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Ohama R, Matsumoto S, Ohama Y, Yokoyama K, Shimodozono M. A new method for detecting unilateral spatial neglect with tracing tasks using the Rey-Osterrieth complex figure: a pilot study. Neurol Sci 2024; 45:4789-4798. [PMID: 38717579 PMCID: PMC11422435 DOI: 10.1007/s10072-024-07540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/22/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE To explore efficacy of the "Rey-Osterrieth complex figure (ROCF) tracing task" as a new test to detect unilateral spatial neglect (USN). METHODS Subjects were 40 healthy control (HC) and 20 right brain-damaged patients with (USN + , n = 10) or without USN (USN - , n = 10). After the ROCF copying task, the tracing task was performed under conditions that did not leave any tracing lines on the sample figure. Evaluation used the conventional 36-point scoring system, laterality index (LI) as the ratio of the left and right structure scores, and the number of overlaps for each of the left and right structures scored. RESULTS In the tracing task, USN + showed a lower LI than HC. Furthermore, left-sided neglect was sometimes more evident than in the copying task. Regarding the total overlapping score, USN + showed a greater score than HC. The right-sided overlapping scores in USN + and USN - were also greater than that in HC. In the right brain-damaged subjects, clinically meaningful correlations were not found between evaluations in the ROCF tracing task and in conventional USN screening tests. Receiver-operating-characteristic analysis to test the power of detection showed moderate performance for the tracing LI (AUC = 0.76, 95% CI = 0.54-0.97), which was greater than that of other tests. Further, the total overlapping score in the tracing task showed sensitivity 0.9 (highest among the tests performed), specificity 0.5, and AUC 0.68 (95% CI = 0.43-0.92). CONCLUSION The ROCF tracing task might be a convenient method to detect USN and to reveal the extent of spatial working memory impairment.
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Affiliation(s)
- Rintaro Ohama
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Shuji Matsumoto
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Inashiki-Gun, Ibaraki, Japan
| | - Yumi Ohama
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Katsuya Yokoyama
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.
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da Silva T, Luvizutto G, Martins L, da Costa R, de Souza J, Winckler F, Sartor L, Modolo G, Ferreira N, Rodrigues J, Kanda R, Fogaroli M, Borges G, Rizzatti G, Ribeiro P, Pires D, Favoretto D, Aguiar L, Bazan S, Betting L, Antunes L, Nunes H, Pereira V, Edwards T, Pontes-Neto O, Conforto A, Bazan R. Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil. Braz J Med Biol Res 2023; 56:e12326. [PMID: 36722659 PMCID: PMC9883007 DOI: 10.1590/1414-431x2023e12326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/26/2022] [Indexed: 01/31/2023] Open
Abstract
There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.
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Affiliation(s)
- T.R. da Silva
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil,Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.J. Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - L.G. Martins
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - R.D.M. da Costa
- Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - J.T. de Souza
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - F.C. Winckler
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - L.C.A. Sartor
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.P. Modolo
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - N.C. Ferreira
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - J.C.S. Rodrigues
- Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - R.G. Kanda
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - M.O. Fogaroli
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.F. Borges
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - G.R.S. Rizzatti
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - P.W. Ribeiro
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - D.S. Pires
- Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - D.B. Favoretto
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L.R. Aguiar
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S.G.Z. Bazan
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - L.E.G. Betting
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - L.C.O. Antunes
- Departamento de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - H.R.C. Nunes
- Departamento de Saúde Pública, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - V.M. Pereira
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - T.G.S. Edwards
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - O. Pontes-Neto
- Departamento de Neurociências e Ciências do Comportamento, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A.B. Conforto
- Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R. Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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Moore MJ, Driscoll R, Colwell M, Hewitt O, Demeyere N. Aligning formal and functional assessments of Visuospatial Neglect: A mixed-methods study. Neuropsychol Rehabil 2022; 32:2560-2579. [PMID: 34392812 DOI: 10.1080/09602011.2021.1967172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACTThe occurrence of visuospatial neglect acts as a key predictor of recovery outcome following stroke. However, the specific behavioural profiles associated with various neglect subtypes are not well understood. This study aims to identify real-world functional impairments associated with neglect, to determine whether functional impairment profiles differ across patients with egocentric and allocentric neglect, and to investigate how neglect severity predicts functional impairments.Notes from 290 stroke patients' occupational therapy functional assessments were qualitatively and quantitatively analysed in the context of neglect type and severity as reported by the OCS Cancellation Task. Overall, neglect patients had more references to having difficulty initiating tasks, finding items, exhibiting spatial inattention, and having difficulty using both arms than patients without neglect. The proportion of theme references did not differ significantly across patients with egocentric and allocentric neglect. The quantitative severity of egocentric neglect was acted as a significant predictor of reference occurrence over and above stroke severity within difficulty finding items, spatial inattention, body inattention, and upper limb use.This study expands on previous findings by identifying real-world functional impairments differentiating patients with and without neglect. This data provides novel insight into the impact of neglect on functional abilities.
