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Jia F, Zhao Y, Wang Z, Chen J, Lu S, Zhang M. Effect of Graded Motor Imagery Combined With Repetitive Transcranial Magnetic Stimulation on Upper Extremity Motor Function in Stroke Patients: A Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:819-825. [PMID: 38110138 DOI: 10.1016/j.apmr.2023.12.002] [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: 02/27/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To investigate the efficacy of graded motor imagery therapy (GMI) and repetitive transcranial magnetic stimulation (rTMS) on upper extremity function alone and in combination in patients with stroke. DESIGN This was a prospective randomized controlled trial. SETTING A rehabilitation hospital. PARTICIPANTS Participants (N=56) were randomized into GMI (n=19), rTMS (n=18), or combined groups (n=19). INTERVENTIONS There were 2 interventions: (1) 20 minutes of 1 Hz rTMS. (2) 30 minutes of GMI. In addition to this, all participants receive conventional rehabilitation including 120 minutes of physical therapy and occupational therapy daily. All treatments were administered once a day, 5 days a week, for 4 weeks. The Fugl-Meyer assessment of upper extremity (FMA-UE), Action Research Arm Test (ARAT), modified Barthel Index (MBI), motor activity log (MAL), and motor evoked potential (MEP) were assessed in a blinded manner at baseline and 4 weeks after treatment, respectively. MAIN OUTCOME MEASURES The primary endpoint was the improvement from baseline in FMA-UE for stroke patients at 4 weeks. RESULTS After 4 weeks of treatment, the FMA-UE scores in the GMI, rTMS, and combined groups were higher than those at baseline assessment, with statistically significant differences among the 3 groups (P=.009). The efficacy of the combined group was significantly better than that of the GMI and rTMS groups (P=.015, P=.043, respectively). In the motor activity log-amount of use (MAL-AOU) score, the efficacy of the combined group was better than that of the rTMS group (P=.035). CONCLUSIONS Both GMI and rTMS were effective in improving upper extremity function in patients with stroke, but the combination of the 2 techniques was more effective. However, GMI was better than rTMS in improving the interest of stroke patients in active training.
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Affiliation(s)
- Fan Jia
- Xuzhou Rehabilitation Hospital affiliated with Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ying Zhao
- Xuzhou Rehabilitation Hospital affiliated with Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhao Wang
- Xuzhou Rehabilitation Hospital affiliated with Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Chen
- Xuzhou Rehabilitation Hospital affiliated with Xuzhou Medical University, Xuzhou, Jiangsu, China; Department of Rehabilitation Medicine of Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Sihan Lu
- Xuzhou Rehabilitation Hospital affiliated with Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ming Zhang
- Xuzhou Rehabilitation Hospital affiliated with Xuzhou Medical University, Xuzhou, Jiangsu, China; Department of Rehabilitation Medicine of Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
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Gammeri R, Schintu S, Salatino A, Vigna F, Mazza A, Gindri P, Barba S, Ricci R. Effects of prism adaptation and visual scanning training on perceptual and response bias in unilateral spatial neglect. Neuropsychol Rehabil 2024; 34:155-180. [PMID: 36652376 DOI: 10.1080/09602011.2022.2158876] [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: 05/16/2022] [Accepted: 12/11/2022] [Indexed: 01/19/2023]
Abstract
In some patients with unilateral spatial neglect, symptoms reflect impaired lateralized spatial attention and representation (perceptual bias) whereas in others the inability to respond to stimuli located in contralesional space (response bias). Here, we investigated whether prismatic adaptation (PA) and visual scanning training (VST) differentially affect perceptual and response bias and whether rehabilitation outcome depends on the type of bias underlying symptoms. Two groups of neglect patients in the subacute phase were evaluated before, immediately after, and two weeks following 10 days of PA (n = 9) or VST (n = 9). Standard neuropsychological tests (i.e., Behavioural Inattentional Test, Diller cancellation test, and Line Bisection test) were administered to assess neglect symptoms, while the Landmark task was used to disentangle perceptual and response biases. Performance on the Landmark task revealed that PA was more effective in improving the perceptual bias, while VST mainly modulated the response bias. Neuropsychological tests performance suggested that VST is better suited to modulate neglect in patients with response bias, while PA may be effective in patients with both types of bias. These findings may offer novel insights into the efficacy of PA and VST in the rehabilitation of perceptual and response biases in patients with neglect.
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Affiliation(s)
- Roberto Gammeri
- Department of Psychology, University of Turin, Torino, Italy
| | - Selene Schintu
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Adriana Salatino
- Department of Psychology, University of Turin, Torino, Italy
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Bruxelles, Belgium
| | - Francesca Vigna
- Department of Psychology, University of Turin, Torino, Italy
| | | | - Patrizia Gindri
- Service of Neuropsychological Rehabilitation, Presidio Sanitario San Camillo, Torino, Italy
| | - Sonia Barba
- Department of Psychology, University of Turin, Torino, Italy
| | - Raffaella Ricci
- Department of Psychology, University of Turin, Torino, Italy
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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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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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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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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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Vilimovsky T, Chen P, Hoidekrova K, Slavicek O, Harsa P. Prism Adaptation Treatment Predicts Improved Rehabilitation Responses in Stroke Patients with Spatial Neglect. Healthcare (Basel) 2022; 10:healthcare10102009. [PMID: 36292456 PMCID: PMC9601909 DOI: 10.3390/healthcare10102009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 01/07/2023] Open
Abstract
Spatial neglect (SN) impedes functional recovery after stroke, leading to reduced rehabilitation gains and slowed recovery. The objective of the present study was to investigate whether integrating prism adaptation treatment (PAT) into a highly intensive rehabilitation program eliminates the negative impact of spatial neglect on functional and motor recovery. We examined clinical data of the 355 consecutive first-time stroke patients admitted to a sub-acute inpatient neurorehabilitation program that integrated PAT. The 7-item Motor Functional Independence Measure, Berg Balance Scale, and Motor Activity Log were used as main outcome measures. We found that 84 patients (23.7%) had SN, as defined by a positive score on the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process (KF-NAP®). Although 71 patients (85%) received PAT, the presence of SN at baseline, regardless of PAT completion, was associated with lower functional independence, higher risk of falls, and a lower functional level of the affected upper limb both at admission and at discharge. The severity of SN was associated with inferior rehabilitation outcomes. Nonetheless, patients with SN who received PAT had similar rehabilitation gains compared to patients without SN. Thus, the present study suggests that integrating PAT in an intensive rehabilitation program will result in improved responses to regular therapies in patients with SN.
