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Ghamgui S, Dahmen R. The Effect of Aerobic Exercise on Visuospatial Attention in Young Adults. Percept Mot Skills 2024:315125241272660. [PMID: 39140830 DOI: 10.1177/00315125241272660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Our objective in this study was to investigate the effect of moderate-intensity aerobic exercise on visuospatial attention bias. We examined line bisection performance at rest before exercise and then immediately after exercise in 20 young adults. Pre-exercise, there was a larger leftward bias in subjective midpoint judgment of all participants than post-exercise (p < .001). Thus, leftward error magnitude decreased according to aerobic exercise, as there were rightward shifts after the exercise. The participants' performancse were modulated by the hand used to perform manual bisection tasks (p < .02). Participants erred to the left of the true midpoint with the non-dominant hand and to the right of the true midpoint with the dominant hand. The use of the non-dominant hand led to greater leftward error than the errors obtained using the dominant hand, though there was no interaction effect between hand use and effort. These findings suggest that moderate aerobic exercise can benefit visuospatial attention in adults.
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Affiliation(s)
- Sana Ghamgui
- Humanities and Social Sciences, High Institute of Sport and Physical Education of Gafsa, Gafsa, Tunisia
| | - Riadh Dahmen
- Humanities and Social Sciences, High Institute of Sport and Physical Education of Sfax, Sfax, Tunisia
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2
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Chen YA, Norgaard M. Important findings of a technology-assisted in-home music-based intervention for individuals with stroke: a small feasibility study. Disabil Rehabil Assist Technol 2024; 19:2239-2249. [PMID: 37910042 DOI: 10.1080/17483107.2023.2274397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To examine the feasibility of stroke survivors receiving music-based rehabilitation via a mobile app. MATERIALS AND METHODS We recruited ten chronic stroke survivors who were community-dwelling with mild-moderate upper extremity (UE) paresis. Participants were encouraged to exercise their paretic UE with a commercial instrument training app, Yousician, with a piano keyboard at home for three weeks. The feasibility of the training was measured by: (a) the acceptance of using the app to receive in-home piano training (e.g., daily usage time, exit interview) and (b) the effects of the app functionality as a rehabilitation tool (e.g., participants' motor improvements after training). RESULTS Our small sample size of participants demonstrated general positive feedback and self-motivation (e.g., interest in extended training time) about using a mobile app to receive in-home, music-based UE training. Participants showed no trend of declined usage and practiced on average ∼33 min per day for 4-5 days per week during the 3-week participation. We also observed positive results in the Fugl-Meyer Assessment, Action Research Arm Test, and Nine Hole Peg Test after training. CONCLUSIONS This study provided insight into the feasibility of delivering music-based interventions through mobile health (mHealth) technology for stroke populations. Although this was a small sample size, participants' positive and negative comments and feedback provided useful information for future rehab app development. We suggest four ways to further improve and design a patient-oriented app to facilitate the use of a mHealth app to deliver in-home music-based interventions for stroke survivors.
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Affiliation(s)
- Yi-An Chen
- Department of Occupational Therapy, Georgia State University, Atlanta, Georgia, USA
| | - Martin Norgaard
- School of Music, Georgia State University, Atlanta, Georgia, USA
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3
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Terruzzi S, Albini F, Massetti G, Etzi R, Gallace A, Vallar G. The Neuropsychological Assessment of Unilateral Spatial Neglect Through Computerized and Virtual Reality Tools: A Scoping Review. Neuropsychol Rev 2024; 34:363-401. [PMID: 36913099 PMCID: PMC10009867 DOI: 10.1007/s11065-023-09586-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 09/28/2022] [Indexed: 03/14/2023]
Abstract
Unilateral Spatial Neglect is a disabling neuropsychological deficit. Patients with spatial neglect fail to detect and report events, and to perform actions in the side of space contralateral to a hemispheric cerebral lesion. Neglect is assessed by evaluating the patients' abilities in daily life activities and by psychometric tests. Computer-based, portable and Virtual Reality technologies may provide more and precise data, and be more sensitive and informative, compared to current paper-and-pencil procedures. Studies since 2010, in which such technologies have been used, are reviewed. Forty-two articles meeting inclusion criteria are categorized according to their technological approaches (computer-, graphics tablet or tablet-, virtual reality-based assessment, and other). The results are promising. However, a definite golden standard, technologically based procedure cannot be still established. Developing technologically based tests is a laborious process, which requires technical and user experience improvements as well as normative data, to increase the evidence of efficacy for clinical evaluation of at least some of the tests considered in this review.
