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Grattan ES, Hounshel Smith B, Mullen K, Woodbury ML. Unilateral Spatial Neglect May Not Be Detected by Performance-Based Functional Neglect Assessment. Am J Occup Ther 2024; 78:7802180200. [PMID: 38350038 PMCID: PMC11017738 DOI: 10.5014/ajot.2024.050497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
IMPORTANCE Unilateral spatial neglect (neglect) poststroke is disabling. It is critical that people with neglect are identified so that treatment can be provided to maximize independence. However, there is some evidence to suggest that existing assessments may not adequately measure neglect. It is unclear whether assessments also fail to identify people with neglect entirely. OBJECTIVE To determine whether there are stroke survivors who self-report neglect symptoms that are not detected by therapist-rated assessments and to compare self-report and therapist-ratings. DESIGN Cross-sectional study. SETTING U.S. university research center. PARTICIPANTS Unilateral stroke survivors (N = 133). INTERVENTION Not applicable. OUTCOMES AND MEASURES The Catherine Bergego Scale (CBS) was administered to participants and scored by a trained occupational therapist. The parallel self-evaluation anosognosia form was also administered to participants to self-report and rate neglect symptoms. RESULTS Forty-eight participants (36.1%) were classified as without neglect on the basis of therapist-rated total CBS scores, yet 30 (62.5%) of these 48 participants reported symptoms of neglect on the CBS self-evaluation anosognosia form. There was a significant difference (p < .001) between therapist-rated and self-rated total CBS scores. CONCLUSIONS AND RELEVANCE Our results indicate that many stroke survivors report some level of disability associated with neglect yet do not meet the criteria to be classified as having neglect according to a commonly used therapist-rated performance-based measure. Plain-Language Summary: The findings of this study contribute to the evidence that existing assessments used by occupational therapists to measure performance-based neglect may not always detect neglect symptoms comprehensively in people poststroke. The finding also suggest that we may be missing neglect symptoms entirely. Occupational therapists should consider using various methods to assess for neglect, including patient self-report and comprehensive occupational profiles. Clinicians should also thoroughly screen all clients with stroke for neglect, regardless of lesion location.
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Affiliation(s)
- Emily S Grattan
- Emily S. Grattan, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA; . At the time this research was completed, Grattan was also Research Health Scientist, VA Pittsburgh Healthcare Center, Pittsburgh, PA
| | - Brice Hounshel Smith
- Brice Hounshel Smith, BS, is Research Assistant and Doctor of Occupational Therapy Student, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Katie Mullen
- Katie Mullen, MOT, OTR/L, is Research Occupational Therapist and Doctor of Clinical Science in Occupational Therapy Student, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Michelle L Woodbury
- Michelle L. Woodbury, PhD, OTR/L, is Professor, Department of Health Sciences and Research and Division of Occupational Therapy, Medical University of South Carolina, Charleston
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Esposito M, Palermo S, Nahi YC, Tamietto M, Celeghin A. Implicit Selective Attention: The Role of the Mesencephalic-basal Ganglia System. Curr Neuropharmacol 2024; 22:1497-1512. [PMID: 37653629 PMCID: PMC11097991 DOI: 10.2174/1570159x21666230831163052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
The ability of the brain to recognize and orient attention to relevant stimuli appearing in the visual field is highlighted by a tuning process, which involves modulating the early visual system by both cortical and subcortical brain areas. Selective attention is coordinated not only by the output of stimulus-based saliency maps but is also influenced by top-down cognitive factors, such as internal states, goals, or previous experiences. The basal ganglia system plays a key role in implicitly modulating the underlying mechanisms of selective attention, favouring the formation and maintenance of implicit sensory-motor memories that are capable of automatically modifying the output of priority maps in sensory-motor structures of the midbrain, such as the superior colliculus. The article presents an overview of the recent literature outlining the crucial contribution of several subcortical structures to the processing of different sources of salient stimuli. In detail, we will focus on how the mesencephalic- basal ganglia closed loops contribute to implicitly addressing and modulating selective attention to prioritized stimuli. We conclude by discussing implicit behavioural responses observed in clinical populations in which awareness is compromised at some level. Implicit (emergent) awareness in clinical conditions that can be accompanied by manifest anosognosic symptomatology (i.e., hemiplegia) or involving abnormal conscious processing of visual information (i.e., unilateral spatial neglect and blindsight) represents interesting neurocognitive "test cases" for inferences about mesencephalicbasal ganglia closed-loops involvement in the formation of implicit sensory-motor memories.