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Affiliation(s)
- Tomas Vilimovsky
- Department of Psychiatry, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
- Correspondence:
| | - Peii Chen
- Kessler Foundation, West Orange, NJ 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ 07101, USA
| | - Kristyna Hoidekrova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
- Rehabilitation Center Kladruby, 257 62 Kladruby, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Ondrej Slavicek
- Department of Informatics and Mathematics in Transport, Faculty of Transport Engineering, University of Pardubice, 532 10 Pardubice, Czech Republic
| | - Pavel Harsa
- Department of Psychiatry, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
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Feasibility study of immersive virtual prism adaptation therapy with depth-sensing camera using functional near-infrared spectroscopy in healthy adults. Sci Rep 2022; 12:767. [PMID: 35031675 PMCID: PMC8760318 DOI: 10.1038/s41598-022-04771-5] [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: 04/17/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
Prism Adaptation (PA) is used to alleviate spatial neglect. We combined immersive virtual reality with a depth-sensing camera to develop virtual prism adaptation therapy (VPAT), which block external visual cues and easily quantify and monitor errors than conventional PA. We conducted a feasibility study to investigate whether VPAT can induce behavioral adaptations by measuring after-effect and identifying which cortical areas were most significantly activated during VPAT using functional near-infrared spectroscopy (fNIRS). Fourteen healthy subjects participated in this study. The experiment consisted of four sequential phases (pre-VPAT, VPAT-10°, VPAT-20°, and post-VPAT). To compare the most significantly activated cortical areas during pointing in different phases against pointing during the pre-VPAT phase, we analyzed changes in oxyhemoglobin concentration using fNIRS during pointing. The pointing errors of the virtual hand deviated to the right-side during early pointing blocks in the VPAT-10° and VPAT-20° phases. There was a left-side deviation of the real hand to the target in the post-VPAT phase, demonstrating after-effect. The most significantly activated channels during pointing tasks were located in the right hemisphere, and possible corresponding cortical areas included the dorsolateral prefrontal cortex and frontal eye field. In conclusion, VPAT may induce behavioral adaptation with modulation of the dorsal attentional network.
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Vilimovsky T, Chen P, Hoidekrova K, Petioky J, Harsa P. Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial. PLoS One 2021; 16:e0245425. [PMID: 33481828 PMCID: PMC7822563 DOI: 10.1371/journal.pone.0245425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/01/2021] [Indexed: 11/21/2022] Open
Abstract
Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.
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Affiliation(s)
- Tomas Vilimovsky
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peii Chen
- Kessler Foundation, West Orange, NJ, United States of America
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States of America
| | - Kristyna Hoidekrova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Rehabilitation Center Kladruby, Kladruby, Czech Republic
- Department of Kinanthropology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jakub Petioky
- Rehabilitation Center Kladruby, Kladruby, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Harsa
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
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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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Evald L, Wilms I, Nordfang M. Assessment of spatial neglect in clinical practice: A nationwide survey. Neuropsychol Rehabil 2020; 31:1374-1389. [PMID: 32573333 DOI: 10.1080/09602011.2020.1778490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study was part of a nationwide, anonymous, open Internet survey conducted amongst healthcare professionals in Denmark on the assessment and treatment of spatial neglect (SN). The objective was to describe knowledge and practices in the assessment of SN in current clinical practice across different healthcare sectors and professions. Data included the perceived prevalence, assessment methods and observations, subtypes and differential diagnostics of SN. A total of 525 professionals participated in the survey. The vast majority (81.5%) reported that assessment of SN was provided by their workplace. The median of perceived prevalence of SN was 35% (IQR 22-51) but major differences were found between professions. Occupational therapists and psychologists appeared to be most involved in assessment, whilst nursing staff and speech therapists were least involved. Subjective observations were the most common assessment method (90%). Conversely, systematic ADL observations, paper-and-pencil tests, confrontational tests and computerized tests were less common. The survey revealed large differences in the assessment methods and awareness of various aspects of SN symptoms (subtypes and differential diagnostics) between different healthcare professions. The results emphasize the need for international multidisciplinary clinical guidelines on how to assess SN and distinguish between different subtypes and differential diagnoses.
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Affiliation(s)
- Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Inge Wilms
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Maria Nordfang
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Hreha K, Rich T, Wong J. A One-Year Follow-Up Study on Community Dwelling Multiple Stroke Survivors with Spatial Neglect. Occup Ther Health Care 2020; 34:48-61. [PMID: 32153228 DOI: 10.1080/07380577.2020.1737894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assessed nine participants, who sustained multiple strokes and had spatial neglect, one year after participation in a prior trial on whether Prism Adaptation Treatment (PAT) was a feasible and effective treatment for spatial neglect remediation compared to standard care. The objectives were to: (1) describe the sample, (2) measure the degree of spatial neglect symptoms if present, and (3) determine group differences in motor and spatial performance. Three (60%) participants from the PAT group and two (50%) from the comparison group still displayed spatial neglect. A series of two-way mixed ANOVAs exploring group (PAT vs. comparison of standard care) and time effects (pretest vs. posttest vs. follow-up) found a main effect of time for all participants on the Kessler Foundation Neglect Assessment (F(1,2) = 30.28, p<.001), Functional Independence Measure (F(1,2) = 16.998, p<.001), and star cancelation (F(1,2) = 11.077, p<.001). An interaction effect of time*prism was observed when assessing the line bisection test (F(1,2) = 6.986, p = .008), suggesting that the PAT group performed significantly better on this test. Additional research should be completed with a larger sample in order to better understand the PAT long term effects as well as develop clinical recommendations for occupational therapy practitioners.