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Affiliation(s)
- Stefano Terruzzi
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy.
- Neurocognitive Rehabilitation Center (CeRiN), University of Trento, Rovereto, Italy.
| | - Federica Albini
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Gemma Massetti
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberta Etzi
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Alberto Gallace
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy.
- Neuropsychological Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Milan, Italy.
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4
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Guilbert A, Bara TG, Bouchara T, Gaffard M, Bourlon C. Feasibility and relevance of an immersive virtual reality cancellation task assessing far space in unilateral spatial neglect. J Neuropsychol 2024; 18:300-311. [PMID: 37942647 DOI: 10.1111/jnp.12353] [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: 07/17/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
Unilateral spatial neglect (USN) is a highly prevalent neuropsychological syndrome. However, its assessment in clinical practice, mainly based on paper-and-pencil tests, encounters limits as only near space, called peripersonal, is assessed. However, USN is a multicomponent syndrome that can also affect far space, called extrapersonal. This space is not assessed in current clinical assessment although it can be more impacted than peripersonal space. Immersive virtual reality (VR) allows developing tasks in far space to assess this heterogeneity. This study aimed to test the feasibility and the relevance of an immersive VR task to assess far space. A cancellation task, the Bells test, was used in its original paper-and-pencil version and was also adapted into a far immersive VR version. Ten patients with left USN and sixteen age-matched healthy participants were included. A single-case method was performed to investigate the performance of each patient. Although five patients showed very similar results between both versions, the five others exhibited a dissociation with a more severe impairment in the VR version. Three of these five patients significantly differed from the healthy participants only on the VR version. As USN in far space is not brought to light by paper-and-pencil tests, immersive VR appears as a promising tool to detect USN affecting this space.
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Affiliation(s)
- A Guilbert
- Laboratoire Vision Action Cognition (VAC), Université Paris Cité, Boulogne-Billancourt, France
| | - T-G Bara
- Centre d'Etudes et De Recherche en Informatique et Communications (CEDRIC), Conservatoire National des Arts et Métiers (CNAM), Paris, France
| | - T Bouchara
- Laboratoire Interdisciplinaire des Sciences du Numérique (LISN), Université Paris-Saclay, Orsay, France
| | - M Gaffard
- Laboratoire Vision Action Cognition (VAC), Université Paris Cité, Boulogne-Billancourt, France
- Hôpitaux de Saint-Maurice, Soins de Suite et Réadaptation Neurologique, Saint Maurice, France
| | - C Bourlon
- Hôpitaux de Saint-Maurice, Soins de Suite et Réadaptation Neurologique, Saint Maurice, France
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Painter DR, Norwood MF, Marsh CH, Hine T, Harvie D, Libera M, Bernhardt J, Gan L, Zeeman H. Immersive virtual reality gameplay detects visuospatial atypicality, including unilateral spatial neglect, following brain injury: a pilot study. J Neuroeng Rehabil 2023; 20:161. [PMID: 37996834 PMCID: PMC10668447 DOI: 10.1186/s12984-023-01283-9] [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: 05/26/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries. METHODS In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds. RESULTS The study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients-those with and without neglect. CONCLUSION Our research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect.