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Affiliation(s)
- Matteo Esposito
- Department of Psychology, University of Torino, Via Verdi 10, 10124, Turin
| | - Sara Palermo
- Department of Psychology, University of Torino, Via Verdi 10, 10124, Turin
- Neuroradiology Unit, Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Marco Tamietto
- Department of Psychology, University of Torino, Via Verdi 10, 10124, Turin
- Department of Medical and Clinical Psychology, and CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Alessia Celeghin
- Department of Psychology, University of Torino, Via Verdi 10, 10124, Turin
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3
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Hemispheric Differences in Self-evaluation Errors of Upper Extremity Movement in Patients with Chronic Stroke. J Int Neuropsychol Soc 2023; 29:59-67. [PMID: 35067270 DOI: 10.1017/s1355617721001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE There is growing evidence that the side of brain lesions results in distinct upper extremity deficits in motor control, movement behavior, and emotional and cognitive function poststroke. We investigated self-evaluation errors, which are the differences in scores between patient self-evaluation and clinician evaluations, and compared patients with left hemisphere damage (LHD) and right hemisphere damage (RHD) poststroke. METHOD Twenty-eight patients with chronic stroke (LHD = 16) performed the actual amount of the test twice with a one-week interval. We videotaped the participants' movements, and participants with stroke and evaluators graded the quality of movement scores by watching video recordings. RESULTS Self-evaluation errors were significantly lower in patients with LHD than in those with RHD (t = 2.350, p = .019). Interestingly, this error did not change after the clinician provided the correct score as feedback. Chi-squared analysis revealed that more patients with LHD underestimated their movements (χ2 = 9.049, p = .002), while more patients with RHD overestimated (χ2 = 7.429, p = .006) in the send evaluation. Furthermore, there were no correlations between self-evaluation error and age, cognitive function, physical impairment, ability to control emotions, or onset months poststroke. CONCLUSIONS Patients with stroke and therapists evaluated the same movements differently, and this can be dependent on hemispheric damage. Therapists might need to encourage patients with LHD who underestimate their movement to ensure continuous use of their more-affected arm. Patients with RHD who overestimate their movement might need treatment to overcome impaired self-awareness, such as video recordings, to protect from unexpected dangerous situations.
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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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5
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1185-1198. [DOI: 10.1093/arclin/acac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
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6
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Wittstock M, Meyer K, Klinke J, Grossmann A, Walter U, Storch A. Effects of insular involvement on functional outcome after intracerebral hemorrhage. Acta Neurol Scand 2021; 144:559-565. [PMID: 34224142 DOI: 10.1111/ane.13496] [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: 03/26/2021] [Revised: 05/31/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ischemic stroke, as well as intracerebral hemorrhage (ICH), involving the insular cortex tends to be more severe. The impact of insular involvement on outcome of ICH remains enigmatic. METHODS We analyzed 159 patients with supratentorial ICH. Depending on insular involvement the patients were classified into two groups (ICHnon-insular vs. ICHinsular ). Volume and symptom severity of ICH were assessed. Electrocardiography, chest X-ray, and laboratory examinations including myocardial enzymes and inflammatory markers were made. In-hospital death and outcome at discharge from hospital were assessed on the modified Rankin scale (mRS). RESULTS The main finding was an association of insular involvement of ICH with worse short-term outcome as measured by mRS (common odds ratio: 4.08 (95% CI: 2.09-7.92); p < .001). This association survived adjustment to relevant covariates such as age, sex, ICH volume, intraventricular hemorrhage, pneumonia, and length of stay (adjusted common odds ratio: 2.51 (95% CI: 1.21-5.21); p = .014) but had no predictive value for side of ICH or rate of atrial fibrillation. There was no association of ICH localization with in-hospital death rate. CONCLUSION Insular localization of ICH lesions predicts worse short-term functional outcome independent of side of bleeding or cardiac dysfunction such as new AF. These findings need clarification in larger prospective cohorts assessed by detailed autonomic/cardiac testing, as well as neuroimaging sub-localization of ICH within the insular region.
