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Aziz JR, Eskes GA. Investigating premotor reaching biases after prism adaptation. Neuropsychol Rehabil 2024; 34:845-869. [PMID: 37599401 DOI: 10.1080/09602011.2023.2247153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Abstract
Prism adaptation (PA) is both a visuomotor learning task and potential treatment for spatial neglect after stroke. While PA's aftereffects can improve neglect symptoms, therapeutic benefits vary across individuals, possibly due to differences in neglect subtypes. Neglect symptoms can be described along an information processing pathway, yielding perceptual (input) and premotor (output) neglect subtypes. There is some evidence that PA mainly benefits persons with premotor neglect. We investigated whether PA modulates the premotor stage of information processing by examining whether PA could induce a premotor bias in healthy adults. We measured perceptual and premotor biases using a speeded reach task that compares the initiation time of leftward and rightward reaches to lateralized targets from different hand start positions. Using a randomized mixed experimental design, 30 right-handed healthy adults completed this speeded reach task before and after either left-shifting (n = 15) or right-shifting (n = 15) PA. As hypothesized, left-shifting PA speeded initiation time specifically for reaches in the rightward direction, regardless of target location (p = .02, ηp2 = .18), suggesting that PA induced a premotor bias in the direction of the prism aftereffect. These findings have implications for PA's underlying mechanisms, which can inform visuomotor learning theories and PA's use as a treatment for spatial neglect.
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Affiliation(s)
- Jasmine R Aziz
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
| | - Gail A Eskes
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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2
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Chen P, Hreha K. Spatial neglect not only occurs after stroke but also after traumatic brain injury. Ann Phys Rehabil Med 2023; 66:101778. [PMID: 37890428 DOI: 10.1016/j.rehab.2023.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
| | - Kimberly Hreha
- Department of Orthopaedic Surgery, Occupational Therapy Division, School of Medicine, Duke University, Durham, NC, USA
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Gunduz ME, Bucak B, Keser Z. Advances in Stroke Neurorehabilitation. J Clin Med 2023; 12:6734. [PMID: 37959200 PMCID: PMC10650295 DOI: 10.3390/jcm12216734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Stroke is one of the leading causes of disability worldwide despite recent advances in hyperacute interventions to lessen the initial impact of stroke. Stroke recovery therapies are crucial in reducing the long-term disability burden after stroke. Stroke recovery treatment options have rapidly expanded within the last decade, and we are in the dawn of an exciting era of multimodal therapeutic approaches to improve post-stroke recovery. In this narrative review, we highlighted various promising advances in treatment and technologies targeting stroke rehabilitation, including activity-based therapies, non-invasive and minimally invasive brain stimulation techniques, robotics-assisted therapies, brain-computer interfaces, pharmacological treatments, and cognitive therapies. These new therapies are targeted to enhance neural plasticity as well as provide an adequate dose of rehabilitation and improve adherence and participation. Novel activity-based therapies and telerehabilitation are promising tools to improve accessibility and provide adequate dosing. Multidisciplinary treatment models are crucial for post-stroke neurorehabilitation, and further adjuvant treatments with brain stimulation techniques and pharmacological agents should be considered to maximize the recovery. Among many challenges in the field, the heterogeneity of patients included in the study and the mixed methodologies and results across small-scale studies are the cardinal ones. Biomarker-driven individualized approaches will move the field forward, and so will large-scale clinical trials with a well-targeted patient population.
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Affiliation(s)
- Muhammed Enes Gunduz
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Bilal Bucak
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (B.B.); (Z.K.)
| | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (B.B.); (Z.K.)
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Carter AR, Barrett A. Recent advances in treatment of spatial neglect: networks and neuropsychology. Expert Rev Neurother 2023; 23:587-601. [PMID: 37273197 PMCID: PMC10740348 DOI: 10.1080/14737175.2023.2221788] [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: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Spatial neglect remains an underdiagnosed and undertreated consequence of stroke that imposes significant disability. A growing appreciation of brain networks involved in spatial cognition is helping us to develop a mechanistic understanding of different therapies under development. AREAS COVERED This review focuses on neuromodulation of brain networks for the treatment of spatial neglect after stroke, using evidence-based approaches including 1) Cognitive strategies that are more likely to impact frontal lobe executive function networks; 2) Visuomotor adaptation, which may depend on the integrity of parietal and parieto- and subcortical-frontal connections and the presence of a particular subtype of neglect labeled Aiming neglect; 3) Non-invasive brain stimulation that may modulate relative levels of activity of the two hemispheres and depend on corpus callosum connectivity; and 4) Pharmacological modulation that may exert its effect primarily via right-lateralized networks more closely involved in arousal. EXPERT OPINION Despite promising results from individual studies, significant methodological heterogeneity between trials weakened conclusions drawn from meta-analyses. Improved classification of spatial neglect subtypes will benefit research and clinical care. Understanding the brain network mechanisms of different treatments and different types of spatial neglect will make possible a precision medicine treatment approach.