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Affiliation(s)
- Kimberly Hreha
- Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
| | - Timothy Rich
- Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
| | - Jennifer Wong
- Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
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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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Choi HS, Kim DJ, Yang YA. The Effect of a Complex Intervention Program for Unilateral Neglect in Patients with Acute-Phase Stroke: A Randomized Controlled Trial. Osong Public Health Res Perspect 2019; 10:265-273. [PMID: 31673487 PMCID: PMC6816354 DOI: 10.24171/j.phrp.2019.10.5.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to examine the combined effects of Prism Adaptation (PA) plus functional electrical stimulation (FES) on stroke patients with unilateral neglect, and suggest a new intervention method for acute-phase stroke patients. Methods There were 30 patients included in this study from April to October 2016 that had unilateral neglect whilst hospitalized following a stroke (diagnosed by a professional). The participants, who were patients receiving occupational therapy, understood the purpose of the study and agreed to participate. The patients were randomly divided into 3 groups: PA plus FES group (Group A), PA group (Group B), and FES group (Group C). Treatments lasted for 50 minutes per day, 5 times per week, for 3 weeks in total. Reevaluation was conducted after 3 weeks of intervention. Results All 3 groups showed unilateral neglect reduction after the intervention, but PA plus FES (complex intervention method) was more effective than PA or FES alone [effect size: Motor-free Visual Perception Test (0.80), Albert test (0.98), CBS (0.92)]. Conclusion The results of this study support further studies to examine complex intervention for the treatment of unilateral neglect.
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Affiliation(s)
- Hyun-Se Choi
- Department of Occupational Therapy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Deok-Ju Kim
- Department of Occupational Therapy, College of Health & Medical Sciences, Cheongju University, Cheongju, Korea
| | - Yeong-Ae Yang
- Department of Occupational Therapy, College of Biomedical Sciences and Engineering, Inje University, Gimhae, Korea
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Pan W, Wang P, Song X, Sun X, Xie Q. The Effects of Combined Low Frequency Repetitive Transcranial Magnetic Stimulation and Motor Imagery on Upper Extremity Motor Recovery Following Stroke. Front Neurol 2019; 10:96. [PMID: 30873100 PMCID: PMC6401593 DOI: 10.3389/fneur.2019.00096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the effects of low frequency transcranial magnetic stimulation (LF-rTMS) combined with motor imagery (MI) on upper limb motor function during stroke rehabilitation. Background: Hemiplegic upper extremity activity obstacle is a common movement disorder after stroke. Compared with a single intervention, sequential protocol or combination of several techniques has been proven to be better for alleviating motor function disorder. Non-invasive neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and motor imagery (MI) have been verified to augment the efficacy of rehabilitation. Methods:Participants were randomly assigned to 2 intervention cohorts: (1) experimental group (rTMS+MI group) was applied at 1 Hz rTMS over the primary motor cortex of the contralesional hemisphere combined with audio-based MI; (2) control group (rTMS group) received the same therapeutic parameters of rTMS combined with audiotape-led relaxation. LF-rTMS protocol was conducted in 10 sessions over 2 weeks for 30 min. Functional measurements include Wolf Motor Function Test (WMFT), the Fugl-Meyer Assessment Upper Extremity (UE-FMA) subscore, the Box and Block Test (BBT), and the Modified Barthel index (MBI) were conducted at baseline, the second week (week 2) and the fourth week (week 4). Results: All assessments of upper limb function improved in both groups at weeks 2 and 4. In particular, significant differences were observed between two groups at end-intervention and after intervention (p < 0.05). In these findings, we saw greater changes of WMFT (p < 0.01), UE-FMA (p < 0.01), BBT (p < 0.01), and MBI (p < 0.001) scores in the experimental group. Conclusions: LF-rTMS combined with MI had a positive effect on motor function of upper limb and can be used for the rehabilitation of upper extremity motor recovery in stroke patients.
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Affiliation(s)
- Wenxiu Pan
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pu Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Song
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaopei Sun
- Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
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Ten Brink AF, Visser-Meily JMA, Schut MJ, Kouwenhoven M, Eijsackers ALH, Nijboer TCW. Prism Adaptation in Rehabilitation? No Additional Effects of Prism Adaptation on Neglect Recovery in the Subacute Phase Poststroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:1017-1028. [DOI: 10.1177/1545968317744277] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Patients with neglect ignore or respond slower to contralesional stimuli. Neglect negatively influences independence in activities of daily living (ADL). Prism adaptation (PA) is one of the most frequently studied treatments, yet there is little evidence regarding positive effects on neglect behavior in ADL. Objective. To assess whether PA in the subacute phase ameliorates neglect in situations of varying complexity. Methods. A total of 70 neglect patients admitted for inpatient stroke rehabilitation received either PA or sham adaptation (SA) for 2 weeks, with full access to standard treatment. There were 7 time-dependent measurements (baseline and 1-4, 6, and 14 weeks after start of treatment). The primary outcome was change of neglect as observed during basic ADL with the Catherine Bergego Scale (CBS). Secondary outcomes were changes in performance on a dynamic multitask (ie, the Mobility Assessment Course [MAC]) and a static paper-and-pencil task (ie, a shape cancellation task [SC]). Results. In all, 34 patients received PA and 35 SA. There were significant time-dependent improvements in performance as measured with the CBS, MAC, and SC (all F > 15.57; P < .001). There was no significant difference in magnitude of improvement between groups on the CBS, MAC, and SC (all F < 2.54; P > .113]. Conclusions. No beneficial effects of PA over SA in the subacute phase poststroke were observed, which was comparable for situations of varying complexity. Heterogeneity of the syndrome, time post–stroke onset, and the content of treatment as usual are discussed. Basic knowledge on subtypes and recovery patterns would aid the development of tailored treatment.
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Affiliation(s)
- Antonia F. Ten Brink
- University Medical Center Utrecht, Netherlands
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | | | | | | | | | - Tanja C. W. Nijboer
- University Medical Center Utrecht, Netherlands
- Utrecht University, Netherlands
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18
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A SYSTEMATIC APPROACH FOR ASSESSING, IN THE ABSENCE OF FULL EVIDENCE, WHETHER MULTICOMPONENT INTERVENTIONS CAN BE MORE COST-EFFECTIVE THAN SINGLE COMPONENT INTERVENTIONS. Int J Technol Assess Health Care 2017; 33:444-453. [PMID: 28889817 DOI: 10.1017/s0266462317000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Multicomponent interventions (MCIs), consisting of at least two interventions, are common in rehabilitation and other healthcare fields. When the effectiveness of the MCI versus that of its single interventions is comparable or unknown, evidence of their expected incremental cost-effectiveness can be helpful in deciding which intervention to recommend. As such evidence often is unavailable this study proposes an approach to estimate what is more cost-effective; the MCI or the single intervention(s). METHODS We reviewed the literature for potential methods. Of those identified, headroom analysis was selected as the most suitable basis for developing the approach, based on the criteria of being able to estimate the cost-effectiveness of the single interventions versus that of the MCI (a) within a limited time frame, (b) in the absence of full data, and (c) taking into account carry-over and interaction effects. We illustrated the approach with an MCI for cancer survivors. RESULTS The approach starts with analyzing the costs of the MCI. Given a specific willingness-to-pay-value, it is analyzed how much effectiveness the MCI would need to generate to be considered cost-effective, and if this is likely to be attained. Finally, the cost-effectiveness of the single interventions relative to the potential of the MCI for being cost-effective can be compared. CONCLUSIONS A systematic approach using headroom analysis was developed for estimating whether an MCI is likely to be more cost effective than one (or more) of its single interventions.