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Affiliation(s)
| | - Kezia Meyer
- Department of Neurology University of Rostock Rostock Germany
| | - Jan Klinke
- Department of Neurology University of Rostock Rostock Germany
| | - Annette Grossmann
- Institute of Diagnostic and Interventional Radiology Pediatric Radiology and Neuroradiology University of Rostock Rostock Germany
| | - Uwe Walter
- Department of Neurology University of Rostock Rostock Germany
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7
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Pasotti F, Serranò S, Aiello EN, Gramegna C, Querzola M, Gallucci M, Micieli G, Bollani A, Agostoni EC, Bottini G. Assessing mood and cognitive functioning in acute stroke: clinical usability of a Visual Analogue Mood Scale (VAMS). Neurol Sci 2021; 43:1741-1745. [PMID: 34365548 PMCID: PMC8860784 DOI: 10.1007/s10072-021-05440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/25/2021] [Indexed: 12/05/2022]
Abstract
Background Patients suffering from stroke in the acute/post-acute phases often present with depressive mood — which negatively impacts on patients’ prognosis. However, psychometric evaluation of mood in acute stroke patients may be challenging due to cognitive deficits. Tools investigating emotional states via a vertical analogue line may overcome language/visuo-spatial disorders. This study thus aimed at (a) investigating the clinical usability of a Visual Analogue Mood Scale (VAMS) in acute stroke patients and (b) investigating the interplay between mood and cognition in this population. Methods Forty-one acute stroke patients were compared to 41 age-, education- and sex-matched healthy participants (HPs) on the VAMS and on cognitive measures (mental performance in acute stroke, MEPS). A control line bisection (LB) task was administered to control for potential visuo-spatial deficits in patients. Results Patients reported higher depression levels than HPs (lower VAMS scores); this between-group difference stayed significant when covarying for LB scores. MEPS scores discriminated patients from HPs; among cognitive measures, only the Clock drawing test (CDT) was positively associated with VAMS scores. Lesion side did not affect patients’ mood state; however, disease duration was inversely related to VAMS scores. Discussion The VAMS proved to be a suitable tool for assessing mood in acute stroke patients, as being independent from post-stroke cognitive sequelae. The CDT might represent an adequate measure of depression-induced, post-stroke cognitive efficiency decrease. Mood disorders might occur and thus should be adequately addressed also in post-acute phases — likely due to longer hospitalization times and regression of anosognosic features.
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Affiliation(s)
- Fabrizio Pasotti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Sabrina Serranò
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Edoardo Nicolò Aiello
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Chiara Gramegna
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Matteo Querzola
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Gallucci
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Milan Center for Neuroscience (NeuroMI), Milan, Italy
| | - Giuseppe Micieli
- Neurology Department, Fondazione Istituto Neurologico Casimiro Mondino, Pavia, Italy
| | - Allesandra Bollani
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gabriella Bottini
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. .,Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. .,Milan Center for Neuroscience (NeuroMI), Milan, Italy.
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De-Rosende-Celeiro I, Rey-Villamayor A, Francisco-de-Miguel I, Ávila-Álvarez A. Independence in Daily Activities after Stroke among Occupational Therapy Patients and Its Relationship with Unilateral Neglect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7537. [PMID: 34299988 PMCID: PMC8306679 DOI: 10.3390/ijerph18147537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Abstract
More research is needed to better understand the impact of occupational therapy (OT) in stroke patients and syndromes of unilateral neglect (UN) and anosognosia. A prospective, observational, longitudinal design was conducted on a sample of 27 OT patients. The objectives were to examine: (1) the presence of UN and anosognosia; (2) the functional outcomes; and (3) the association of UN at baseline with functional status at discharge from OT. The outcomes were Barthel (functional independence) and the Rivermead Mobility Index (RMI). The baseline proportion of participants with UN was 33% according to the Star Cancellation Test (STC), and 48.1% according to the Catherine Bergego Scale (CBS) therapist-version. There was a significant difference between the therapist and participant-rated CBS scores (p = 0.004). Functional independence improved significantly between the initial and final assessments (p < 0.001); the effect size (r) was large (r = 0.61). There was a significant improvement in RMI scores (p < 0.001), which was large in size (r = 0.59). Both the STC and CBS-therapist scores were significantly correlated with the Barthel (p < 0.001, p = 0.005, respectively) and with the RMI (p = 0.004, p = 0.028, respectively). The participants substantially enhanced their functional status skills. UN and anosognosia were common problems, and neglect was associated with worse OT program outcomes.
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Affiliation(s)
- Iván De-Rosende-Celeiro
- Occupational Therapy Research Unit in Non-Pharmacological Interventions, University of A Coruña, 15071 A Coruña, Spain;
| | | | | | - Adriana Ávila-Álvarez
- Occupational Therapy Research Unit in Non-Pharmacological Interventions, University of A Coruña, 15071 A Coruña, Spain;
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9
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Daniell K, Kim J, Iwata Y, Caravaggio F, Brown E, Remington G, Agid O, Graff-Guerrero A, Gerretsen P. Exploring the relationship between impaired illness awareness and visuospatial inattention in patients with schizophrenia. J Psychiatr Res 2021; 136:468-473. [PMID: 33168197 DOI: 10.1016/j.jpsychires.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Anosognosia, described as impairment in an individual's ability to perceive and understand their illness, and visuospatial inattention commonly co-occur as a result of structural brain lesions in the right posterior parietal area. Anosognosia or impaired illness awareness is a common feature of schizophrenia that contributes to medication nonadherence and poor clinical outcomes. A recent pilot study suggests patients with impaired illness awareness have a rightward visuospatial bias. We aimed to examine this relationship in a large sample of patients. This study consisted of 106 patients with schizophrenia spectrum disorder (henceforth, schizophrenia) and 20 healthy controls. Visuospatial attention was assessed using the line bisection test (LBT). Illness awareness was assessed using the VAGUS self-report version. A Welch's t-test was used to examine differences in LBT scores between patients with schizophrenia and healthy controls. Correlation analyses between LBT and VAGUS scores were performed in patients with schizophrenia. For exploratory purposes, intra-subject reliability of the LBT was also examined using a two-way mixed intra-class correlation coefficient (ICC). There were no differences in LBT scores between patients with schizophrenia and healthy controls. In patients, there were no associations between LBT and VAGUS scores. ICCs between two consecutively acquired LBTs were 0.92 (95% CI: 0.81-0.96) in patients with schizophrenia and 0.93 (95% CI: 0.81-0.97) in healthy controls. Our results, using a reliable measure, did not support our previous preliminary finding that suggested a relationship between impaired illness awareness and visuospatial bias in patients with schizophrenia. Future studies should consider more sensitive visuospatial attention tasks when testing this hypothesis.
