 56 eligible for full-text screening. A total of 18 studies were included in the review and provided evidence that people with unilateral neglect have more severe proprioceptive impairment than people without unilateral neglect. This impairment is present in multiple subtypes of unilateral neglect and aspects of proprioception. Most studies had a moderate risk of bias. Conclusion: People with unilateral neglect after stroke are more likely to have impaired processing of multiple types of proprioceptive information than those without unilateral neglect. However, the available evidence is limited by the large heterogeneity of assessment tools used to identify unilateral neglect and proprioception. Unilateral neglect and proprioception were rarely assessed comprehensively. PROSPERO Registration: CRD42018086070.
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Affiliation(s)
- Georgia Fisher
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Simon Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, Sydney, NSW, Australia
| | - David Kennedy
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
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44
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Van Vleet T, Bonato P, Fabara E, Dabit S, Kim S, Chiu C, Bisogno AL, Merzenich M, Corbetta M, DeGutis J. Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect. Ann Neurol 2020; 88:747-758. [DOI: 10.1002/ana.25862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas Van Vleet
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Boston MA USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Eric Fabara
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Sawsan Dabit
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Sarah‐Jane Kim
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Christopher Chiu
- Department of Psychology University of Massachusetts Boston MA USA
| | - Antonio Luigi Bisogno
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
| | - Michael Merzenich
- Department of Research and Development Posit Science Inc San Francisco CA USA
- School of Medicine University of California San Francisco CA USA
| | - Maurizio Corbetta
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
- Department of Neurology, Radiology Neuroscience Washington University School of Medicine St. Louis MO USA
- Venetian Institute of Molecular Medicine, VIMM Padova Italy
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
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45
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Chen X, Delcourt C, Sun L, Zhou Z, Yoshimura S, You S, Malavera A, Torii-Yoshimura T, Carcel C, Arima H, Hackett ML, Robinson T, Song L, Wang X, Lindley RI, Chalmers J, Anderson CS. Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm. Cerebrovasc Dis 2020; 49:427-436. [PMID: 32702699 DOI: 10.1159/000509226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). METHODS ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly divided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years; 38.4% female; 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24-2.29) and deep (OR 1.50, 95% CI: 1.03-2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty - atrophy, white matter change, and old infarcts - were significantly associated with adverse physical but not emotional HRQoL domains. CONCLUSIONS In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.
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Affiliation(s)
- Xiaoying Chen
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Candice Delcourt
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lingli Sun
- The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Zien Zhou
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sohei Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Alejandra Malavera
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Takako Torii-Yoshimura
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Lili Song
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The George Institute China at Peking University Health Science Centre, Beijing, China
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia, .,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia, .,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, .,The George Institute China at Peking University Health Science Centre, Beijing, China, .,Heart Health Research Center, Beijing, China,
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46
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Zigiotto L, Damora A, Albini F, Casati C, Scrocco G, Mancuso M, Tesio L, Vallar G, Bolognini N. Multisensory stimulation for the rehabilitation of unilateral spatial neglect. Neuropsychol Rehabil 2020; 31:1410-1443. [PMID: 32558611 DOI: 10.1080/09602011.2020.1779754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Unilateral spatial neglect (USN) is a neuropsychological syndrome, typically caused by lesions of the right hemisphere, whose features are the defective report of events occurring in the left (contralesional) side of space and the inability to orient and set up actions leftwards. Multisensory integration mechanisms, largely spared in USN patients, may temporally modulate spatial orienting. In this pilot study, the effects of an intensive audio-visual Multisensory Stimulation (MS) on USN were assessed, and compared with those of a treatment that ameliorates USN, Prismatic Adaptation (PA). Twenty USN stroke patients received a 2-week treatment (20 sessions, twice per day) of MS or PA. The effects of MS and PA were assessed by a set of neuropsychological clinical tests (target cancellation, line bisection, sentence reading, personal neglect, complex drawing) and the Catherine Bergego Scale for functional disability. Results showed that MS brought about an amelioration of USN deficits overall comparable to that induced by PA; personal neglect was improved only by MS, not by PA. The clinical gains of the MS treatment were not influenced by duration of disease and lesion volume, and they persisted up to one month post-treatment. In conclusion, MS represents a novel and promising rehabilitation procedure for USN.
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Affiliation(s)
- Luca Zigiotto
- Department of Psychology & Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milan, Italy.,Division of Neurosurgery, Santa Chiara Hospital, Trento, Italy
| | - Alessio Damora
- Department of Psychology & Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milan, Italy.,Tuscany Rehabilitation Clinic, Arezzo, Italy
| | - Federica Albini
- Department of Psychology & Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milan, Italy.,Clinical Neuropsychology Unit, Rehabilitation Department, S. Antonio Abate Hospital, Gallarate, Italy
| | - Carlotta Casati
- Laboratory of Neuropsychology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gessica Scrocco
- Department of Psychology & Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milan, Italy.,Tuscany Rehabilitation Clinic, Arezzo, Italy
| | - Mauro Mancuso
- Tuscany Rehabilitation Clinic, Arezzo, Italy.,Physical and Rehabilitative Medicine Unit, NHS South-Est Tuscany, Grossetto, Italy
| | - Luigi Tesio
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology & Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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47
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Schintu S, Freedberg M, Gotts SJ, Cunningham CA, Alam ZM, Shomstein S, Wassermann EM. Prism Adaptation Modulates Connectivity of the Intraparietal Sulcus with Multiple Brain Networks. Cereb Cortex 2020; 30:4747-4758. [PMID: 32313949 DOI: 10.1093/cercor/bhaa032] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 12/19/2022] Open
Abstract
Prism adaptation (PA) alters spatial cognition according to the direction of visual displacement by temporarily modifying sensorimotor mapping. Right-shifting prisms (right PA) improve neglect of left visual field in patients, possibly by decreasing activity in the left hemisphere and increasing it in the right. Left PA shifts attention rightward in healthy individuals by an opposite mechanism. However, functional imaging studies of PA are inconsistent, perhaps because of differing activation tasks. We measured resting-state functional connectivity (RSFC) in healthy individuals before and after PA. When contrasted, right versus left PA decreased RSFC in the spatial navigation network defined by the right posterior parietal cortex (PPC), hippocampus, and cerebellum. Within-PA-direction comparisons showed that right PA increased RSFC in subregions of the PPCs and between the PPCs and the right middle frontal gyrus and left PA decreased RSFC between these regions. Both right and left PA decreased RSFC between the PPCs and bilateral temporal areas. In summary, right PA increases connectivity in the right frontoparietal network and left PA produces essentially opposite effects. Furthermore, right, compared with left, PA modulates RSFC in the right hemisphere navigation network.