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Chen P, Pitteri M, Gillen G, Ayyala H. Ask the experts how to treat individuals with spatial neglect: a survey study. Disabil Rehabil 2017; 40:2677-2691. [DOI: 10.1080/09638288.2017.1347720] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peii Chen
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, USA
| | - Marco Pitteri
- Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Glen Gillen
- Department of Regenerative and Rehabilitation Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY, USA
| | - Harsha Ayyala
- New Jersey Medical School, Rutgers University, Newark, NJ, USA
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20
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Yang NYH, Fong KNK, Li-Tsang CWP, Zhou D. Effects of repetitive transcranial magnetic stimulation combined with sensory cueing on unilateral neglect in subacute patients with right hemispheric stroke: a randomized controlled study. Clin Rehabil 2016; 31:1154-1163. [PMID: 27920261 DOI: 10.1177/0269215516679712] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To compare the effects of rTMS combined with sensory cueing, rTMS alone, and conventional rehabilitation on unilateral neglect, hemiplegic arm functions and performance of activities of daily living. Design: A single-blinded randomized controlled trial. Setting: A convalescent hospital. Subjects: Sixty inpatients with left unilateral neglect after stroke. Interventions: Patients were randomly assigned to three groups: rTMS combined with sensory cueing, rTMS, and conventional rehabilitation alone. rTMS at 1 Hz was applied over P5 of the contralesional hemisphere while vibration cueing was emitted using a wristwatch device on the hemiplegic arm, five days per week for two weeks. The first two groups received the same dosage of conventional rehabilitation on top of their experimental interventions. Blinded assessments were administered at baseline, 2 weeks postintervention, and 6 weeks follow-up. Main measures: Neglect and arm motor performance. Results: Both rTMS combined with sensory cueing (99.6±33.0) and rTMS alone (88.2±28.7) significantly reduced unilateral neglect than conventional rehabilitation (72.7±33.1) when measured using the conventional subtests of the Behavioural Inattention Test, but the combination was better than rTMS alone. Hemiplegic arm functions and activities of daily living improved in all patients across the three groups but no significant differences were found between the groups. Conclusion: The combination of inhibitory P5-rTMS with sensory cueing was better than either rTMS or conventional rehabilitation alone in producing a stronger and long-lasting improvement in unilateral neglect, but the improvement was not associated with improved arm function or independence in activities of daily living.
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Affiliation(s)
- Nicole YH Yang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, China
- Institute for Disaster Management and Reconstruction, Sichuan University, China
| | - Kenneth NK Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Cecilia WP Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - D Zhou
- Department of Neurology, West China Hospital, Sichuan University, China
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Kristjánsson Á, Moldoveanu A, Jóhannesson ÓI, Balan O, Spagnol S, Valgeirsdóttir VV, Unnthorsson R. Designing sensory-substitution devices: Principles, pitfalls and potential1. Restor Neurol Neurosci 2016; 34:769-87. [PMID: 27567755 PMCID: PMC5044782 DOI: 10.3233/rnn-160647] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An exciting possibility for compensating for loss of sensory function is to augment deficient senses by conveying missing information through an intact sense. Here we present an overview of techniques that have been developed for sensory substitution (SS) for the blind, through both touch and audition, with special emphasis on the importance of training for the use of such devices, while highlighting potential pitfalls in their design. One example of a pitfall is how conveying extra information about the environment risks sensory overload. Related to this, the limits of attentional capacity make it important to focus on key information and avoid redundancies. Also, differences in processing characteristics and bandwidth between sensory systems severely constrain the information that can be conveyed. Furthermore, perception is a continuous process and does not involve a snapshot of the environment. Design of sensory substitution devices therefore requires assessment of the nature of spatiotemporal continuity for the different senses. Basic psychophysical and neuroscientific research into representations of the environment and the most effective ways of conveying information should lead to better design of sensory substitution systems. Sensory substitution devices should emphasize usability, and should not interfere with other inter- or intramodal perceptual function. Devices should be task-focused since in many cases it may be impractical to convey too many aspects of the environment. Evidence for multisensory integration in the representation of the environment suggests that researchers should not limit themselves to a single modality in their design. Finally, we recommend active training on devices, especially since it allows for externalization, where proximal sensory stimulation is attributed to a distinct exterior object.
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Affiliation(s)
- Árni Kristjánsson
- Laboratory of Visual Perception and Visuomotor control, University of Iceland, Faculty of Psychology, School of Health Sciences, Reykjavik, Iceland
| | - Alin Moldoveanu
- University Politehnica of Bucharest, Faculty of Automatic Control and Computers, Computer Science and Engineering Department, Bucharest, Romania
| | - Ómar I. Jóhannesson
- Laboratory of Visual Perception and Visuomotor control, University of Iceland, Faculty of Psychology, School of Health Sciences, Reykjavik, Iceland
| | - Oana Balan
- University Politehnica of Bucharest, Faculty of Automatic Control and Computers, Computer Science and Engineering Department, Bucharest, Romania
| | - Simone Spagnol
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, Reykjavik, Iceland
| | - Vigdís Vala Valgeirsdóttir
- Laboratory of Visual Perception and Visuomotor control, University of Iceland, Faculty of Psychology, School of Health Sciences, Reykjavik, Iceland
| | - Rúnar Unnthorsson
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, Reykjavik, Iceland
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Implicit learning: A way to improve visual search in spatial neglect? Conscious Cogn 2016; 43:102-12. [PMID: 27262690 DOI: 10.1016/j.concog.2016.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 11/22/2022]
Abstract
Studies have shown that neglect patients are able to use stimulus regularities to orient faster toward the neglected side, without necessarily being aware of that information, or at the very least without being able to verbalize their knowledge. In order to better control for the involvement of explicit processes, the present study sought to test neglect patients' ability to detect more complex associations between stimuli using tasks similar to those used in implicit learning studies. Our results demonstrate that neglect patients had difficulties implicitly learning complex associations, contrary to what we found with controls. The possible influence of attentional and working memory impairments are discussed.