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Affiliation(s)
- Alex R. Carter
- Department of Neurology, Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - A.M. Barrett
- UMass Chan Medical School and UMass Memorial Healthcare, Worcester, MA, USA
- Central Western MA VA Healthcare System, Worcester, MA, USA
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Rich TJ, Pylarinos M, Parrott D, Chen P. Prism Adaptation Treatment for Right-Sided and Left-Sided Spatial Neglect: A Retrospective Case-Matched Study. Arch Rehabil Res Clin Transl 2023; 5:100263. [PMID: 37312976 PMCID: PMC10258371 DOI: 10.1016/j.arrct.2023.100263] [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] [Indexed: 06/15/2023] Open
Abstract
Objective To compare the effectiveness of prism adaptation treatment (PAT) between patients with right- and left-sided spatial neglect (SN). Design Retrospective case-matched design. Setting Inpatient rehabilitation hospitals and facilities. Participants A total of 118 participants were selected from a clinical dataset of 4256 patients from multiple facilities across the United States. Patients with right-sided SN (median age: 71.0 [63.5-78.5] years; 47.5% female; 84.8% stroke, 10.1% traumatic/nontraumatic brain injury) were matched 1:1 with patients with left-sided SN (median age: 70.0 [63.0-78.0] years; 49.2% female; 86.4% stroke, 11.8% traumatic/nontraumatic brain injury) based on age, neglect severity, overall functional ability at admission, and number of PAT sessions completed during their hospital stay. Intervention Prism adaptation treatment. Main Outcome Measures Primary outcomes were pre-post change on the Kessler Foundation Neglect Assessment Process (KF-NAP) and the Functional Independence Measure (FIM). Secondary outcomes were whether the minimal clinically important difference was achieved for pre-post change on the FIM. Results We found greater KF-NAP gain for patients with right-sided SN than those with left-sided SN (Z = 2.38, P=.018). We found no differences between patients with right-sided and left-sided SN for Total FIM gain (Z=-0.204, P=.838), Motor FIM gain (Z=-0.331, P=.741), or Cognitive FIM gain (Z=-0.191, P=.849). Conclusions Our findings suggest PAT is a viable treatment for patients with right-sided SN just as it is for patients with left-sided SN. Therefore, we suggest prioritizing PAT within the inpatient rehabilitation setting as a treatment to improve SN symptoms regardless of brain lesion side.
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Affiliation(s)
- Timothy J. Rich
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
- Rutgers New Jersey Medical School, Newark, NJ
| | | | - Devan Parrott
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN
- Research, Training, and Outcome Center for Brain Injury, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
- Rutgers New Jersey Medical School, Newark, NJ
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Bonavita A, Bellagamba M, Verde P, Boccia M, Guariglia C. The Effect of Cognitive Style on Individual Differences in Prismatic Adaptation: A Pilot Study. Brain Sci 2023; 13:brainsci13040641. [PMID: 37190606 DOI: 10.3390/brainsci13040641] [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: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Prism adaptation (PA) is a well-known and widely used technique for rehabilitating unilateral spatial neglect and studying sensory-motor plasticity. However, there is conflicting evidence in the literature regarding its effectiveness which may arise from differences in the type of prisms used, clinical characteristics of the patients, and the procedure used in training. Individual differences may play a role in PA effectiveness in rehabilitating neglect, affecting both its development and its effects. Field-dependent/independent cognitive style is a pervasive characteristic of individual functioning, affecting how environmental information is processed. Here, we tested the hypothesis that cognitive style plays a role in PA efficacy by submitting to a protocol of prism adaptation to 38 health participants, who were classified as field-dependent (FD, N = 19) or field-independent (FI, N = 19), by using the Embedded Figure Test. Results show that during the exposure phase, FI individuals needed a lesser number of pointing movements to reduce the deviation error than FD individuals. However, there are no differences in the extinction of sensory-motor and cognitive after-effects. These results suggest that prismatic adaptation is affected by individuals' cognitive style since FI individuals will need fewer trials to reach adaptation and this could explain why using this rehabilitation technique with a unique, standard protocol is not always effective.
