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Wheeler C, Smith LJ, Sakel M, Wilkinson D. A systematic review of vestibular stimulation in post-stroke visual neglect. Neuropsychol Rehabil 2024:1-33. [PMID: 38605647 DOI: 10.1080/09602011.2024.2338603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
Unilateral visual neglect is a condition that negatively impacts the lives of many stroke survivors. Studies have investigated different forms of vestibular stimulation as a potential therapy, but evidence is yet to be systematically reviewed. We therefore reviewed the effects of vestibular stimulation on outcomes of neglect and activities of daily living (ADL) for people with visual neglect. We searched relevant databases up until September 2022. Eligible articles included any form of vestibular stimulation, study design, or control condition. Included participants were 18 years or older, presenting with neglect following a haemorrhagic or ischaemic stroke. Relevant outcomes were clinically validated measures of neglect and ADL. Cochrane risk of bias tools were used to assess study quality. Meta-analyses and narrative methods were used to synthesize the data. Our search returned 17 relevant studies comprising 180 participants. Meta-analyses showed no difference between galvanic vestibular stimulation and sham conditions on outcomes, whereas caloric vestibular stimulation led to improvement compared to pre-stimulation scores. Narrative syntheses showed mixed results. Clinical and methodological heterogeneity was found both within and between studies. Overall, results were inconsistent regarding the effects of vestibular stimulation as a treatment for neglect. Further trials are warranted but require more careful methodological planning.
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Affiliation(s)
- Charlotte Wheeler
- School of Psychology, Keynes College, University of Kent, Kent, UK
- Norfolk and Suffolk NHS Foundation Trust, Norfolk, UK
| | - Laura J Smith
- School of Psychology, Keynes College, University of Kent, Kent, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Mohamed Sakel
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - David Wilkinson
- School of Psychology, Keynes College, University of Kent, Kent, UK
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Umeonwuka CI, Roos R, Ntsiea V. Clinical and demographic predictors of unilateral spatial neglect recovery after prism therapy among stroke survivors in the sub-acute phase of recovery. Neuropsychol Rehabil 2023; 33:1624-1649. [PMID: 36242544 DOI: 10.1080/09602011.2022.2131582] [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: 03/22/2022] [Accepted: 09/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS: Unilateral Spatial Neglect (USN) affects the rehabilitation process and leads to poor outcomes after stroke. Factors that influence USN recovery following prism adaptation therapy have not been investigated. This study investigated predictors of USN recovery after prism therapy at the sub-acute phase of recovery. METHODS: This study was a randomized controlled trial. USN was assessed with the Behavioural Inattention Test and Catherine Bergego scale. Seventy-four patients with USN were divided into control and intervention group (prism). The prism group used 20 dioptre prism lenses for repeated aiming for 12 sessions while the control group used neutral lenses for aiming training. Regression analysis was conducted to establish clinical and sociodemographic factors that influence USN recovery. RESULTS: Gender, age, years of education, race, employment status, handedness, type of stroke, time since stroke and site of stroke (p > 0.005) showed no significant influence on USN recovery following PA treatment. Higher Cognitive function (OR = 1.52, CI = 1.08-2.14, p = 0.016) and group allocationng (being in the prism group) (OR = 63.10, CI = 9.70-410.59, P < 0.001) were found to significantly influence USN recovery following PA treatment session. CONCLUSIONS: A significant modulating effect on general cognitive ability was found in this study. This suggests that prism adaptation therapy's effect on neural activity and spatial neglect depends on the cognitive function of stroke survivors.Trial registration: Pan African Clinical Trial Registry identifier: PACTR201903732473573.