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Affiliation(s)
- David R Painter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
| | - Michael F Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia.
| | - Chelsea H Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Trevor Hine
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Daniel Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University South Australia, Adelaide, SA, Australia
| | - Marilia Libera
- Psychology Department, Logan Hospital, Logan, QLD, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Leslie Gan
- Rehabilitation Unit, Logan Hospital, Meadowbrook, QLD, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
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Bosma MS, Caljouw MAA, Achterberg WP, Nijboer TCW. Prevalence, Severity and Impact of Visuospatial Neglect in Geriatric Stroke Rehabilitation, a Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1798-1805. [PMID: 37634546 DOI: 10.1016/j.jamda.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Visuospatial neglect (VSN) is a common cognitive deficit of lateralized attention after stroke and can have a negative influence on patients' daily activities, community participation, and caregiver burden. VSN prevalence has been investigated in several mixed-age populations, but rarely in only an older population. As the population in geriatric rehabilitation (GR) is understudied and VSN may influence rehabilitation goals in GR (return home), we examined the prevalence of VSN as well as associations between VSN (severity) and population characteristics and the impact of VSN on functioning, length of stay, and discharge destination after GR. DESIGN Multicenter cross-sectional study. SETTING AND PARTICIPANTS Stroke patients admitted to GR. METHODS Three VSN tests (Star cancelation task, Line bisection task, and Catherine Bergego Scale) were administered in the first 2 weeks of GR admission. To examine VSN severity, a composite score was calculated based on scores of the 3 tests. RESULTS A total of 114 stroke patients were included [55.3% female; mean age 80.2 (SD 8.0) years]. VSN prevalence was 47.4%, in which allocentric and egocentric neglect were more prevalent than VSN during activities of daily living. Participants with VSN spent more days in GR compared to participants without VSN (median 68.5 vs 35.5 days) and had fewer home returns. In addition, VSN participants showed less mobility, lower cognitive functioning, and less independence during self-care compared to participants without VSN. Mobility, self-care, cognition, duration of rehabilitation, and home return were negatively associated with VSN severity. CONCLUSIONS AND IMPLICATIONS VSN is very prevalent in the GR stroke population. VSN severely hampers older people during daily activities and their rehabilitation process and, therefore, has a major personal and societal impact. Accordingly, systematic assessment of VSN in the early phase of geriatric rehabilitation with multiple VSN screening tests is recommended.
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Affiliation(s)
- Martine S Bosma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Zorggroep Florence, Rijswijk, the Netherlands; University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands.
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Tanja C W Nijboer
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
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7
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Ten Brink AF, van Heijst M, Portengen BL, Naber M, Strauch C. Uncovering the (un)attended: Pupil light responses index persistent biases of spatial attention in neglect. Cortex 2023; 167:101-114. [PMID: 37542802 DOI: 10.1016/j.cortex.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 08/07/2023]
Abstract
Visuospatial neglect is a frequent and disabling disorder, mostly after stroke, that presents in impaired awareness to stimuli on one side of space. Neglect causes disability and functional dependence, even long after the injury. Improving measurements of the core attentional deficit might hold the key for better understanding of the condition and development of treatment. We present a rapid, pupillometry-based method that assesses automatic biases in (covert) attention, without requiring behavioral responses. We exploit the phenomenon that pupil light responses scale with the degree of covert attention to stimuli, and thereby reveal what draws (no) attention. Participants with left-sided neglect after right-sided lesions following stroke (n = 5), participants with hemianopia/quadrantanopia following stroke (n = 11), and controls (n = 22) were presented with two vertical bars, one of which was white and one of which was black, while fixating the center. We varied which brightness was left and right, respectively across trials. In line with the hypotheses, participants with neglect demonstrated biased pupil light responses to the brightness on the right side. Participants with hemianopia showed similar biases to intact parts of the visual field, whilst controls exhibited no bias. Together, this demonstrates that the pupil light response can reveal not only visual, but also attentional deficits. Strikingly, our pupillometry-based bias estimates were not in agreement with neuropsychological paper-and-pencil assessments conducted on the same day, but were with those administered in an earlier phase post-stroke. Potentially, we pick up on persistent biases in the covert attentional system that participants increasingly compensate for in classical neuropsychological tasks and everyday life. The here proposed method may not only find clinical application, but also advance theory and aid the development of successful restoration therapies by introducing a precise, longitudinally valid, and objective measurement that might not be affected by compensation.