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Affiliation(s)
- Alessia Bonavita
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Via Ardeatina 306/354, 00142 Rome, Italy
- Ph.D. Program in Behavioral Neuroscience, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Martina Bellagamba
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Via Ardeatina 306/354, 00142 Rome, Italy
| | - Paola Verde
- Aerospace Medicine Department, Aerospace Test Division, Pratica di Mare, AFB, 00071 Pomezia, Italy
| | - Maddalena Boccia
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Via Ardeatina 306/354, 00142 Rome, Italy
| | - Cecilia Guariglia
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Santa Lucia, Via Ardeatina 306/354, 00142 Rome, Italy
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Faity G, Sidahmed Y, Laffont I, Froger J. Quantification and Rehabilitation of Unilateral Spatial Neglect in Immersive Virtual Reality: A Validation Study in Healthy Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 23:3481. [PMID: 37050541 PMCID: PMC10098895 DOI: 10.3390/s23073481] [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: 02/06/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Unilateral spatial neglect is a common sensorimotor disorder following the occurrence of a stroke, for which prismatic adaptation is a promising rehabilitation method. However, the use of prisms for rehabilitation often requires the use of specific equipment that may not be available in clinics. To address this limitation, we developed a new software package that allows for the quantification and rehabilitation of unilateral spatial neglect using immersive virtual reality. In this study, we compared the effects of virtual and real prisms in healthy subjects and evaluated the performance of our virtual reality tool (HTC Vive) against a validated motion capture tool. Ten healthy subjects were randomly exposed to virtual and real prisms, and measurements were taken before and after exposure. Our findings indicate that virtual prisms are at least as effective as real prisms in inducing aftereffects (4.39° ± 2.91° with the virtual prisms compared to 4.30° ± 3.49° with the real prisms), but that these effects were not sustained beyond 2 h regardless of exposure modality. The virtual measurements obtained with our software showed excellent metrological qualities (ICC = 0.95, error = 0.52° ± 1.18°), demonstrating its validity and reliability for quantifying deviation during pointing movements. Overall, our results suggest that our virtual reality software (Virtualis, Montpellier, France) could provide an easy and reliable means of quantifying and rehabilitating spatial neglect. Further validation of these results is required in individuals with unilateral spatial neglect.
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Affiliation(s)
- Germain Faity
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Ales, 34090 Montpellier, France
| | - Yasmine Sidahmed
- Physical Medicine and Rehabilitation, Nîmes University Hospital, Université Montpellier, 30240 Le Grau-du-Roi, France
| | - Isabelle Laffont
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Ales, 34090 Montpellier, France
- Physical Medicine and Rehabilitation, Montpellier University Hospital, 34295 Montpellier, France
| | - Jérôme Froger
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Ales, 34090 Montpellier, France
- Physical Medicine and Rehabilitation, Nîmes University Hospital, Université Montpellier, 30240 Le Grau-du-Roi, France
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Longley V, Woodward-Nutt K, Turton AJ, Stocking K, Checketts M, Bamford A, Douglass E, Taylor J, Woodley J, Moule P, Vail A, Bowen A. A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial. Clin Rehabil 2023; 37:381-393. [PMID: 36285484 PMCID: PMC9912302 DOI: 10.1177/02692155221134060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Investigate feasibility and acceptability of prism adaptation training for people with inattention (spatial neglect), early after stroke, during usual care. DESIGN Phase II feasibility randomised controlled trial with 3:1 stratified allocation to standard occupational therapy with or without intervention, and nested process evaluation. SETTING Ten hospital sites providing in-patient stroke services. PARTICIPANTS Screened positive for inattention more than one-week post-stroke; informal carers. Occupational therapists participated in qualitative interviews. INTERVENTION Adjunctive prism adaptation training at the start of standard occupational therapy sessions for three weeks. MAIN MEASURES Feasibility measures included recruitment and retention rates, intervention fidelity and attrition. Outcomes collected at baseline, 3 weeks and 12 weeks tested measures including Nottingham Extended Activities of Daily Living Scale. Acceptability was explored through qualitative interviews and structured questions. RESULTS Eighty (31%) patients were eligible, 57 (71%) consented, 54 randomised (40:13, +1 exclusion) and 39 (74%) completed 12-week outcomes. Treatment fidelity was good: participants received median eight intervention sessions (IQR: 5, 12) lasting 4.7 min (IQR: 4.1, 5.0). All six serious adverse events were unrelated. There was no signal that patients allocated to intervention did better than controls. Twenty five of 35 recruited carers provided outcomes with excellent data completeness. Therapists, patients and carers found prism adaptation training acceptable. CONCLUSIONS It is feasible and acceptable to conduct a high-quality definitive trial of prism adaptation training within occupational therapy early after stroke in usual care setting, but difficult to justify given no sign of benefit over standard occupational therapy. CLINICAL TRIAL REGISTRATION https://www.isrctn.com/ Ref ISRCTN88395268.