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Affiliation(s)
- Kyle Daniell
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ofer Agid
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, Toronto, Ontario, Canada.
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Bartoli M, Palermo S, Stanziano M, Cipriani GE, Leotta D, Valentini MC, Amanzio M. Reduced Self-Awareness Following a Combined Polar and Paramedian Bilateral Thalamic Infarction. A Possible Relationship With SARS-CoV-2 Risk of Contagion? Front Psychol 2020; 11:570160. [PMID: 33132979 PMCID: PMC7566041 DOI: 10.3389/fpsyg.2020.570160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/04/2020] [Indexed: 01/07/2023] Open
Abstract
Reduced self-awareness is a well-known phenomenon investigated in patients with vascular disease; however, its impact on neuropsychological functions remains to be clarified. Importantly, selective vascular lesions provide an opportunity to investigate the key neuropsychological features of reduced self-awareness in neurocognitive disorders. Because of its rarity, we present an unusual case of a woman affected by a combined polar and paramedian bilateral thalamic infarction. The patient underwent an extensive neuropsychological evaluation to assess cognitive, behavioral, and functional domains, with a focus on executive functions. She was assessed clinically in the acute phase and after 6 months from the stroke, both clinically and by magnetic resonance imaging. The patient developed a cognitive impairment, characterised by prevalent executive dysfunction associated with reduced self-awareness and mood changes, in terms of apathy and depression. Such condition persisted after 6 months. In May 2020, the patient underwent the serology test in chemiluminescence to detect IgG antibodies against SARS-CoV-2. The result of the quantitative test highlighted a high probability of previous contact with the virus. We suggest that reduced self-awareness related to executive dysfunction and behavioral changes may be due to combined polar and paramedian bilateral thalamic lesion. Metacognitive–executive dysfunction affecting the instrumental abilities of everyday life might make people less able to take appropriate precautions, facilitating the risk of SARS-CoV-2 contagion.
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Affiliation(s)
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Mario Stanziano
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy.,Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | | | | | - Maria C Valentini
- Neuroradiology Unit, Azienda Ospedaliera Universitaria "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
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Portnova GV. Lack of a Sense of Threat and Higher Emotional Lability in Patients With Chronic Microvascular Ischemia as Measured by Non-linear EEG Parameters. Front Neurol 2020; 11:122. [PMID: 32226407 PMCID: PMC7080963 DOI: 10.3389/fneur.2020.00122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/03/2020] [Indexed: 01/10/2023] Open
Abstract
We aimed to investigate the non-linear features of the electroencephalogram (EEG) findings in patients with chronic microvascular ischemia (CMI) in order to determine the brain correlates of emotional impairment that could impact the risk of developing acute ischemia. We compared the EEG responses of patients with CMI and age-matched healthy volunteers to non-verbal emotionally charged sounds. We analyzed the EEG data, the psychological assessment of the stimuli, and the results of neuropsychological and behavioral testing. We assessed the (in)stability of the envelope's amplitude by calculating its average frequency and the ratio of its standard deviation to its mean. The non-linear features were lower in the patient group in the resting state. The emotional stimulation induced a decrease in the frequency of the envelope's amplitude in all subjects. Changes in the fractal dimension during stimulation were only seen in the patient group, and they correlated with symptoms of emotional lability. The lower ratio of the alpha-rhythm envelope's standard deviation to its mean in the right hemisphere correlated with a higher sense of threat. The EEG and behavioral correlates of emotional impairment in patients with CMI were found.