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Spaccavento S, Cellamare F, Cafforio E, Loverre A, Craca A. Efficacy of visual-scanning training and prism adaptation for neglect rehabilitation. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:313-21. [DOI: 10.1080/23279095.2015.1038386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Simona Spaccavento
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Fara Cellamare
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Elisabetta Cafforio
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Anna Loverre
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
| | - Angela Craca
- Neurorehabilitation Unit, IRCCS Salvatore Maugeri Foundation, Cassano Murge (Bari), Italy
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24
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Klinke ME, Hafsteinsdóttir TB, Hjaltason H, Jónsdóttir H. Ward-based interventions for patients with hemispatial neglect in stroke rehabilitation: A systematic literature review. Int J Nurs Stud 2015; 52:1375-403. [DOI: 10.1016/j.ijnurstu.2015.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/28/2015] [Accepted: 04/03/2015] [Indexed: 11/26/2022]
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25
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Hopfner S, Cazzoli D, Müri RM, Nef T, Mosimann UP, Bohlhalter S, Vanbellingen T, Nyffeler T. Enhancing treatment effects by combining continuous theta burst stimulation with smooth pursuit training. Neuropsychologia 2015; 74:145-51. [DOI: 10.1016/j.neuropsychologia.2014.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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26
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Aparicio-López C, García-Molina A, García-Fernández J, Lopez-Blazquez R, Enseñat-Cantallops A, Sánchez-Carrión R, Muriel V, Tormos JM, Roig-Rovira T. Cognitive rehabilitation with right hemifield eye-patching for patients with sub-acute stroke and visuo-spatial neglect: a randomized controlled trial. Brain Inj 2015; 29:501-7. [PMID: 25565480 DOI: 10.3109/02699052.2014.995230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess whether, following a right-hemisphere stroke, the combined administration of computer-based cognitive rehabilitation and right hemifield eye-patching in patients with visuo-spatial neglect is more effective than computer-based cognitive rehabilitation alone. METHODS Twelve patients were randomized into two treatment groups: a single treatment group (n = 7) and a combination treatment group (n = 5). In both cases, the treatment consisted of a mean number of 15 sessions, each lasting 1 hour. Visuo-spatial neglect was assessed using a specific exploration protocol (Bell Cancellation Test, Figure Copying of Odgen, Line Bisection, Baking Tray Task and Reading Task). The functional effects of the treatment were assessed using the Catherine Bergego Scale. RESULTS Significant between-group differences were observed when comparing the pre- and post-treatment scores for the Reading Task. No differences were observed in either group in the Catherine Bergego Scale administered at baseline and at the final intervention. CONCLUSION The results obtained do not allow one to conclude that the combination treatment with cognitive rehabilitation and right hemifield eye-patching is more effective than cognitive rehabilitation alone. Although partial improvement in the performance of neuropsychological tests was observed, this improvement is not present at functional level.
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Affiliation(s)
- Celeste Aparicio-López
- Institut Guttmann, Institut Universitari de Neurorehabilitació , adscrit UAB, Badalona, Barcelona , Spain
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Saevarsson S, Eger S, Gutierrez-Herrera M. Neglected premotor neglect. Front Hum Neurosci 2014; 8:778. [PMID: 25360095 PMCID: PMC4197652 DOI: 10.3389/fnhum.2014.00778] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/13/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Styrmir Saevarsson
- Clinical Neuropsychology Research Group (EKN), Department of Neuropsychology, Bogenhausen Academical Hospital Munich, Germany
| | - Simone Eger
- Clinical Neuropsychology Research Group (EKN), Department of Neuropsychology, Bogenhausen Academical Hospital Munich, Germany ; Department of Psychology, University of Innsbruck Innsbruck, Austria
| | - Maria Gutierrez-Herrera
- Clinical Neuropsychology Research Group (EKN), Department of Neuropsychology, Bogenhausen Academical Hospital Munich, Germany ; Department Biology II Neurobiology, Graduate School of Systemic Neurosciences, University of Munich (LMU) Munich, Germany
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Wansard M, Meulemans T, Gillet S, Segovia F, Bastin C, Toba MN, Bartolomeo P. Visual neglect: is there a relationship between impaired spatial working memory and re-cancellation? Exp Brain Res 2014; 232:3333-43. [PMID: 24989636 DOI: 10.1007/s00221-014-4028-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
In visual search tasks, neglect patients tend to explore and repeatedly re-cancel stimuli on the ipsilesional side, as if they did not realize that they had previously examined the rightward locations favoured by their lateral bias. The aim of this study was to explore the hypothesis that a spatial working memory deficit explains these ipsilesional re-cancellation errors in neglect patients. For the first time, we evaluated spatial working memory and re-cancellation through separate and independent tasks in a group of patients with right hemisphere damage and a diagnosis of left neglect. Results showed impaired spatial working memory in neglect patients. Compared to the control group, neglect patients cancelled fewer targets and made more re-cancellations both on the left side and on the right side. The spatial working memory deficit appears to be related to re-cancellations, but only for some neglect patients. Alternative interpretations of re-exploration of space are discussed.