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Affiliation(s)
- Chuka Ifeanyi Umeonwuka
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
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da Silva T, Luvizutto G, Martins L, da Costa R, de Souza J, Winckler F, Sartor L, Modolo G, Ferreira N, Rodrigues J, Kanda R, Fogaroli M, Borges G, Rizzatti G, Ribeiro P, Pires D, Favoretto D, Aguiar L, Bazan S, Betting L, Antunes L, Nunes H, Pereira V, Edwards T, Pontes-Neto O, Conforto A, Bazan R. Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil. Braz J Med Biol Res 2023; 56:e12326. [PMID: 36722659 PMCID: PMC9883007 DOI: 10.1590/1414-431x2023e12326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/26/2022] [Indexed: 01/31/2023] Open
Abstract
There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.
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Affiliation(s)
- T.R. da Silva
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil,Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.J. Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - L.G. Martins
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - R.D.M. da Costa
- Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - J.T. de Souza
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - F.C. Winckler
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - L.C.A. Sartor
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.P. Modolo
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - N.C. Ferreira
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - J.C.S. Rodrigues
- Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - R.G. Kanda
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - M.O. Fogaroli
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.F. Borges
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.R.S. Rizzatti
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - P.W. Ribeiro
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - D.S. Pires
- Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - D.B. Favoretto
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L.R. Aguiar
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S.G.Z. Bazan
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - L.E.G. Betting
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - L.C.O. Antunes
- Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - H.R.C. Nunes
- Departamento de Saúde Pública, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - V.M. Pereira
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - T.G.S. Edwards
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - O. Pontes-Neto
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A.B. Conforto
- Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R. Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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Choi HS, Lee BM. A Complex Intervention Integrating Prism Adaptation and Neck Vibration for Unilateral Neglect in Patients of Chronic Stroke: A Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13479. [PMID: 36294062 PMCID: PMC9603544 DOI: 10.3390/ijerph192013479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Unilateral neglect in patients of chronic stroke reduces the quality of life and interferes with activities of daily living (ADL). This study aimed to investigate the effects of a complex rehabilitative programme that integrates prism adaptation (PA) and neck vibration (NV) for unilateral neglect in patients of chronic stroke. Thirty-six patients were randomised among the PA + NV group (Group A, n = 12), the NV-only group (Group B, n = 12), and the PA-only group (Group C, n = 12). The intervention was performed for 50 min/day, with five sessions per week, for 4 weeks. Albert's test and the Catherine Bergego Scale were used to measure the effects of each intervention on unilateral neglect, whereas the modified Barthel Index was used to assess the effect on ADL. All three groups exhibited a reduction in unilateral neglect and an improvement in activities of daily living after the intervention (p < 0.05). Notably, Group A (PA + NV) exhibited a significantly greater level of reduction in unilateral neglect than the other groups (p < 0.05); however, the improvement in ADL did not significantly vary across the three groups (p > 0.05). This novel complex intervention comprising PA + NV is recommended for the rehabilitation, in the clinical setting, of patients of chronic stroke with unilateral neglect.
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Affiliation(s)
- Hyun-Se Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Bo-Min Lee
- Department of Rehabilitation Science, Inje University Graduate School, Gimhae 50834, Korea
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Cha S, Jeong B, Choi M, Kwon S, Lee SH, Paik NJ, Kim WS, Han CE. White matter tracts involved in subcortical unilateral spatial neglect in subacute stroke. Front Neurol 2022; 13:992107. [PMID: 36247754 PMCID: PMC9561922 DOI: 10.3389/fneur.2022.992107] [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: 07/12/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUnilateral spatial neglect (USN) is common and associated with poor motor and cognitive outcomes as well as impaired quality of life following stroke. Traditionally, the neural substrates underlying USN have been thought to be cortical areas, such as the posterior parietal cortex. However, patients with stroke involving only subcortical structures may also present with USN. While only a few studies have reported on USN in subcortical stroke, the involvement of white matter tracts related to brain networks of visuospatial attention is one possible explanation for subcortical neglect. Therefore, this study aimed to investigate which specific white matter tracts are