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Affiliation(s)
- Galina V Portnova
- Human Higher Nervous Activity Lab, Institute of Higher Nervous Activity and Neurophysiology of RAS, Moscow, Russia
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Zebhauser PT, Vernet M, Unterburger E, Brem AK. Visuospatial Neglect - a Theory-Informed Overview of Current and Emerging Strategies and a Systematic Review on the Therapeutic Use of Non-invasive Brain Stimulation. Neuropsychol Rev 2019; 29:397-420. [PMID: 31748841 PMCID: PMC6892765 DOI: 10.1007/s11065-019-09417-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/27/2019] [Indexed: 01/12/2023]
Abstract
Visuospatial neglect constitutes a supramodal cognitive deficit characterized by reduction or loss of spatial awareness for the contralesional space. It occurs in over 40% of right- and 20% of left-brain-lesioned stroke patients with lesions located mostly in parietal, frontal and subcortical brain areas. Visuospatial neglect is a multifaceted syndrome - symptoms can be divided into sensory, motor and representational neglect - and therefore requires an individually adapted diagnostic and therapeutic approach. Several models try to explain the origins of visuospatial neglect, of which the "interhemispheric rivalry model" is strongly supported by animal and human research. This model proposes that allocation of spatial attention is balanced by transcallosal inhibition and both hemispheres compete to direct attention to the contralateral hemi-space. Accordingly, a brain lesion causes an interhemispheric imbalance, which may be re-installed by activation of lesioned, or deactivation of unlesioned (over-activated) brain areas through noninvasive brain stimulation. Research in larger patient samples is needed to confirm whether noninvasive brain stimulation can improve long-term outcomes and whether these also affect activities of daily living and discharge destination.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany.,Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar der Technischen Universität, Munich, Germany
| | - Marine Vernet
- Section on Neurocircuitry, Laboratory of Brain and Cognition, NIMH/NIH, Bethesda, MD, USA
| | - Evelyn Unterburger
- Division of Neuropsychology, Universitätsklinik Zürich USZ, Frauenklinikstrasse 26, Zurich, Switzerland
| | - Anna-Katharine Brem
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany. .,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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O’Connell EL, Lawson DW, New PW, Stolwyk RJ. Agreement between patients and nurses of neurobehavioral disability following stroke in an inpatient rehabilitation setting. Disabil Rehabil 2019; 42:2868-2875. [DOI: 10.1080/09638288.2019.1572792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elissa L. O’Connell
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Melbourne, Australia
| | - David W. Lawson
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Peter W. New
- Rehabilitation and Aged Care Services, Medicine Program, Monash Health, Melbourne, Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Renerus J. Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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14
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Cameron KV, Ponsford JL, Stolwyk RJ. Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction? Neuropsychol Rehabil 2019; 30:1430-1448. [PMID: 30874467 DOI: 10.1080/09602011.2019.1586734] [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: 10/27/2022]
Abstract
This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months' post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = -4.21, p < .001) and instrumental activity limitation (Z = -4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = -4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors' predictions, clinicians' predictions were more closely aligned with actual stroke survivor functioning at three months' post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.
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Affiliation(s)
- Kate V Cameron
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jennie L Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Renerus J Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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15
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Tobler-Ammann BC, Weise A, Knols RH, Watson MJ, Sieben JM, de Bie RA, de Bruin ED. Patients’ experiences of unilateral spatial neglect between stroke onset and discharge from inpatient rehabilitation: a thematic analysis of qualitative interviews. Disabil Rehabil 2018; 42:1578-1587. [DOI: 10.1080/09638288.2018.1531150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Bernadette C. Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital, Zurich, Switzerland
- Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, the Netherlands
| | - Andrea Weise
- Institute of Occupational Therapy, University of Applied Sciences of Zurich (ZHAW), Winterthur, Switzerland
- Rehabilitation Center Valens, Valens, Switzerland
| | - Ruud H. Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital, Zurich, Switzerland
| | - Martin J. Watson
- Retired UK-based physiotherapy academic, Faculty of Medicine and Health Sciences, University of East Anglia, East Anglia, UK
| | - Judith M. Sieben
- Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, the Netherlands
- Department of Anatomy & Embryology, Maastricht University, Maastricht, the Netherlands
| | - Rob A. de Bie
- Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, the Netherlands
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
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16
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Stangeland H, Orgeta V, Bell V. Poststroke psychosis: a systematic review. J Neurol Neurosurg Psychiatry 2018; 89:879-885. [PMID: 29332009 PMCID: PMC6204934 DOI: 10.1136/jnnp-2017-317327] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/08/2017] [Accepted: 12/18/2017] [Indexed: 12/22/2022]
Abstract
A preregistered systematic review of poststroke psychosis examining clinical characteristics, prevalence, diagnostic procedures, lesion location, treatments, risk factors and outcome. Neuropsychiatric outcomes following stroke are common and severely impact quality of life. No previous reviews have focused on poststroke psychosis despite clear clinical need. CINAHL, MEDLINE and PsychINFO were searched for studies on poststroke psychosis published between 1975 and 2016. Reviewers independently selected studies for inclusion, extracted data and rated study quality. Out of 2442 references, 76 met inclusion criteria. Average age for poststroke psychosis was 66.6 years with slightly more males than females affected. Delayed onset was common. Neurological presentation was typical for stroke, but a significant minority had otherwise 'silent strokes'. The most common psychosis was delusional disorder, followed by schizophrenia-like psychosis and mood disorder with psychotic features. Estimated delusion prevalence was 4.67% (95% CI 2.30% to 7.79%) and hallucinations 5.05% (95% CI 1.84% to 9.65%). Twelve-year incidence was 6.7%. No systematic treatment studies were found. Case studies frequently report symptom remission after antipsychotics, but serious concerns about under-representation of poor outcome remain. Lesions were typically right hemisphere, particularly frontal, temporal and parietal regions, and the right caudate nucleus. In general, poststroke psychosis was associated with poor functional outcomes and high mortality. Poor methodological quality of studies was a significant limitation. Psychosis considerably adds to illness burden of stroke. Delayed onset suggests a window for early intervention. Studies on the safety and efficacy of antipsychotics in this population are urgently needed.