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Affiliation(s)
- Murielle Wansard
- Neuropsychology Unit, Department of Psychology, Behavior and Cognition, University of Liège, Boulevard du Rectorat, B33, 4000, Liège, Belgium,
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The case for causal influences of action videogame play upon vision and attention. Atten Percept Psychophys 2014; 75:667-72. [PMID: 23386038 DOI: 10.3758/s13414-013-0427-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past decade, exciting findings have surfaced suggesting that routine action videogame play improves attentional and perceptual skills. Apparently, performance during multiple-object tracking, useful-field-of-view tests, and task switching improves, contrast sensitivity and spatial-resolution thresholds decrease, and the attentional blink and backward masking are lessened by short-term training on action videogames. These are remarkable findings showing promise for the training of attention and the treatment of disorders of attentional function. While the findings are interesting, evidence of causal influences of videogame play is not as strong as is often claimed. In many studies, observers with game play experience and those without are tested. Such studies do not address causality, since preexisting differences are not controlled for. Other studies investigate the training of videogame play, with some evidence of training benefits. Methodological shortcomings and potential confounds limit their impact, however, and they have not always been replicated. No longitudinal studies on videogame training exist, but these may be required to provide conclusive answers about any benefits of videogame training and any interaction with preexisting differences. Suggestions for methodological improvement are made here, including recommendations for longitudinal studies. Such studies may become crucial for the field of attentional training to reach its full potential.
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Fasotti L, van Kessel M. Novel insights in the rehabilitation of neglect. Front Hum Neurosci 2013; 7:780. [PMID: 24298249 PMCID: PMC3828556 DOI: 10.3389/fnhum.2013.00780] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/29/2013] [Indexed: 11/13/2022] Open
Abstract
Visuospatial neglect due to right hemisphere damage, usually a stroke, is a major cause of disability, impairing the ability to perform a whole range of everyday life activities. Conventional and long-established methods for the rehabilitation of neglect like visual scanning training, optokinetic stimulation, or limb activation training have produced positive results, with varying degrees of generalization to (un)trained tasks, lasting from several minutes up to various months after training. Nevertheless, some promising novel approaches to the remediation of left visuospatial neglect have emerged in the last decade. These new therapy methods can be broadly classified into four categories. First, non-invasive brain stimulation techniques by means of transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS), after a period of mainly diagnostic utilization, are increasingly applied as neurorehabilitative tools. Second, two classes of drugs, dopaminergic and noradrenergic, have been investigated for their potential effectiveness in rehabilitating neglect. Third, prism adaptation treatment has been shown to improve several neglect symptoms consistently, sometimes during longer periods of time. Finally, virtual reality technologies hold new opportunities for the development of effective training techniques for neglect. They provide realistic, rich, and highly controllable training environments. In this paper the degree of effectiveness and the evidence gathered to support the therapeutic claims of these new approaches is reviewed and discussed. The conclusion is that for all these approaches there still is insufficient unbiased evidence to support their effectiveness. Further neglect rehabilitation research should focus on the maintenance of therapy results over time, on a more functional evaluation of treatment effects, on the design and execution of true replication studies and on the exploration of optimal combinations of treatments.
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Affiliation(s)
- Luciano Fasotti
- Rehabilitation Medical Centre Groot Klimmendaal, SIZA Support and Rehabilitation , Arnhem , Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen , Nijmegen , Netherlands
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Daini R, Albonico A, Malaspina M, Martelli M, Primativo S, Arduino LS. Dissociation in Optokinetic Stimulation Sensitivity between Omission and Substitution Reading Errors in Neglect Dyslexia. Front Hum Neurosci 2013; 7:581. [PMID: 24062678 PMCID: PMC3775017 DOI: 10.3389/fnhum.2013.00581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/29/2013] [Indexed: 11/16/2022] Open
Abstract
Although omission and substitution errors in neglect dyslexia (ND) patients have always been considered as different manifestations of the same acquired reading disorder, recently, we proposed a new dual mechanism model. While omissions are related to the exploratory disorder which characterizes unilateral spatial neglect (USN), substitutions are due to a perceptual integration mechanism. A consequence of this hypothesis is that specific training for omission-type ND patients would aim at restoring the oculo-motor scanning and should not improve reading in substitution-type ND. With this aim we administered an optokinetic stimulation (OKS) to two brain-damaged patients with both USN and ND, MA and EP, who showed ND mainly characterized by omissions and substitutions, respectively. MA also showed an impairment in oculo-motor behavior with a non-reading task, while EP did not. The two patients presented a dissociation with respect to their sensitivity to OKS, so that, as expected, MA was positively affected, while EP was not. Our results confirm a dissociation between the two mechanisms underlying omission and substitution reading errors in ND patients. Moreover, they suggest that such a dissociation could possibly be extended to the effectiveness of rehabilitative procedures, and that patients who mainly omit contralesional-sided letters would benefit from OKS.
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Affiliation(s)
- Roberta Daini
- Psychology Department, University of Milano-Bicocca, Milano, Italy
| | - Andrea Albonico
- Psychology Department, University of Milano-Bicocca, Milano, Italy
| | | | - Marialuisa Martelli
- Psychology Department, University of Rome La Sapienza, Rome, Italy
- Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Silvia Primativo
- Psychology Department, University of Rome La Sapienza, Rome, Italy
- Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Lisa S. Arduino
- Department of Human Sciences, University LUMSA & Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy
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Guinet M, Michel C. Prism adaptation and neck muscle vibration in healthy individuals: are two methods better than one? Neuroscience 2013; 254:443-51. [PMID: 24035829 DOI: 10.1016/j.neuroscience.2013.08.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 11/18/2022]
Abstract
Studies involving therapeutic combinations reveal an important benefit in the rehabilitation of neglect patients when compared to single therapies. In light of these observations our present work examines, in healthy individuals, sensorimotor and cognitive after-effects of prism adaptation and neck muscle vibration applied individually or simultaneously. We explored sensorimotor after-effects on visuo-manual open-loop pointing, visual and proprioceptive straight-ahead estimations. We assessed cognitive after-effects on the line bisection task. Fifty-four healthy participants were divided into six groups designated according to the exposure procedure used with each: 'Prism' (P) group; 'Vibration with a sensation of body rotation' (Vb) group; 'Vibration with a move illusion of the LED' (Vl) group; 'Association with a sensation of body rotation' (Ab) group; 'Association with a move illusion of the LED' (Al) group; and 'Control' (C) group. The main findings showed that prism adaptation applied alone or combined with vibration showed significant adaptation in visuo-manual open-loop pointing, visual straight-ahead and proprioceptive straight-ahead. Vibration alone produced significant after-effects on proprioceptive straight-ahead estimation in the Vl group. Furthermore all groups (except C group) showed a rightward neglect-like bias in line bisection following the training procedure. This is the first demonstration of cognitive after-effects following neck muscle vibration in healthy individuals. The simultaneous application of both methods did not produce significant greater after-effects than prism adaptation alone in both sensorimotor and cognitive tasks. These results are discussed in terms of transfer of sensorimotor plasticity to spatial cognition in healthy individuals.