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Affiliation(s)
- Antonia F Ten Brink
- Utrecht University, Experimental Psychology, Helmholtz Institute, Utrecht, the Netherlands
| | - Marlies van Heijst
- Utrecht University, Experimental Psychology, Helmholtz Institute, Utrecht, the Netherlands
| | - Brendan L Portengen
- Utrecht University, Experimental Psychology, Helmholtz Institute, Utrecht, the Netherlands; University Medical Center Utrecht, Ophthalmology, Utrecht, the Netherlands
| | - Marnix Naber
- Utrecht University, Experimental Psychology, Helmholtz Institute, Utrecht, the Netherlands
| | - Christoph Strauch
- Utrecht University, Experimental Psychology, Helmholtz Institute, Utrecht, the Netherlands.
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8
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Shin JH, Kim M, Lee JY, Kim MY, Jeon YJ, Kim K. Feasibility of hemispatial neglect rehabilitation with virtual reality-based visual exploration therapy among patients with stroke: randomised controlled trial. Front Neurosci 2023; 17:1142663. [PMID: 37152602 PMCID: PMC10157074 DOI: 10.3389/fnins.2023.1142663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Background Hemispatial neglect (HSN) was diagnosed using a virtual reality-based test (FOPR test) that explores the field of perception (FOP) and field of regard (FOR). Here, we developed virtual reality-visual exploration therapy (VR-VET) combining elements from the FOPR test and visual exploration therapy (VET) and examined its efficacy for HSN rehabilitation following stroke. Methods Eleven participants were randomly assigned to different groups, training with VR-VET first then waiting without VR-VET training (TW), or vice versa (WT). The TW group completed 20 sessions of a VR-VET program using a head-mounted display followed by 4 weeks of waiting, while the WT group completed the opposite regimen. Clinical HSN measurements [line bisection test (LBT), star cancellation test (SCT), Catherine Bergego Scale (CBS), CBS perceptual-attentional (CBS-PA), and CBS motor-explanatory (CBS-ME)] and FOPR tests [response time (RT), success rate (SR), and head movement (HM) for both FOP and FOR] were assessed by blinded face-to-face assessments. Results Five and six participants were allocated to the TW and WT groups, respectively, and no dropout occurred throughout the study. VR-VET considerably improved LBT scores, FOR variables (FOR-RT, FOR-SR), FOP-LEFT variables (FOP-LEFT-RT, FOP-LEFT-SR), and FOR-LEFT variables (FOR-LEFT-RT, FOR-LEFT-SR) compared to waiting without VR-VET. Additionally, VR-VET extensively improved FOP-SR, CBS, and CBS-PA, where waiting failed to make a significant change. The VR-VET made more improvements in the left hemispace than in the right hemispace in FOP-RT, FOP-SR, FOR-RT, and FOR-SR. Conclusion The observed improvements in clinical assessments and FOPR tests represent the translatability of these improvements to real-world function and the multi-dimensional effects of VR-VET training. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03463122, identifier NCT03463122.
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Affiliation(s)
- Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Mingyu Kim
- Department of Computer Science, Hanyang University, Seoul, Republic of Korea
| | - Ji-Yeong Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Mi-Young Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Yu-Jin Jeon
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Kwanguk Kim
- Department of Computer Science, Hanyang University, Seoul, Republic of Korea
- *Correspondence: Kwanguk Kim,
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Giannakou I, Lin D, Punt D. Computer-based assessment of unilateral spatial neglect: A systematic review. Front Neurosci 2022; 16:912626. [PMID: 36061603 PMCID: PMC9437703 DOI: 10.3389/fnins.2022.912626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background To date, no gold standard exists for the assessment of unilateral spatial neglect (USN), a common post-stroke cognitive impairment, with limited sensitivity provided by currently used clinical assessments. Extensive research has shown that computer-based (CB) assessment can be more sensitive, but these have not been adopted by stroke services yet. Objective We conducted a systematic review providing an overview of existing CB tests for USN to identify knowledge gaps and positive/negative aspects of different methods. This review also investigated the benefits and barriers of introducing CB assessment tasks to clinical settings and explored practical implications for optimizing future designs. Methodology We included studies that investigated the efficacy of CB neglect assessment tasks compared to conventional methods in detecting USN for adults with brain damage. Study identification was conducted through electronic database searches (e.g., Scopus), using keywords and standardized terms combinations, without date limitation (last search: 08/06/2022). Literature review and study selection were based on prespecified inclusion criteria. The quality of studies was assessed with the quality assessment of diagnostic accuracy studies tool (Quadas-2). Data synthesis included a narrative synthesis, a table summarizing the evidence, and vote counting analysis based on a direction of effect plot. Results A total of 28 studies met the eligibility criteria and were included in the review. According to our results, 13/28 studies explored CB versions of conventional tasks, 11/28 involved visual search tasks, and 5/28 other types of tasks. The vote counting analysis revealed that 17/28 studies found CB tasks had either equal or higher sensitivity than conventional methods and positive correlation with conventional methods (15/28 studies). Finally, 20/28 studies showed CB tasks effectively detected patients with USN within different patient groups and control groups (17/28). Conclusions The findings of this review provide practical implications for the implementation of CB assessment in the future, offering important information to enhance a variety of methodological issues. The study adds to our understanding of using CB tasks for USN assessment, exploring their efficacy and benefits compared to conventional methods, and considers their adoption in clinical environments.