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Affiliation(s)
- Helle Stangeland
- Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Division of Psychiatry, University College London, London, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Vaughan Bell
- Division of Psychiatry, University College London, London, UK
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17
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Buchmann I, Jung R, Liepert J, Randerath J. Assessing Anosognosia in Apraxia of Common Tool-Use With the VATA-NAT. Front Hum Neurosci 2018; 12:119. [PMID: 29636672 PMCID: PMC5880953 DOI: 10.3389/fnhum.2018.00119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
In neurological patients, a lack of insight into their impairments can lead to possibly dangerous situations and non-compliance in rehabilitation therapy with worse rehabilitation outcomes as a result. This so called anosognosia is a multifaceted syndrome that can occur after brain damage affecting different neurological or cognitive functions. To our knowledge no study has investigated anosognosia for apraxia of common tool-use (CTU) so far. CTU-apraxia is a disorder frequently occurring after stroke that affects the use of familiar objects. Here, we introduce a new questionnaire to diagnose anosognosia for CTU-apraxia, the Visual Analogue Test assessing Anosognosia for Naturalistic Action Tasks (VATA-NAT). This assessment is adapted from a series of VATA-questionnaires that evaluate insight into motor (VATA-M) or language (VATA-L) impairment and take known challenges such as aphasia into account. Fifty one subacute stroke patients with left (LBD) or right (RBD) brain damage were investigated including patients with and without CTU-apraxia. Patients were assessed with the VATA-L, -M and -NAT before and after applying a diagnostics session for each function. Interrater reliability, composite reliability as well as convergent and divergent validity were evaluated for the VATA-NAT. Seven percent of the LBD patients with CTU-apraxia demonstrated anosognosia. After tool-use diagnostics this number increased to 20 percent. For the VATA-NAT, psychometric data revealed high interrater-reliability (τ ≥ 0.828), composite reliability (CR ≥ 0.809) and convergent validity (τ = -0.626). When assessing patients with severe aphasia, the possible influence of language comprehension difficulties needs to be taken into account for interpretation. Overall, close monitoring of anosognosia over the course of rehabilitation is recommended. With the VATA-NAT we hereby provide a novel assessment for anosognosia in patients with CTU-apraxia. For diagnosing anosognosia we recommend to combine this new tool with the existing VATA-M and -L subtests, particularly in patients who demonstrate severe functional deficits.
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Affiliation(s)
- Ilka Buchmann
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | - Rebecca Jung
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Joachim Liepert
- Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany.,Kliniken Schmieder, Allensbach, Germany
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
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18
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Grattan ES, Skidmore ER, Woodbury ML. Examining Anosognosia of Neglect. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 38:113-120. [PMID: 29251546 DOI: 10.1177/1539449217747586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unilateral neglect (neglect) and anosognosia often co-occur post stroke. It is unknown whether anosognosia of neglect varies for different types of daily activities. The objective is to examine the frequency of anosognosia of neglect for items on the Catherine Bergego Scale (CBS) and to determine the level of agreement between participant/assessor item ratings and total scores. Secondary analysis of data was carried out. We conducted descriptive analyses and interrater reliability analyses (Cohen's kappa) to determine the level of agreement between assessor and participant item ratings. A paired t test was conducted to compare assessor and participant total scores. The frequency of anosognosia among items varied (29.2%-83.3%) and Kappa statistics ranged from -0.07 (no agreement) to 0.23 (fair agreement) for item ratings. There was a significant difference- t(36) = 3.02, p ≤ .01)-between assessor ( M = 8.0, SD = 5.2) and participant-rated ( M = 5.3, SD = 4.5) total CBS scores. Anosognosia is prevalent among those with neglect. Findings highlight the importance of assessing for anosognosia.