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Affiliation(s)
- Selene Schintu
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke Bethesda, MD 20892, USA.,Department of Psychology George Washington University Washington, DC 20052, USA
| | - Michael Freedberg
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke Bethesda, MD 20892, USA
| | - Stephen J Gotts
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD 20892, USA
| | - Catherine A Cunningham
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke Bethesda, MD 20892, USA
| | - Zaynah M Alam
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke Bethesda, MD 20892, USA
| | - Sarah Shomstein
- Department of Psychology George Washington University Washington, DC 20052, USA
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke Bethesda, MD 20892, USA
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48
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Hou Y, Liu Y, Li M, Ning B, Wen Z, Fu W. Acupuncture plus Rehabilitation for Unilateral Neglect after Stroke: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:5301568. [PMID: 32256649 PMCID: PMC7085868 DOI: 10.1155/2020/5301568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To systematically assess the efficacy of acupuncture combined with rehabilitation on unilateral neglect after stroke. METHODS The Cochrane Library, PubMed, Excerpt Medical Database (EMBASE), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (CBM), and Wan Fang databases were searched online for randomised controlled trials (RCTs) of acupuncture and its effects on unilateral neglect after stroke from their inception to September 2019. RCTs on acupuncture combined with rehabilitation in the experimental group for unilateral neglect compared with rehabilitation alone or rehabilitation plus sham acupuncture in the control group were included. Two authors separately screened the literature, extracted the data, and evaluated the quality of the included studies. Review Manager 5.3 software was used for the data analysis. RESULTS A total of 542 patients from nine RCTs were included. The meta-analysis showed that the experimental groups could significantly improve Fugl-Meyer Assessment (FMA) (MD = 11.54, 95% CI [9.54, 13.54], P < 0.00001) and the ability of daily living (SMD = 1.35, 95% CI [0.64, 2.07], P < 0.00001) and the ability of daily living (SMD = 1.35, 95% CI [0.64, 2.07], P < 0.00001) when compared with the control groups. However, there was no significant difference in the drop of Catherine Bergego Scale (CBS) and Behavioural Inattention Test-conventional (BIT-C) between the two groups. CONCLUSIONS Acupuncture combined with rehabilitation was more effective in improving the motor function and the ability of daily living. Because of the limitations regarding the quantity and quality of the studies in this meta-analysis, high-quality and well-designed RCTs are necessary to validate the above conclusions.
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Affiliation(s)
- Yonghui Hou
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei, China
| | - Ying Liu
- The First Hospital of Shijiazhuang City, Shijiazhuang, Hebei, China
| | - Minying Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Baile Ning
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zehuai Wen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- National Center for Design Measurement and Evaluation in Clinical Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenbin Fu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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49
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Fortis P, Ronchi R, Velardo V, Calzolari E, Banco E, Algeri L, Spada MS, Vallar G. A home-based prism adaptation training for neglect patients. Cortex 2020; 122:61-80. [DOI: 10.1016/j.cortex.2018.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/25/2018] [Accepted: 09/02/2018] [Indexed: 11/15/2022]
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50
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Evald L, Wilms IL, Nordfang M. Treatment of spatial neglect in clinical practice: A nationwide survey. Acta Neurol Scand 2020; 141:81-89. [PMID: 31602640 DOI: 10.1111/ane.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Clinical research has documented a range of evidence-based treatment approaches for spatial neglect (SN), but there is a lack of research on the implementation of treatment into clinical practice. The purpose of this study is to describe the current clinical practice of SN treatment across healthcare sectors including involved professions, methods, timing and sources of evidence. MATERIAL AND METHODS This is the second part of a nationwide, anonymous, open Internet survey that was conducted among healthcare professionals in Denmark on assessment and treatment of SN. RESULTS A total of 525 healthcare professionals participated in the survey of which 411 (78.3%) reported that SN treatment was provided at their workplace. Occupational and physiotherapist were most often involved in the treatment, most commonly characterized by training of activities of daily living (ADL), sensoric stimulation and cueing. Less frequently reported were evidence-based methods such as prism adaptation and visual scanning. The overall intensity of the SN treatment varied considerably across sectors and might consequently be inadequate. A minority of the participants consulted clinical research evidence in their choice of SN treatment approaches. CONCLUSIONS There is a profound lack of dissemination and translation of clinical research into current clinical practice, which unarguably leads to an underuse of evidence-based treatment approaches in SN rehabilitation. The results call for international multidisciplinary clinical guidelines for the treatment of SN at different stages of rehabilitation and the tailoring of treatment approaches to the individual patient.
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Affiliation(s)
- Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic Hammel Denmark
| | - Inge Linda Wilms
- Department of Psychology University of Copenhagen Copenhagen Denmark
| | - Maria Nordfang
- Department of Neurology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
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