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Affiliation(s)
- Margaret Jane Moore
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Rebecca Driscoll
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Michael Colwell
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Olivia Hewitt
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
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Zhang Y, Ye L, Cao L, Song W. Resting-state electroencephalography changes in poststroke patients with visuospatial neglect. Front Neurosci 2022; 16:974712. [PMID: 36033611 PMCID: PMC9399887 DOI: 10.3389/fnins.2022.974712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to explore the electrophysiological characteristics of resting-state electroencephalography (rsEEG) in patients with visuospatial neglect (VSN) after stroke. Methods A total of 44 first-event sub-acute strokes after right hemisphere damage (26 with VSN and 18 without VSN) were included. Besides, 18 age-matched healthy participants were used as healthy controls. The resting-state electroencephalography (EEG) of 64 electrodes was recorded to obtain the power of the spectral density of different frequency bands. The global delta/alpha ratio (DAR), DAR over the affected hemispheres (DARAH), DAR over the unaffected hemispheres (DARUH), and the pairwise-derived brain symmetry index (pdBSI; global and four bands) were compared between groups and receiver operating characteristic (ROC) curve analysis was conducted. The Barthel index (BI), Fugl-Meyer motor function assessment (FMA), and Berg balance scale (BBS) were used to assess the functional state of patients. Visuospatial neglect was assessed using a battery of standardized tests. Results We found that patients with VSN performed poorly compared with those without VSN. Analysis of rsEEG revealed increased delta and theta power and decreased alpha and beta power in stroke patients with VSN. Compared to healthy controls and poststroke non-VSN patients, patients with VSN showed a higher DAR (P < 0.001), which was significantly positively correlated with the BBS (DAR: r = –0.522, P = 0.006; DARAH: r = –0.521, P = 0.006; DARUH: r = –0.494, P = 0.01). The line bisection task was positively correlated with DAR (r = 0.458, P = 0.019) and DARAH (r = 0.483, P = 0.012), while the star cancellation task was only positively correlated with DARAH (r = 0.428, P = 0.029). DARAH had the best discriminating value between VSN and non-VSN, with an area under the curve (AUC) of 0.865. Patients with VSN showed decreased alpha power in the parietal and occipital areas of the right hemisphere. A higher parieto-occipital pdBSIalpha was associated with a worse line bisection task (r = 0.442, P = 0.024). Conclusion rsEEG may be a useful tool for screening for stroke patients with visuospatial neglect, and DAR and parieto-occipital pdBSIalpha may be useful biomarkers for visuospatial neglect after stroke.
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Moore M, Milosevich E, Beisteiner R, Bowen A, Checketts M, Demeyere N, Fordell H, Godefroy O, Laczó J, Rich T, Williams L, Woodward-Nutt K, Husain M. Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations. Eur J Neurol 2022; 29:2596-2606. [PMID: 35510782 PMCID: PMC9544365 DOI: 10.1111/ene.15381] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time‐limited clinical environments. Methods Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations. Results A total of 512 articles were screened, and 42 were included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copying, reading/writing, and behavioral. Cancellation tasks were most frequently used (97.6% of studies), followed by bisection, copying, behavioral, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying, and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, the literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible. Conclusions This study provides consensus recommendations for rapid bedside detection of neglect in real‐world, clinical environments.