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Affiliation(s)
| | | | - Michelle L Woodbury
- 1 Medical University of South Carolina, Charleston, USA.,3 Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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19
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Egbert AR. A Framework for Ethical Decision Making in the Rehabilitation of Patients with Anosognosia. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017281057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Claessen MHG, Visser-Meily JMA, de Rooij NK, Postma A, van der Ham IJM. The Wayfinding Questionnaire as a Self-report Screening Instrument for Navigation-related Complaints After Stroke: Internal Validity in Healthy Respondents and Chronic Mild Stroke Patients. Arch Clin Neuropsychol 2016; 31:839-854. [PMID: 27506237 DOI: 10.1093/arclin/acw044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In current stroke care, cognitive problems are usually diagnosed in a stepwise manner. More specifically, screening instruments are first applied to support healthcare professionals in deciding whether a second step (an extensive assessment) would be appropriate. None of the existing screening instruments, however, takes navigation ability into account. This is problematic, as navigation impairment after stroke has been shown to be common, more so than previously thought. The Wayfinding Questionnaire (WQ) is therefore presented as a screening instrument for navigation-related complaints after stroke. The internal validity of the WQ was investigated in two samples of participants to establish the final version. METHOD AND RESULTS In Study 1, the WQ was administered in a representative sample of 356 healthy participants. Its factor structure was investigated using a principal component analysis. This procedure resulted in deletion of four items and revealed a three-factor structure: "Navigation and Orientation," "Spatial Anxiety," and "Distance Estimation". In Study 2, a confirmatory analysis was performed to directly verify the factor structure as obtained in Study 1 based on data of 158 chronic mild stroke patients. Fit indices of the confirmatory analysis indicated acceptable model fit. The reliability of the three subscales was found to be very good in both healthy participants and patients. CONCLUSIONS These studies allowed us to determine the final version of the WQ. The results indicated that the WQ is an internally valid and reliable instrument that can be interpreted using a three-factor structure in both healthy respondents and chronic mild stroke patients.
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Affiliation(s)
- Michiel H G Claessen
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Nicolien K de Rooij
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Ineke J M van der Ham
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
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21
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Savage SA, Piguet O, Hodges JR. "Knowing What You Don't Know": Language Insight in Semantic Dementia. J Alzheimers Dis 2016; 46:187-98. [PMID: 25720396 DOI: 10.3233/jad-142703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reduced insight commonly occurs in dementia and can be specific to one area of functioning. Despite recent models identifying a role for semantic memory, little investigation of insight has been conducted in semantic dementia (SD), with patients often described as being aware of their language problems. OBJECTIVE This study aims to investigate language insight in SD. METHOD Twenty-two SD (n = 11 severe, n = 11 mild-moderate) and 9 nonfluent primary progressive aphasic patients completed three experimental language tasks to assess knowledge and awareness of certain words. Skills in evaluating language were tested by comparing performance ratings on the Cookie Theft task with objective scoring. Awareness regarding the existence and previous use of certain words was tested using two additional tasks. RESULTS While SD patients were as accurate as nonfluent patients in rating their own performance on the Cookie Theft immediately following the task, they were significantly poorer at evaluating the same content re-recorded, or other examples of poor language. Compared to nonfluent patients, severe SD patients also made more errors identifying previously known low frequency words. Lastly, when tested on labels for specific aspects of an object, only SD patients made errors regarding the existence, or their past knowledge, of certain words. CONCLUSION SD patients show a general awareness of their language impairments, but have difficulty evaluating language content. These difficulties adversely affect the ability to reflect upon current and past language skills producing an under-awareness of language deficits. This mild, secondary form of anosognosia appears to increase with greater levels of semantic impairment.
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Affiliation(s)
- Sharon A Savage
- Neuroscience Research Australia, Sydney, Australia.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, Australia.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, Australia.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, Australia
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22
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Morin A. The “self-awareness–anosognosia” paradox explained: How can one process be associated with activation of, and damage to, opposite sides of the brain? Laterality 2016; 22:105-119. [DOI: 10.1080/1357650x.2016.1173049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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23
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Nadeau SE, Dobkin B, Wu SS, Pei Q, Duncan PW. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience. Neurorehabil Neural Repair 2015; 30:615-25. [PMID: 26498434 DOI: 10.1177/1545968315613851] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait.