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Affiliation(s)
- M Guinet
- Université de Bourgogne, Campus Universitaire, UFR STAPS, BP 27877, Dijon F-21078, France; INSERM, U 1093, Cognition, Action et Plasticité sensorimotrice, Dijon F-21078, France
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Pitteri M, Arcara G, Passarini L, Meneghello F, Priftis K. Is two better than one? Limb activation treatment combined with contralesional arm vibration to ameliorate signs of left neglect. Front Hum Neurosci 2013; 7:460. [PMID: 23966926 PMCID: PMC3735991 DOI: 10.3389/fnhum.2013.00460] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 07/24/2013] [Indexed: 11/13/2022] Open
Abstract
In the present study, we evaluated the effects of the Limb Activation Treatment (LAT) alone and in combination with the Contralateral Arm Vibration (CAV) on left neglect (LN) rehabilitation. We conceived them as techniques that both prompt the activation of the lesioned right hemisphere because of the activation (with the LAT as an active technique) and the stimulation (with the CAV as a passive technique) of the left hemibody. To test the effect of the simultaneous use of these two techniques (i.e., LAT and CAV) on visuo-spatial aspects of LN, we described the case of an LN patient (GR), who showed high intra-individual variability (IIV) in performance. Given the high IIV of GR, we used an ABAB repeated-measures design to better define the effectiveness of the combined application of LAT and CAV, as a function of time. The results showed an improvement of GR's performance on the Bells test following the combined application of LAT and CAV, with respect to the application of LAT alone. We did not find, however, significant effects of treatment on two other LN tests (i.e., Line bisection and Picture scanning). We propose that the combined application of LAT and CAV can be beneficial for some aspects of LN.
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Affiliation(s)
- Marco Pitteri
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
| | - Giorgio Arcara
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
| | - Laura Passarini
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
| | | | - Konstantinos Priftis
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
- Department of General Psychology, University of Padova, Padova, Italy
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van Kessel ME, Geurts ACH, Brouwer WH, Fasotti L. Visual Scanning Training for Neglect after Stroke with and without a Computerized Lane Tracking Dual Task. Front Hum Neurosci 2013; 7:358. [PMID: 23847519 PMCID: PMC3707289 DOI: 10.3389/fnhum.2013.00358] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/21/2013] [Indexed: 11/13/2022] Open
Abstract
Neglect patients typically fail to explore the contralesional half-space. During visual scanning training, these patients learn to consciously pay attention to contralesional target stimuli. It has been suggested that combining scanning training with methods addressing non-spatial attention might enhance training results. In the present study, a dual task training component was added to a visual scanning training (i.e., Training di Scanning Visuospaziale - TSVS; Pizzamiglio et al., 1990). Twenty-nine subacute right hemisphere stroke patients were semi-randomly assigned to an experimental (N = 14) or a control group (N = 15). Patients received 30 training sessions during 6 weeks. TSVS consisted of four standardized tasks (digit detection, reading/copying, copying drawings, and figure description). Moreover, a driving simulator task was integrated in the training procedure. Control patients practiced a single lane tracking task for 2 days a week during 6 weeks. The experimental group was administered the same training schedule, but in weeks 4-6 of the training, the TSVS digit detection task was combined with lane tracking on the same projection screen, so as to create a dual task (computerized visual reaction time task designed for training). Various neglect tests and driving simulator tasks were administered before and after training. No significant group and interaction effects were found that might reflect additional positive effects of dual task training. Significant improvements after training were observed in both groups taken together on most assessment tasks. Ameliorations were generally not correlated to post-onset time, but spontaneous recovery, test-retest variability, and learning effects could not be ruled out completely, since these were not controlled for. Future research might focus on increasing the amount of dual task training, the implementation of progressive difficulty levels in driving simulator tasks, and further exploration of relationships between dual task training and daily functioning.
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Affiliation(s)
- M. E. van Kessel
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
- Medisch Spectrum Twente Hospital Group, Enschede, Netherlands
| | - A. C. H. Geurts
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - W. H. Brouwer
- Department of Neurology, University Medical Center Groningen, Groningen, Netherlands
- Department of Psychology, University of Groningen, Groningen, Netherlands
| | - L. Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
- Medical Rehabilitation Centre Groot Klimmendaal/SIZA Support and Rehabilitation, Arnhem, Netherlands
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Priftis K, Passarini L, Pilosio C, Meneghello F, Pitteri M. Visual Scanning Training, Limb Activation Treatment, and Prism Adaptation for Rehabilitating Left Neglect: Who is the Winner? Front Hum Neurosci 2013; 7:360. [PMID: 23847520 PMCID: PMC3703546 DOI: 10.3389/fnhum.2013.00360] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/22/2013] [Indexed: 12/02/2022] Open
Abstract
WE COMPARED, FOR THE FIRST TIME, THE OVERALL AND DIFFERENTIAL EFFECTS OF THREE OF THE MOST WIDELY USED LEFT NEGLECT (LN) TREATMENTS: visual scanning training (VST), limb activation treatment (LAT), and prism adaptation (PA). Thirty-three LN patients were assigned in quasi-random order to the three groups (VST, LAT, or PA). Each patient received only one type of treatment. LN patients' performance on everyday life tasks was assessed four times (over a period of 6 weeks): A1 and A2 (i.e., the two pre-treatment assessments); A3 and A4 (i.e., the two post-treatment assessments). LN patients in each of the three treatment conditions were treated for the same number of sessions (i.e., 20). The results showed that improvements were present in the majority of the tests assessing the peripersonal space in everyday life activities. Our findings were independent of unspecific factors and lasted for at least 2 weeks following the end of the treatments. There were no interactions, however, between LN treatments and assessments. We suggest that all three treatments can be considered as valid rehabilitation interventions for LN and could be employed for ameliorating LN signs.