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Affiliation(s)
- Margaret Moore
- Dept Experimental Psychology, University of Oxford, Oxford, UK.,Queensland Brain Institute, University of Brisbane, Brisbane, Australia
| | | | | | - Audrey Bowen
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Matthew Checketts
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, UK
| | - Nele Demeyere
- Dept Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Olivier Godefroy
- Department of Neurology and Laboratoire de Neurosciences Fonctionnelles et Pathologies, Amiens University Medical Center, Jules Verne University of Picardy, Amiens, France
| | - Jan Laczó
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Timothy Rich
- Kessler Foundation, West Orange, New Jersey, USA & Rutgers University, Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Lindy Williams
- Cognitive Aging and Impairment Neurosciences Lab, University of South Australia, Adelaide, Australia
| | - Kate Woodward-Nutt
- Research and Innovation, Northern Care Alliance NHS Group, Salford, United Kingdom
| | - Masud Husain
- Dept Experimental Psychology, University of Oxford, Oxford, UK.,Nuffield Dept Clinical Neurosciences, University of Oxford, Oxford, UK
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From Patient to Musician: A Multi-Sensory Virtual Reality Rehabilitation Tool for Spatial Neglect. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Unilateral Spatial Neglect (USN) commonly results from a stroke or acquired brain injury. USN affects multiple modalities and results in failure to respond to stimuli on the contralesional side of space. Although USN is a heterogeneous syndrome, present-day therapy methods often fail to consider multiple modalities. Musical Neglect Therapy (MNT) is a therapy method that succeeds in incorporating multiple modalities by asking patients to make music. This research aimed to exploit the immersive and modifiable aspect of VR to translate MNT to a VR therapy tool. The tool was evaluated in a 2-week pilot study with four clinical users. These results are compared to a control group of four non-clinical users. Results indicated that patients responded to triggers in their entire environment and performance results could be clearly differentiated between clinical and non-clinical users. Moreover, patients increasingly corrected their head direction towards their neglected side. Patients stated that the use of VR increased their enjoyment of the therapy. This study contributes to the current research on rehabilitation for USN by proposing the first system to apply MNT in a VR environment. The tool shows promise as an addition to currently used rehabilitation methods. However, results are limited to a small sample size and performance metrics. Future work will focus on validating these results with a larger sample over a longer period. Moreover, future efforts should explore personalisation and gamification to tailor to the heterogeneity of the condition.
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Novotny V, Aarli SJ, Netland Khanevski A, Bjerkreim AT, Elnan Kvistad C, Fromm A, Waje‐Andreassen U, Naess H, Thomassen L, Logallo N. Clinical manifestation of acute cerebral infarcts in multiple arterial territories. Brain Behav 2021; 11:e2296. [PMID: 34333856 PMCID: PMC8413735 DOI: 10.1002/brb3.2296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/18/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to assess frequencies and radiological aspects of single- and multiterritory clinical manifestation among patients with acute cerebral infarcts in multiple arterial territories (MACI). MATERIALS & METHODS We retrospectively reviewed admission records and diffusion-weighted magnetic resonance imaging of patients with MACI admitted to our stroke unit between 2006 and 2017. MACI was defined as acute cerebral ischemic lesions in at least two out of three arterial cerebral territories, that is, the left anterior, right anterior and the bilateral posterior territory. Patients with single- and multiterritory clinical manifestation were then compared for topographical distribution of the ischemic lesions, the number of ischemic lesions, and The Oxfordshire Community Stroke Project classification. RESULTS Out of 311 patients with MACI, 222 (71.4%) presented with single-territory clinical manifestation. Involvement of the left hemisphere (OR = 0.37, 95% CI 0.16-0.82), less than five ischemic lesions (OR = 0.58, 95% CI 0.35-0.97), and partial anterior circulation infarct clinical stroke syndrome (OR = 0.57, 95% CI 0.34-0.97) were associated with single-territory clinical manifestation. Involvement of all three territories (OR = 2.58, 95% = 1.48-4.50), more than 10 ischemic lesions (OR = 2.30, 95% CI 1.32-4.01) and total anterior circulation infarct clinical stroke syndrome (OR = 3.31, 95% CI 1.39-7.86) were associated with multiterritory clinical manifestation. CONCLUSION Most patients with MACI present with single-territory clinical manifestation on admission. Diffusion-weighted magnetic resonance imaging is therefore necessary for a definite diagnosis.