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Affiliation(s)
- Ioanna Giannakou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Dan Lin
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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10
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Cavedoni S, Cipresso P, Mancuso V, Bruni F, Pedroli E. Virtual reality for the assessment and rehabilitation of neglect: where are we now? A 6-year review update. VIRTUAL REALITY 2022; 26:1663-1704. [PMID: 35669614 PMCID: PMC9148943 DOI: 10.1007/s10055-022-00648-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/24/2022] [Indexed: 06/13/2023]
Abstract
Unilateral spatial neglect (USN) is a frequent repercussion of a cerebrovascular accident, typically a stroke. USN patients fail to orient their attention to the contralesional side to detect auditory, visual, and somatosensory stimuli, as well as to collect and purposely use this information. Traditional methods for USN assessment and rehabilitation include paper-and-pencil procedures, which address cognitive functions as isolated from other aspects of patients' functioning within a real-life context. This might compromise the ecological validity of these procedures and limit their generalizability; moreover, USN evaluation and treatment currently lacks a gold standard. The field of technology has provided several promising tools that have been integrated within the clinical practice; over the years, a "first wave" has promoted computerized methods, which cannot provide an ecological and realistic environment and tasks. Thus, a "second wave" has fostered the implementation of virtual reality (VR) devices that, with different degrees of immersiveness, induce a sense of presence and allow patients to actively interact within the life-like setting. The present paper provides an updated, comprehensive picture of VR devices in the assessment and rehabilitation of USN, building on the review of Pedroli et al. (2015). The present paper analyzes the methodological and technological aspects of the studies selected, considering the issue of usability and ecological validity of virtual environments and tasks. Despite the technological advancement, the studies in this field lack methodological rigor as well as a proper evaluation of VR usability and should improve the ecological validity of VR-based assessment and rehabilitation of USN.
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Affiliation(s)
- S. Cavedoni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - P. Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, TO Italy
| | - V. Mancuso
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - F. Bruni
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - E. Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, eCampus University, Novedrate, Italy
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11
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Williams LJ, Kernot J, Hillier SL, Loetscher T. Spatial Neglect Subtypes, Definitions and Assessment Tools: A Scoping Review. Front Neurol 2021; 12:742365. [PMID: 34899565 PMCID: PMC8653914 DOI: 10.3389/fneur.2021.742365] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: The objective of this scoping review was to capture the reported definitions for the subtypes of neglect post stroke and map the range of assessment tools employed for each neglect subtype. Methods: EMBASE, Emcare, Medline, and psychINFO were searched from database inception. Searching included all allied terms and mesh headings for stroke, spatial neglect, measurement, screening tools, psychometric properties. Two reviewers independently screened studies for inclusion. Primary studies with documented protocols of a spatial neglect tool for adults post stroke, with some aspect of validity or reliability were included. Two reviewers independently reviewed the documented protocols of each tool to determine the underlying subtypes and disagreements were resolved through discussion. Results: There were 371 articles included with 292 tools used for the screening or diagnosis of neglect. The majority of studies (67%) included a tool that did not specify the neglect subtype being assessed, therefore an analysis of the underlying subtypes for each tool is presented. Conclusions: There is no consistency with the terms used to refer to the syndrome of spatial neglect with over 200 different terms used within the included studies to refer to the syndrome as a whole or one of its subtypes. It is essential to unify the terminology and definition for each neglect subtype. There are hundreds of neglect tools available, however many are not able to differentiate presenting subtypes. It is important for clinicians and researchers to critically evaluate the neglect tools being used for the screening and diagnosis of neglect.