neural substrates for USN in patients with subcortical stroke.MethodsTwenty-two patients with subcortical stroke without cortical involvement who were admitted to the Department of Rehabilitation Medicine at Seoul National University Bundang Hospital were retrospectively enrolled. Nine subjects were subclassified into a “USN(+)” group, as they had at least two positive results on three tests (the Schenkenberg line bisection test, Albert's test, and house drawing test) and a score of 1 or higher on the Catherine Bergego scale. The remaining 13 subjects without abnormalities on those tests were subclassified into the “USN(–)” group. Stroke lesions on MRI were manually drawn using MRIcron software. Lesion overlapping and atlas-based analyses of MRI images were conducted. The correlation was analyzed between the overlapped lesion volumes with white matter tracts and the severity of USN (in the Albert test and the Catherine Bergego scale).ResultsLesions were more widespread in the USN(+) group than in the USN(–) group, although their locations in the right hemisphere were similar. The atlas-based analyses identified that the right cingulum in the cingulate cortex, the temporal projection of the superior longitudinal fasciculus, and the forceps minor significantly overlapped with the lesions in the USN(+) group than in the USN(–) group. The score of the Catherine Bergego scale correlated with the volume of the involved white matter tracts.ConclusionIn this study, white matter tracts associated with USN were identified in patients with subcortical stroke without any cortical involvement. Our study results, along with previous findings on subcortical USN, support that USN may result from damage to white matter pathways.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - ByeongChang Jeong
- Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, South Korea
| | - Myungwon Choi
- Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
| | - Sohyun Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Stephanie Hyeyoung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Won-Seok Kim
| | - Cheol E. Han
- Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, South Korea
- *Correspondence: Cheol E. Han
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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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Lin S, Guo J, Chen X, Lin N, Li Z, Liu F. Effect of acupuncture on unilateral spatial neglect after stroke: A systematic review and meta-analysis of randomized controlled trials. Geriatr Nurs 2022; 46:13-20. [DOI: 10.1016/j.gerinurse.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
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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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Imura T, Mitsutake T, Hori T, Tanaka R. Predicting the prognosis of unilateral spatial neglect using magnetic resonance imaging in patients with stroke: A systematic review. Brain Res 2022; 1789:147954. [DOI: 10.1016/j.brainres.2022.147954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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Umeonwuka CI, Roos R, Ntsiea V. Current knowledge and practice of post-stroke unilateral spatial neglect rehabilitation: A cross-sectional survey of South African neurorehabilitation physiotherapists. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1624. [PMID: 35402745 PMCID: PMC8991368 DOI: 10.4102/sajp.v78i1.1624] [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: 09/06/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Unilateral spatial neglect (USN) affects the rehabilitation process leading to poor functional outcomes after stroke. South African physiotherapists’ level of uptake of available evidence in USN rehabilitation and the barriers they encounter are not known. Objectives To evaluate knowledge, current practice enablers and barriers to USN management in stroke survivors amongst physiotherapists in South Africa. Methods Our cross-sectional survey used a total sampling technique. Questionnaires were sent to neurorehabilitation physiotherapists in South Africa. Descriptive and inferential statistics analysed the data. Results The overall knowledge score of USN was 14.11 ± 5.23 of a total of 25. The knowledge was good for definitions of USN; moderate for incidences, causes, screening, diagnosis and prognosis of USN and poor for pharmacological approaches to the management of USN. A significant low positive correlation between respondents’ age (r = 0.46; p = 0.016) and years of practice as a physiotherapist (r = 0.43; p = 0.026) and knowledge of USN was found. The most frequently utilised intervention was constraint-induced movement therapy; the commonly utilised assessment tool was the comb and razor test. ‘Inadequate therapy time’ (55.56%) and ‘lack of relevant equipment for rehabilitation of USN’ (38.89%) were identified as major barriers to USN rehabilitation. Major enablers to USN rehabilitation were the ‘presence of multidisciplinary stroke team in clinical practice’ (83.35%) and ‘availability of adequate staff’ (76.47%). Conclusion Physiotherapists demonstrated a fair knowledge of USN although knowledge about pharmacological management of USN was modest. Current practice in post-stroke USN by South African neuro-physiotherapists follows current evidence and practice guidelines. Clinical implication Our study shows the level of knowledge and current practice of post-stroke USN rehabilitation. The demonstrated fair knowledge of USN may be improved through training, curriculum modifications or continuing professional development. Identified barriers to the rehabilitation of post-stroke USN can assist health policy, managers and clinicians to improve stroke-specific care.