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Affiliation(s)
- Vojtech Novotny
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Sander Johan Aarli
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | | | - Anna Therese Bjerkreim
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Christopher Elnan Kvistad
- Department of NeurologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Annette Fromm
- Department of NeurologyHaukeland University HospitalBergenNorway
| | | | - Halvor Naess
- Department of NeurologyHaukeland University HospitalBergenNorway
- Centre for Age‐related MedicineStavanger University HospitalStavangerNorway
| | - Lars Thomassen
- Department of NeurologyHaukeland University HospitalBergenNorway
| | - Nicola Logallo
- Department of NeurosurgeryHaukeland University HospitalBergenNorway
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Bedside video-oculographic evaluation of eye movements in acute supratentorial stroke patients: A potential biomarker for hemispatial neglect. J Neurol Sci 2021; 425:117442. [PMID: 33857735 DOI: 10.1016/j.jns.2021.117442] [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: 01/27/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The presence of hemispatial neglect adversely affects functional outcomes in stroke patients; consequently, it warrants early targeted rehabilitative intervention. Nevertheless, hemispatial neglect in the acute phase of stroke has often been underdiagnosed. In this study, we aimed to detect hemispatial neglect at the bedside in acute stroke patients by measuring eye movements using video-oculography (VOG). METHODS Forty-seven patients with acute unilateral supratentorial stroke were enrolled. We quantitatively measured horizontal saccade (latency, velocity, and amplitude) and smooth pursuit (gain) at the bedside using VOG and compared these variables with scores on the Behavioral Inattention Test (BIT), a screening battery to assess hemispatial neglect. RESULTS Contralesional saccade latency, velocity, and amplitude, and ipsilesional smooth pursuit gain were suppressed compared with those in the opposite directions (p = 0.08, 0.02, 0.04, and 0.02, respectively). These directional ocular hypokinesia values correlated with the total BIT score (correlation coefficients -0.53, 0.48, 0.51, and 0.39, respectively). The association was significant even after adjusting for age and stroke severity. CONCLUSIONS Eye movement measurements performed using VOG significantly correlated with the tendency for hemispatial neglect in acute supratentorial stroke patients. Bedside VOG measurement may be a simple biomarker for detecting hemispatial neglect even in patients in the supine position during the acute phase of stroke.
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Morse H, Biggart L, Pomeroy V, Rossit S. Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke. Neuropsychol Rehabil 2020; 32:707-731. [PMID: 32942950 DOI: 10.1080/09602011.2020.1819827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable therapies and remotely monitor adherence without the presence of a therapist at all times. Researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and, ultimately, optimize adherence and efficacy. This study aims to explore end-user perspectives on the use of self-administered VR for spatial neglect in a university environment to identify barriers and facilitators prior to extending its use remotely as a telerehabilitation tool. We used a mixed-method design including focus groups, self-administered questionnaires and interviews with stroke survivors (N = 7), their carers (N = 3) and stroke clinicians (N = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators were performance feedback, engagement and enjoyment, and psychological benefits associated with self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform development, enhance engagement and uptake of VR telerehabilitation and inform future studies.
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Affiliation(s)
- Helen Morse
- School of Psychology, University of East Anglia, Norwich, UK.,Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK
| | - Laura Biggart
- School of Psychology, University of East Anglia, Norwich, UK
| | - Valerie Pomeroy
- Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK.,School of Health Sciences, University of East Anglia, Norwich, UK.,National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative, Cambridge, UK
| | - Stéphanie Rossit
- School of Psychology, University of East Anglia, Norwich, UK.,Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK
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Bieth T, Beauvais D, Romeu P, Legris N, Chassin O, Sarov M, Rouquette A, Azouvi P, Denier C. Validation of a new test for early assessment of unilateral neglect in acute stroke: The Rapid Unilateral Neglect Screening (RUNS) test. Ann Phys Rehabil Med 2020; 64:101399. [PMID: 32534155 DOI: 10.1016/j.rehab.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/17/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Theophile Bieth
- Stroke Unit, Neurology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | - Diane Beauvais
- Stroke Unit, Neurology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Pauline Romeu
- Stroke Unit, Neurology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nicolas Legris
- Stroke Unit, Neurology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Chassin
- Stroke Unit, Neurology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mariana Sarov
- Stroke Unit, Neurology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Alexandra Rouquette
- CESP, Inserm, Maison de Solenn, Université Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France; Public Health and Epidemiology Department, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Philippe Azouvi
- Rehabilitation Department, AP-HP, Hôpital Raymond-Poincaré, Garches, France
| | - Christian Denier
- Stroke Unit, Neurology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Hammerbeck U, Gittins M, Vail A, Paley L, Tyson SF, Bowen A. Spatial Neglect in Stroke: Identification, Disease Process and Association with Outcome During Inpatient Rehabilitation. Brain Sci 2019; 9:brainsci9120374. [PMID: 31847166 PMCID: PMC6956021 DOI: 10.3390/brainsci9120374] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 11/17/2022] Open
Abstract
We established spatial neglect prevalence, disease profile and amount of therapy that inpatient stroke survivors received, and outcomes at discharge using Sentinel Stroke National Audit Programme (SSNAP) data. We used data from 88,664 National Health Service (NHS) admissions in England, Wales and Northern Ireland (July 2013–July 2015), for stroke survivors still in hospital after 3 days with a completed baseline neglect National Institute for Health Stroke Scale (NIHSS) score. Thirty percent had neglect (NIHSS item 11 ≥ 1) and they were slightly older (78 years) than those without neglect (75 years). Neglect was observed more commonly in women (33 vs. 27%) and in individuals with a premorbid dependency (37 vs. 28%). Survivors of mild stroke were far less likely to present with neglect than those with severe stroke (4% vs. 84%). Those with neglect had a greatly increased length of stay (27 vs. 10 days). They received a comparable amount of average daily occupational and physiotherapy during their longer inpatient stay but on discharge a greater percentage of individuals with neglect were dependent on the modified Rankin scale (76 vs. 57%). Spatial neglect is common and associated with worse clinical outcomes. These results add to our understanding of neglect to inform clinical guidelines, service provision and priorities for future research.