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Affiliation(s)
- Lindy J Williams
- Cognitive Aging and Impairment Neurosciences Lab, University of South Australia, Adelaide, SA, Australia.,Innovation IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, SA, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Jocelyn Kernot
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Susan L Hillier
- Innovation IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, SA, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Tobias Loetscher
- Cognitive Aging and Impairment Neurosciences Lab, University of South Australia, Adelaide, SA, Australia.,Justice and Society, University of South Australia, Adelaide, SA, Australia
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12
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Gomes Paiva AF, Sorrentino G, Bignami B, Kemlin C, Gueorguieva S, Pradat-Diehl P, Thoumie P, Bayen E. Feasibility of assessing post-stroke neglect with eye-tracking glasses during a locomotion task. Ann Phys Rehabil Med 2021; 64:101436. [PMID: 33049400 DOI: 10.1016/j.rehab.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 10/20/2022]
Affiliation(s)
- Ana Flavia Gomes Paiva
- Department of Physical Rehabilitation Medicine, Sorbonne Université, Rothschild hospital AP-HP, Paris, France; Université Paris-Est Créteil, UFR SESS-STAPS, Créteil, France
| | - Gregorio Sorrentino
- Department of Physical Rehabilitation Medicine, Sorbonne Université GRC24, Pitié-Salpêtrière hospital AP-HP, Paris, France
| | - Blaise Bignami
- Department of Physical Rehabilitation Medicine, Sorbonne Université GRC24, Pitié-Salpêtrière hospital AP-HP, Paris, France
| | - Claire Kemlin
- Department of Physical Rehabilitation Medicine, Sorbonne Université GRC24, Pitié-Salpêtrière hospital AP-HP, Paris, France
| | - Sofia Gueorguieva
- Department of Physical Rehabilitation Medicine, Sorbonne Université GRC24, Pitié-Salpêtrière hospital AP-HP, Paris, France
| | - Pascale Pradat-Diehl
- Department of Physical Rehabilitation Medicine, Sorbonne Université GRC24, Pitié-Salpêtrière hospital AP-HP, Paris, France; Laboratoire d'Imagerie Biomédicale (LIB) Inserm U1146, Paris, France
| | - Philippe Thoumie
- Department of Physical Rehabilitation Medicine, Sorbonne Université, Rothschild hospital AP-HP, Paris, France; Agathe Isir Lab Inserm U1150, Paris, France
| | - Eleonore Bayen
- Department of Physical Rehabilitation Medicine, Sorbonne Université GRC24, Pitié-Salpêtrière hospital AP-HP, Paris, France; Laboratoire d'Imagerie Biomédicale (LIB) Inserm U1146, Paris, France; Global Brain Health Institute, Memory and Aging Center, University of California San Francisco, San Francisco, USA.