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Affiliation(s)
- Konstantinos Priftis
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
- Department of General Psychology, University of Padova, Padova, Italy
| | - Laura Passarini
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
| | - Cristina Pilosio
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
| | | | - Marco Pitteri
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital, Lido-Venice, Italy
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Saevarsson S. Motor Response Deficits of Unilateral Neglect: Assessment, Therapy, and Neuroanatomy. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 20:292-305. [DOI: 10.1080/09084282.2012.710682] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Styrmir Saevarsson
- a Clinical Neuropsychology Research Group (EKN), Bogenhausen University Hospital , Munich , Germany
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Wu CY, Wang TN, Chen YT, Lin KC, Chen YA, Li HT, Tsai PL. Effects of Constraint-Induced Therapy Combined With Eye Patching on Functional Outcomes and Movement Kinematics in Poststroke Neglect. Am J Occup Ther 2013; 67:236-45. [DOI: 10.5014/ajot.2013.006486] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk–arm kinematics in stroke patients with neglect syndrome.
METHOD. Twenty-four participants were recruited and randomly allocated to three intervention groups. All participants received intervention 2 hr/day, 5 days/wk, for 3 wk. Outcome measures included the Catherine Bergego Scale, eye movement, and trunk–arm kinematic analysis.
RESULTS. The CIT + EP and CIT groups demonstrated larger improvements in functional performance than the control group. The CIT group showed better performance with left fixation points than the CIT+EP group and shorter reaction time than the control group. The CIT + EP group improved more in preplanned control and leftward trunk shift than the other two groups.
CONCLUSION. CIT + EP and CIT were more effective interventions than conventional treatment of patients with neglect syndrome in daily functional performance.
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Affiliation(s)
- Ching-Yi Wu
- Ching-Yi Wu, ScD, OTR, is Professor and Chair, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, and Professor, Healthy Aging Research Center, Taoyuan, Taiwan
| | - Tien-Ni Wang
- Tien-Ni Wang, PhD, OT, is Assistant Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Chen
- Yu-Ting Chen, MS, OT, is Research Assistant, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- Keh-Chung Lin, ScD, OTR, is Professor and Chair, School of Occupational Therapy, College of Medicine, National Taiwan University, and Director, Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 17, F4, Xu Zhou Road, Taipei, Taiwan;
| | - Yi-An Chen
- Yi-An Chen, MS, OT, is Doctoral Student, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles. At the time of the study, she was Research Assistant, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Ting Li
- Hsiang-Ting Li, MS, OT, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Municipal Wan Fang Hospital, Taipei, Taiwan. At the time of the study, she was Master’s Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Luen Tsai
- Pei-Luen Tsai, PhD, OTR, is Instructor, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Saevarsson S, Kristjánsson A. A note on Striemer and Danckert's theory of prism adaptation in unilateral neglect. Front Hum Neurosci 2013; 7:44. [PMID: 23437014 PMCID: PMC3578204 DOI: 10.3389/fnhum.2013.00044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 02/04/2013] [Indexed: 12/02/2022] Open
Affiliation(s)
- Styrmir Saevarsson
- Clinical Neuropsychology Research Group (EKN), Bogenhausen University Hospital Munich, Germany
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Mewes JC, Steuten LM, IJzerman MJ, van Harten WH. Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review. Oncologist 2012; 17:1581-93. [PMID: 22982580 PMCID: PMC3528391 DOI: 10.1634/theoncologist.2012-0151] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/20/2012] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Many cancer survivors suffer from a combination of disease- and treatment-related morbidities and complaints after primary treatment. There is a growing evidence base for the effectiveness of monodimensional rehabilitation interventions; in practice, however, patients often participate in multidimensional programs. This study systematically reviews evidence regarding effectiveness of multidimensional rehabilitation programs for cancer survivors and cost-effectiveness of cancer rehabilitation in general. METHODS The published literature was systematically reviewed. Data were extracted using standardized forms and were summarized narratively. RESULTS Sixteen effectiveness and six cost-effectiveness studies were included. Multidimensional rehabilitation programs were found to be effective, but not more effective than monodimensional interventions, and not on all outcome measures. Effect sizes for quality of life were in the range of -0.12 (95% confidence interval [CI], -0.45-0.20) to 0.98 (95% CI, 0.69-1.29). Incremental cost-effectiveness ratios ranged from -€16,976, indicating cost savings, to €11,057 per quality-adjusted life year. CONCLUSIONS The evidence for multidimensional interventions and the economic impact of rehabilitation studies is scarce and dominated by breast cancer studies. Studies published so far report statistically significant benefits for multidimensional interventions over usual care, most notably for the outcomes fatigue and physical functioning. An additional benefit of multidimensional over monodimensional rehabilitation was not found, but this was also sparsely reported on. Available economic evaluations assessed very different rehabilitation interventions. Yet, despite low comparability, all showed favorable cost-effectiveness ratios. Future studies should focus their designs on the comparative effectiveness and cost-effectiveness of multidimensional programs.
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Affiliation(s)
- Janne C. Mewes
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Lotte M.G. Steuten
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Maarten J. IJzerman
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Wim H. van Harten
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands
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40
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P300 in neglect. Clin Neurophysiol 2012; 123:496-506. [DOI: 10.1016/j.clinph.2011.07.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 07/04/2011] [Accepted: 07/13/2011] [Indexed: 11/23/2022]
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Saevarsson S, Kristjansson A, Halsband U. Strength in numbers: combining neck vibration and prism adaptation produces additive therapeutic effects in unilateral neglect. Neuropsychol Rehabil 2010; 20:704-24. [PMID: 20503132 PMCID: PMC3129649 DOI: 10.1080/09602011003737087] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Unilateral neglect is a multifaceted disorder. Many authors have, for this reason, speculated that the best treatment for neglect will involve combinations of different therapeutic techniques. Two well-known interventions, neck vibration (NV) and prism adaptation (PA), have often been considered to be among the most effective treatments for neglect. Here, two experiments were performed to explore possible additive benefits when these interventions are used in combination to treat chronic neglect. Both experimental groups received NV for 20 minutes, while the second group received simultaneous PA. The effects of treatment were measured with a time-restricted and feedback-based visual search task, which has previously been found to abolish the beneficial effects of PA, and with standard neglect tests. Baseline and intervention measures were performed on separate days. Findings for both groups indicated improved visual search following intervention, but the patients that underwent the combined intervention (NVPA) showed clear improvements on visual search paper and pencil neglect tests unlike the NV-only group. Overall, our results suggest that PA strengthens the effects of NV and that feedback-based tasks do not abolish the beneficial effects of PA, when NV is applied simultaneously. The results support the view that the most effective treatment for neglect will involve the combination of different treatments.
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