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Affiliation(s)
- Ulrike Hammerbeck
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester M13 9PL, UK;
| | - Matthew Gittins
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester M13 9PL, UK; (M.G.); (A.V.)
| | - Andy Vail
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester M13 9PL, UK; (M.G.); (A.V.)
| | - Lizz Paley
- School of Population Health and Environmental Sciences, Kings College London, London SE1 1UL, UK;
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, University of Manchester, MAHSC, Manchester M13 9PL, UK;
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Manchester M13 9PL, UK;
- Correspondence: ; Tel.:+44-161-275-1235
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Revet M, Immerzeel J, Voogt L, Paulis W. Patients with neuropsychological disorders short after stroke have worse functional outcome: a systematic review and meta-analysis. Disabil Rehabil 2019; 43:2233-2252. [PMID: 31766909 DOI: 10.1080/09638288.2019.1693642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate if patients with neuropsychological disorders (neglect, aphasia, or cognitive dysfunction measured with the Mini-mental state examination) short after stroke have different functional outcome at follow-up compared to patients without these disorders. METHODS Embase, Medline-Ovid, PsycINFO, Cochrane CENTRAL, Web of Science and Google Scholar were systematically searched for cohort studies up to 3 March 2019. PRISMA guidelines were followed. Functional outcome had to be measured with the Barthel Index or the Functional Independence Measure. If at least three studies studying the same neuropsychological disorder reported functional outcome at comparable follow-up, meta-analysis were performed and the quality of evidence was assessed using GRADE. RESULTS The search resulted in 5398 unique articles and finally 27 articles were included. Pooled results show a standardized mean difference of -0.93 (95% confidence interval [-1.27 to -0.59]), indicating that the group with neglect short after stroke has significant lower functional outcome at follow-up. Regarding aphasia, the standardized mean difference was -0.50 (95% confidence interval [-0.72 to -0.28]). It appears in the limited articles available that patients with cognitive dysfunction have lower scores for functional outcome. CONCLUSIONS Patients with neglect or aphasia, especially aphasia with comprehension deficits, short after stroke have significant worse functional outcome.Implications for rehabilitationClinicians should perform an extensive screening for neglect, aphasia, and cognitive disorders to make sure to diagnose the different neuropsychological disorders correctly.When patients with neuropsychological disorders are referred for rehabilitation, it can be expected that they need a longer rehabilitation period or may never reach the same level of functioning.Clinicians should pay attention to instructions of training moments outside therapy and involve caregivers and patients family making these training moments more effective.
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Affiliation(s)
- Mirjam Revet
- Department of Physiotherapy Studies and Research Centre of Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Jeroen Immerzeel
- Department of Physiotherapy, De Zellingen - Rijckehove, Capelle aan den IJssel, The Netherlands
| | - Lennard Voogt
- Department of Physiotherapy Studies and Research Centre of Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Winifred Paulis
- Department of Physiotherapy Studies and Research Centre of Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Barrett A, Abdou A, Caulfield MD. The cingulate cortex and spatial neglect. HANDBOOK OF CLINICAL NEUROLOGY 2019; 166:129-150. [DOI: 10.1016/b978-0-444-64196-0.00009-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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