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13
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Effects of Prism Adaptation on Unilateral Neglect After Stroke: An Updated Meta-Analysis of Randomized Controlled Trials. Am J Phys Med Rehabil 2021; 100:259-265. [PMID: 33595938 DOI: 10.1097/phm.0000000000001557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of prism adaptation (PA) on unilateral neglect after stroke. METHODS Randomized clinical trials, published up to January 31, 2020, comparing PA with neutral goggles or no goggles were systematically searched and included. Two independent reviewers performed data extraction and assessed the quality of studies using the Physiotherapy Evidence Database scale. RESULTS A total of seven randomized trials, involving 211 participants, satisfied the inclusion criteria. There was no significant immediate benefit of PA as measured by Behavioral Inattention Test (BIT) (weighted mean difference [WMD], 5.10; [95% confidence interval (CI), -6.68 to 16.88]), behavioral subset (BIT-B; WMD, 3.40 [95% CI, -3.97 to 10.76), conventional subset (BIT-C; WMD, 9.98 [95% CI, -0.42 to 20.38]), and Catherine Bergego Scale (WMD, -0.52 [95% CI, -1.98 to 0.93]). No statistical difference was observed between PA and control on the long-term effect (BIT: WMD, 1.92 [95% CI, -9.34 to 13.18]; BIT-B: WMD, -3.28 [95% CI, -11.89 to 5.34]; BIT-C: WMD, 2.66 [95% CI, -10.35 to 11.67]; Catherine Bergego Scale: WMD, -1.22 [95% CI, -3.05 to 0.62]). CONCLUSIONS PA did not show a greater improvement on neglect symptoms in post-stroke patients with unilateral neglect, compared with placebo or no treatment. These findings do not support the routine use of PA in patients with unilateral neglect after stroke.
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14
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Embrechts E, Van Criekinge T, Schröder J, Nijboer T, Lafosse C, Truijen S, Saeys W. The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review. Ann Phys Rehabil Med 2020; 64:101449. [PMID: 33152521 DOI: 10.1016/j.rehab.2020.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although previous narrative reviews have highlighted a potential association between visuospatial neglect (VSN) and balance disorders, to what extent different areas of balance and mobility could be affected is still unclear. OBJECTIVES This systematic review updates previous literature findings and systematically reviews sitting balance, standing balance and mobility outcomes. METHODS PubMed, Web of Science, ScienceDirect, Naric-Rehabdata, PEDro and the Cochrane Trials Library were systematically searched. Methodological quality was assessed by the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The association between VSN and sitting balance, standing balance and mobility (walking, stair climbing/descending and transfers) was investigated. RESULTS In total, 48 studies were included (4595 stroke survivors): at least 1319 (29%) showed symptoms of VSN. VSN was associated with less independence during sitting, with an asymmetric posture toward the affected body side. For standing balance, we revealed a significant negative association between VSN and mediolateral stability and weight shifting, whereas only activities of daily living-related VSN was associated with weight-bearing asymmetry during static stance. While walking, patients with VSN laterally deviated from their path. Results were inconclusive regarding other aspects of mobility. The association between VSN and balance/mobility seemed to decrease over time. CONCLUSIONS Despite great heterogeneity in results, this study suggests that stroke survivors with VSN show specific deviations in posture and movement in the mediolateral direction. Although the association between VSN and balance/mobility has been extensively investigated, explanatory studies evaluating underlying mechanisms of the frequently present association are lacking. Future studies should address this by combining clinical and instrumented assessment of balance and gait performance, preferably longitudinally to investigate the associations over time.
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Affiliation(s)
- Elissa Embrechts
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium.
| | - Tamaya Van Criekinge
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Jonas Schröder
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Tanja Nijboer
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Christophe Lafosse
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Steven Truijen
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Wim Saeys
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
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15
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Fisher G, Quel de Oliveira C, Verhagen A, Gandevia S, Kennedy D. Proprioceptive impairment in unilateral neglect after stroke: A systematic review. SAGE Open Med 2020; 8:2050312120951073. [PMID: 32913649 PMCID: PMC7444113 DOI: 10.1177/2050312120951073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/24/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Unilateral neglect is a debilitating condition that can occur after stroke and can affect a variety of domains and modalities, including proprioception. Proprioception is a sensorimotor process essential to motor function and is thus important to consider in unilateral neglect. To date, there has not been a comprehensive review of studies examining the various aspects of proprioceptive impairment in unilateral neglect after stroke. This review aimed to determine if people with unilateral neglect have more severe proprioceptive impairments than those without unilateral neglect after stroke. Methods: The MEDLINE, Embase, Scopus, CINAHL and Web of Science databases were searched from inception to September 2019 using an a priori search strategy. Two independent reviewers screened abstracts and full texts, and extracted data from the included full texts. A third reviewer resolved disagreements at each step. Risk of bias was assessed using the AXIS Quality Assessment tool. Results: A total of 191 abstracts were identified, with 56 eligible for full-text screening. A total of 18 studies were included in the review and provided evidence that people with unilateral neglect have more severe proprioceptive impairment than people without unilateral neglect. This impairment is present in multiple subtypes of unilateral neglect and aspects of proprioception. Most studies had a moderate risk of bias. Conclusion: People with unilateral neglect after stroke are more likely to have impaired processing of multiple types of proprioceptive information than those without unilateral neglect. However, the available evidence is limited by the large heterogeneity of assessment tools used to identify unilateral neglect and proprioception. Unilateral neglect and proprioception were rarely assessed comprehensively. PROSPERO Registration: CRD42018086070.