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Affiliation(s)
- Chuka I Umeonwuka
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Swayne OB, Gorgoraptis N, Leff A, Ajina S. Exploring the use of dopaminergic medication to treat hemispatial inattention during in-patient post-stroke neurorehabilitation. J Neuropsychol 2022; 16:518-536. [PMID: 35384324 DOI: 10.1111/jnp.12276] [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: 10/28/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/20/2022]
Abstract
Hemispatial inattention (HSI), a lateralised impairment of spatial processing, is a common consequence of stroke. It is a poor prognostic indicator for functional recovery and interferes with the progress during in-patient neurorehabilitation. Dopaminergic medication has shown promise in improving HSI in the chronic post-stroke period but is untested in more acute settings, e.g. during in-patient neurorehabilitation. We audited the use of dopaminergic medication in ten sequential patients with post-stroke HSI, on an open-label exploratory basis. Patients' response to medication was assessed individually, using a three-week Off-On-Off protocol. We employed a mixture of bedside and functional measures, and made a multidisciplinary judgement of efficacy in individual patients. In six out of 10 patients, there was a convincing improvement of HSI while on medication, which reversed when it was paused. There was a mean 57% relative increase in target detection in the star cancellation test on the most affected side (on vs. off medication). In the six responders, medication was therefore continued throughout their admission without adverse effects. The star cancellation test was sensitive to HSI in most patients but in two cases failed to detect changes that were picked up by a functional assessment (Kessler Functional Neglect Assessment Protocol). We found this multidisciplinary approach to be feasible in an in-patient neurorehabilitation setting. We suggest further research to explore the efficacy of dopaminergic medication in improving neurorehabilitation outcomes for patients with post-stroke HSI. We suggest that more detailed N-of-1 assessments of treatment response, with internal blinding, may be a productive approach.
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Affiliation(s)
- Orlando B Swayne
- National Hospital for Neurology & Neurosurgery, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, UK
| | - Nikos Gorgoraptis
- Department of Neurology, Barts Health NHS Trust, London, UK.,Regional Neurorehabilitation Unit, Homerton University Hospital NHS Foundation Trust, London, UK.,Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Alex Leff
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, UK
| | - Sara Ajina
- National Hospital for Neurology & Neurosurgery, London, UK.,Wellcome Centre for Integrative Neuroimaging, FMRIB, Oxford, UK
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12
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Liu Z, King M. The influencing factors and coping styles of mental health stress responses of stroke caregivers. Work 2021; 69:499-513. [PMID: 34120931 DOI: 10.3233/wor-213495] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For family caregivers, sudden stroke events and heavy caring works are stressful events. At present, controversies about the factors affecting caregivers' stress response and their correlation with coping styles still exist. OBJECTIVE To explore the influencing factors and coping styles of mental health stress responses of stroke caregivers and promote caregivers to adopt positive coping styles for diseases and caring works. METHODS The convenience sampling method is used to select stroke caregivers as the research objects. The general information questionnaires, Relative Stress Scale (RSS), General Self-Efficacy Scale (GSES), Social Support Rate Scale (SSRS), Positive and Negative Affect Schedule (PANAS), and Simplified Coping Style Questionnaire (SCSQ) are utilized for investigation. RESULTS 205 valid questionnaires are returned. Analysis suggests that the influential factors of mental health stress responses of stroke caregivers include the course of the disease, the impact of the disease on economic conditions, obligation to take care of other family members, understanding of stroke-associated diseases, and whether the patient is at risk. Social support and self-efficacy are negatively correlated with stress responses, while negative coping style is significantly positively correlated with stress responses. CONCLUSIONS By increasing social support and self-efficacy, medical workers can guide stroke caregivers to take positive coping styles, thereby reducing their mental health stress responses.