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Affiliation(s)
- Stephen E Nadeau
- Malcom Randall VA Medical Center, Gainesville, FL, USA University of Florida College of Medicine, Gainesville, FL, USA
| | - Bruce Dobkin
- Geffen/UCLA School of Medicine, Los Angeles, CA, USA
| | - Samuel S Wu
- University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL, USA
| | - Qinglin Pei
- University of Florida Colleges of Medicine and Public Health and Health Professions, Gainesville, FL, USA
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24
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Saj A, Vocat R, Vuilleumier P. Action-monitoring impairment in anosognosia for hemiplegia. Cortex 2015; 61:93-106. [PMID: 25481468 DOI: 10.1016/j.cortex.2014.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/05/2014] [Accepted: 10/21/2014] [Indexed: 11/17/2022]
Abstract
Every movement begins with action programming, and ends with a produced effect. Anosognosia for hemiplegia (AH), involving unawareness of motor deficits after brain damage, is a striking but also poorly understood symptom in clinical neurology. It has been suggested that it may result from a combination of cognitive and sensorimotor dysfunctions, including impairments in monitoring motor action and detecting the mismatch between intention and outcome. Here we investigated the relationship between motor action awareness and monitoring of self-produced movements by using a motor imaginary task, which was performed with either the intact or the affected limb. We tested 10 right brain-damaged patients, including 5 with AH, in comparison with 5 healthy controls. In a first phase, participants were asked to either realize or imagine a movement with their right or left arm. In a subsequent recognition phase, the participants had to recall whether the movement was a realized or imagined and which arm was used. AH patients performed significantly worse relative to no-AH patients and healthy controls for the left movements. Specifically, we found that AH patients believed they had realized movements with their (paralyzed) left arm even when they failed in the left execution condition. However, they also made more errors for movements actually realized with the right hand. These findings confirm that impaired action monitoring may contribute to AHP. Furthermore, our results support the notion of an action control system integrating "feedforward" signals through a comparison process between the intention and execution of movement, but also indicate that monitoring deficits in AHP are not strictly unilateral. Combined together, dysfunction of motor comparator processes and more general monitoring deficits may add up to lead to unawareness of paralysis.
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Affiliation(s)
- Arnaud Saj
- Department of Neurology, University Hospital of Geneva, Geneva, Switzerland.
| | - Roland Vocat
- Hospital of Valais, St-Maurice, Martigny and Sierre, Switzerland
| | - Patrik Vuilleumier
- Department of Neurology, University Hospital of Geneva, Geneva, Switzerland; Department of Neurosciences, Medical School, University of Geneva, Switzerland
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25
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Gasquoine PG. Blissfully unaware: Anosognosia and anosodiaphoria after acquired brain injury. Neuropsychol Rehabil 2015; 26:261-85. [DOI: 10.1080/09602011.2015.1011665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Ronchi R, Bolognini N, Gallucci M, Chiapella L, Algeri L, Spada MS, Vallar G. (Un)awareness of unilateral spatial neglect: A quantitative evaluation of performance in visuo-spatial tasks. Cortex 2014; 61:167-82. [DOI: 10.1016/j.cortex.2014.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 06/06/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
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27
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Assessing anosognosias after stroke: A review of the methods used and developed over the past 35 years. Cortex 2014; 61:43-63. [DOI: 10.1016/j.cortex.2014.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/03/2014] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
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28
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Boosman H, van Heugten CM, Winkens I, Heijnen VA, Visser-Meily JMA. Awareness of memory functioning in patients with stroke who have a good functional outcome. Brain Inj 2014; 28:959-64. [DOI: 10.3109/02699052.2014.888763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Subjective cognitive-affective status following thalamic stroke. J Neurol 2012; 260:386-96. [DOI: 10.1007/s00415-012-6635-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/06/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
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30
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de Joode E, Proot I, Slegers K, van Heugten C, Verhey F, van Boxtel M. The use of standard calendar software by individuals with acquired brain injury and cognitive complaints: a mixed methods study. Disabil Rehabil Assist Technol 2011; 7:389-98. [DOI: 10.3109/17483107.2011.644623] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Di Monaco M, Schintu S, Dotta M, Barba S, Tappero R, Gindri P. Severity of Unilateral Spatial Neglect Is an Independent Predictor of Functional Outcome After Acute Inpatient Rehabilitation in Individuals With Right Hemispheric Stroke. Arch Phys Med Rehabil 2011; 92:1250-6. [DOI: 10.1016/j.apmr.2011.03.018] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 03/14/2011] [Accepted: 03/20/2011] [Indexed: 11/26/2022]
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32
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Robinson RG. Neuropsychiatric disorders following stroke. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:339-40. [PMID: 20540827 DOI: 10.1177/070674371005500601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert G Robinson
- Paul W Penningroth Chair, Professor and Head, Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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