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Affiliation(s)
- Verity Longley
- Faculty of Health and Education, Manchester Metropolitan
University, Manchester, UK
- Verity Longley, Faculty of Health and
Education, Manchester Metropolitan University, Manchester, UK.
| | - Kate Woodward-Nutt
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
| | - Ailie J. Turton
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Katie Stocking
- Centre for Biostatistics, The Manchester Academic Health Science
Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Matthew Checketts
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
| | - Ann Bamford
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
| | - Emma Douglass
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Julie Taylor
- Dorothy House Hospice Care, Bradford-on-Avon, UK
| | - Julie Woodley
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Pam Moule
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Andy Vail
- Centre for Biostatistics, The Manchester Academic Health Science
Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Audrey Bowen
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
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Abstract
Stroke recovery therapeutics include many classes of intervention and numerous treatment targets. Stroke is a very heterogeneous disease. As such, stroke recovery therapeutics benefit from a personalized medicine approach that considers intersubject differences, such as in infarct location or stroke severity, when assigning treatment. Prediction of treatment responders can be improved by incorporating biological measures, such as neural injury and neural function, as the bedside behavioral phenotype has an incomplete relationship with the biological events underlying stroke recovery. Another ramification of high variability between patients is the need to examine effects of restorative therapies in relation to dose, time poststroke, and stroke severity in clinical trials. For example, enrollment across a wide time interval poststroke or in a population with a very broad range of deficits means high variance across patients in the biological state of the brain. The doses of rehabilitation therapy being studied are often low; it takes substantial practice to acquire a skill in the healthy brain; this is more, not less, pronounced after a stroke. Recognition and treatment of poststroke depression represents a major unmet need. These points are considered in the context of a review of recent advances in stroke recovery therapeutics.
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Affiliation(s)
- Lorie G Richards
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City (L.G.R.)
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles (S.C.C.).,California Rehabilitation Institute, Los Angeles (S.C.C.)
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Diaz-Segarra N, Steenburgh E, Broadley G, Teale A. Prism adaptation treatment improves spatial neglect after severe traumatic brain injury: A case series. NeuroRehabilitation 2023; 53:403-411. [PMID: 37458051 DOI: 10.3233/nre-230064] [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] [Indexed: 07/18/2023]
Abstract
BACKROUND Spatial neglect (SN) after traumatic brain injury (TBI) is common, hindering rehabilitation progress and functional outcomes. Most research has focused on SN treatment after stroke with few published instances of post-TBI SN treated using prism adaptation treatment (PAT) in inpatient rehabilitation. OBJECTIVE This case series characterizes the dose, after-effect, and treatment response of PAT in patients with SN after severe TBI. METHODS Six patients exhibiting severe (n = 2), moderate (n = 2), or mild (n = 2) SN after severe TBI received 5 to 10 PAT sessions during their inpatient rehabilitation stay. Functional improvement in SN was measured by the Catherine Bergego Scale (CBS). RESULTS Patients presented with a mean initial CBS score of 16.8 (range: 8.8-24.3). Prism after-effect was present after PAT. Following 5-10 sessions, the mean CBS score improved by 11.6 points to 5.2 (range: 7.8-21.8); the change in initial versus final CBS scores was significant (P = 0.031). CONCLUSION This study is the first to demonstrate prism after-effect and functional SN improvement in individual patients with TBI. Patients showed a clinically meaningful improvement in mild, moderate, and severe SN following 5 to 10 PAT sessions. Additional studies are needed to assess tolerability, benefit, and optimal PAT dose for SN after TBI.
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Affiliation(s)
- Nicole Diaz-Segarra
- Department of Physical Medicine and Rehabilitation, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Emily Steenburgh
- Department of Occupational Therapy, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Gabrielle Broadley
- Department of Occupational Therapy, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Amy Teale
- James A. Eddy Memorial Foundation Research Institute, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
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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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12
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Chen P, Boukrina O, Krch D. Visuomotor misalignment induced through immersive virtual reality to improve spatial neglect: a case-series study. Neurocase 2022; 28:393-402. [PMID: 36219753 DOI: 10.1080/13554794.2022.2134037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
One evidence-based treatment for spatial neglect is prism adaptation (PA) treatment. PA after-effects, i.e., the implicit shifts in the arm reaching position toward the neglected side of space after prism removal, are considered fundamental to PA treatment effects. In the present study, the arm reaching position was shifted through a visuomotor misalignment procedure using immersive virtual reality (VR). To examine whether this procedure might have a beneficial impact on spatial neglect, we conducted a multi-baseline experiment in three individuals with chronic left-sided neglect post stroke. Improved spatial neglect was observed in all participants immediately after 5 sessions with two rounds in each. Two participants demonstrated lasting or continuous improvement two weeks later. Participants' pattern of brain lesions did not appear to clearly explain performance differences. The findings suggest that VR-induced visuomotor misalignment may improve spatial neglect immediately after a multi-session treatment course. The optimal number of sessions will be determined by future studies with a larger sample size, which may also elucidate the number of sessions sufficient for sustained improvement in most patients. Further investigations will identify the neural mechanisms underlying VR-induced visuomotor misalignment, which may or may not be identical to PA after-effects.
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Affiliation(s)
- Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Olga Boukrina
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Denise Krch
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA.,Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA
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