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Affiliation(s)
- Zhe Liu
- College of Culture and Education, Henan Economy and Trade Vocational College, Zhengzhou, China
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Deb-Chatterji M, Konnopka A, Flottmann F, Leischner H, Fiehler J, Gerloff C, Thomalla G. Patient-reported, health-related, quality of life after stroke thrombectomy in clinical practice. Neurology 2020; 95:e1724-e1732. [PMID: 32680947 DOI: 10.1212/wnl.0000000000010356] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine patient-reported health-related quality of life (HRQOL) after stroke thrombectomy in clinical practice and to identify predictors of better HRQOL by analyzing data of 504 consecutive patients treated in a large university stroke center. METHODS All patients with stroke treated by thrombectomy (June 2015-October 2018) were prospectively enrolled in this observational study. At 90 days, functional outcome was assessed by the modified Rankin Scale (mRS) and patient-reported HRQOL was assessed by the EuroQol Group 5-Dimension (EQ-5D) self-report questionnaire, consisting of 5 health domains. The EQ-5D utility index (EQ-5D-I) score (-0.594 to 1.00, with higher values indicating better HRQOL) was calculated. Linear regression analysis was applied to identify predictors of better HRQOL (higher EQ-5D-I score). RESULTS Of 504 patients (median age 76 years, 51.8% female), the mean EQ-5D-I score was 0.39 (SD 0.44). The proportion of stroke survivors who reported complaints in the different domains decreased from 66% in Usual Activities to 57% in Mobility, 50.4% in Self-Care, 41.7% in Pain/Discomfort, and 40.8% Anxiety/Depression. Lower age, lower prestroke mRS score, lower baseline NIH Stroke Scale score, higher Alberta Stroke Program Early CT Score, concomitant thrombolysis therapy, and a successful recanalization were independent predictors of better HRQOL. CONCLUSIONS Patient-reported HRQOL provides a more comprehensive assessment of stroke outcome than the mRS score. Health domains involving motor function most frequently showed complaints in HRQOL after stroke thrombectomy, while a large proportion of patients did not report any complaints across the different health domains. Predictors of better HRQOL closely match the predictors of better functional outcome measured by the mRS in other thrombectomy studies.
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Affiliation(s)
- Milani Deb-Chatterji
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Alexander Konnopka
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- From the Departments of Neurology (M.D.-C., C.G., G.T.), Health Economics (A.K.), and Interventional Neuroradiology and Diagnostics (F.F., H.L., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Aprile I, Germanotta M, Cruciani A, Pecchioli C, Loreti S, Papadopoulou D, Montesano A, Galeri S, Diverio M, Falsini C, Speranza G, Langone E, Carrozza MC, Cecchi F. Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial. Int J Stroke 2020; 16:396-405. [PMID: 32640881 DOI: 10.1177/1747493020937192] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Poststroke shoulder pain is a common complication. We aimed to investigate the prevalence of poststroke shoulder pain, with attention to the neuropathic component, and the relationship between poststroke shoulder pain and upper limb improvement in motor function, strength, disability, and quality of life after upper limb rehabilitation. METHODS This is a secondary analysis of a multicenter randomized controlled trial to compare upper limb conventional or robotic rehabilitation on 224 patients enrolled in eight rehabilitation centers. We assessed poststroke shoulder pain (using the Numerical Rating Scale and the Douleur Neuropathique 4), and upper limb motor function, strength, disability, and quality of life at baseline (T0), after 30 rehabilitation sessions (T1), and three months after the end of rehabilitation (T2). RESULTS A moderate/severe poststroke shoulder pain was reported by 28.9% of patients, while 19.6% of them showed a neuropathic component. At T0, the intensity of pain was higher in women and in patients with neglect syndrome, positively correlated with the time since stroke and disability and negatively correlated with motor function, strength, and the physical aspects of the quality of life.Moderate/severe pain and neuropathic component significantly reduced after both treatments and this reduction was maintained at T2. Finally, the intensity of pain at baseline was negatively correlated with the improvement of upper limb motor function. CONCLUSIONS Poststroke shoulder pain negatively impact on motor performance, strength, disability, and physical aspects of the quality of life as well as on upper limb motor recovery; however, it can be reduced after a robotic or a conventional rehabilitation. Therefore, we suggest considering poststroke shoulder pain when planning the rehabilitation intervention.
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Affiliation(s)
- I Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - A Cruciani
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C Pecchioli
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S Loreti
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - A Montesano
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - S Galeri
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Diverio
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Speranza
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - E Langone
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M C Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - F Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Lucente G, Valls-Sole J, Murillo N, Rothwell J, Coll J, Davalos A, Kumru H. Noninvasive Brain Stimulation and Noninvasive Peripheral Stimulation for Neglect Syndrome Following Acquired Brain Injury. Neuromodulation 2019; 23:312-323. [PMID: 31725939 DOI: 10.1111/ner.13062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/10/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hemispatial neglect is a frequent condition usually following nondominant hemispheric brain injury. It strongly affects rehabilitation strategies and everyday life activities. It is associated with behavioral and cognitive disability with a strong impact on patient's life. METHODS We reviewed the published literature on the use of noninvasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), and of noninvasive peripheral muscle stimulation, as therapeutic strategies for rehabilitation of neglect after acquired brain injury, such as in stroke or in traumatic injuries. The studies were grouped as controlled or uncontrolled studies in each stimulation techniques. RESULTS Thirty-four studies were identified and 16 on rTMS, 10 on tDCS, and 8 on vibration. All studies were conducted in adult patients who suffered a stroke, except for one that was conducted in a patient suffering traumatic acquired brain injury and another that was conducted in a patient with brain tumor. In spite of significant variability in treatment protocols, patients' features and assessment of neglect, improvement was reported in almost all studies with no side-effects. CONCLUSIONS Noninvasive brain stimulation and neuromuscular vibration are promising therapeutic neuromodulatory approaches for neglect. Further randomized-controlled studies are needed to corroborate their effectiveness as separate and combined techniques.
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Affiliation(s)
- Giuseppe Lucente
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep Valls-Sole
- EMG Department, Hospital Clinic, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Narda Murillo
- Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916, Badalona, Spain
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, University College London, London, UK
| | - Jaume Coll
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Antoni Davalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Hatice Kumru
- Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916, Badalona, Spain
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Abstract
OBJECTIVES Healthy young adults often demonstrate a leftward spatial bias called "pseudoneglect" which often diminishes with aging. One hypothesis for this phenomenon is an age-related deterioration in right hemisphere functions (right hemi-aging). If true, then a greater rightward bias should be evident on all spatial attention tasks regardless of content. Another hypothesis is a decrease in asymmetrical hemispheric activation with age (HAROLD). If true, older participants may show reduced bias in all spatial tasks, regardless of leftward or rightward biasing of specific spatial content. METHODS Seventy right-handed healthy participants, 33 younger (21-40) and 37 older (60-78), were asked to bisect solid and character-letter lines as well as to perform left and right trisections of solid lines. RESULTS Both groups deviated toward the left on solid line bisections and left trisections. Both groups deviated toward the right on right trisections and character line bisections. In all tasks, the older participants were more accurate than the younger participants. CONCLUSIONS The finding that older participants were more accurate than younger participants across all bisection and trisection conditions suggests a decrease in the asymmetrical hemispheric activation of these specialized networks important in the allocation of contralateral spatial attention or spatial action intention.
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