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Affiliation(s)
- Georgia Fisher
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Simon Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, Sydney, NSW, Australia
| | - David Kennedy
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
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16
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Spreij LA, Ten Brink AF, Visser-Meily JM, Nijboer TC. Increasing cognitive demand in assessments of visuo-spatial neglect: Testing the concepts of static and dynamic tests. J Clin Exp Neuropsychol 2020; 42:675-689. [DOI: 10.1080/13803395.2020.1798881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lauriane A. Spreij
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Antonia F. Ten Brink
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
- Department of Psychology, University of Bath, Bath, UK
| | - Johanna M.A. Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tanja C.W. Nijboer
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
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17
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Knobel SEJ, Kaufmann BC, Gerber SM, Cazzoli D, Müri RM, Nyffeler T, Nef T. Immersive 3D Virtual Reality Cancellation Task for Visual Neglect Assessment: A Pilot Study. Front Hum Neurosci 2020; 14:180. [PMID: 32528265 PMCID: PMC7263018 DOI: 10.3389/fnhum.2020.00180] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/22/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Unilateral spatial neglectis an attention disorder frequently occurring after a right-hemispheric stroke. Neglect results in a reduction in qualityof life and performance in activities of daily living. With current technical improvements in virtual reality (VR) technology, trainingwith stereoscopic head-mounted displays (HMD) has become a promising new approach for the assessment and the rehabilitation of neglect. The focus of this pilot study was to develop and evaluate a simple visual search task in VR for HMD. The VR system was tested regarding feasibility, acceptance, and potential adverse effects in healthy controls and right-hemispheric stroke patients with and without neglect. Methods: The VR system consisted of two main components, a head-mounted display to present the virtual environment, and a hand-held controller for the interaction with the latter. The task followed the rationale of diagnostic paper-pencil cancellation tasks; i.e., the participants were asked to search targets among distractors. However, instead of a two-dimensional setup, the targets and distractors were arranged in three dimensions, in a sphere around the subject inside its field of view. Usability and acceptance of the task, as well as the performance in the latter, were tested in 15 right-hemispheric subacute stroke patients (10 of whom with and five of whom without unilateral spatial neglect; mean age: 67.1 ± 10.5 years) and 35 age-matched healthy controls. Results: System usability and acceptance were rated as high both in stroke patients and healthy controls, close to the maximum score of the questionnaire scale. No relevant adverse effects occurred. There was a high correlation (r = 0.854, p = 0.002) between the Center of Cancellation [an objective neglect measure) calculated from a paper-pencil cancellation task (Sensitive Neglect Test (SNT)] and the newly developed VR cancellation task. Conclusion: Overall, the developed visual search task in the tested VR system is feasible, well-accepted, enjoyable, and does not evoke any significant negative effects, both for healthy controls and for stroke patients. Findings for task performance show that the ability of the VR cancellation to detect neglect in stroke patients is similar to paper-pencil cancellation tasks.
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Affiliation(s)
- Samuel E J Knobel
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Brigitte C Kaufmann
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stephan M Gerber
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René M Müri
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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18
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Hreha K, Chen P, LaRosa J, Santos C, Gocon C, Barrett A. Implementing a Rehabilitation Protocol for Spatial Neglect Assessment and Treatment in an Acute Care Hospital. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Stone A, Cooke D, Morton D, Steele M. Reliability of revised scoring methods for the Schenkenberg Line Bisection Test with adults following stroke: Preliminary findings. Br J Occup Ther 2019. [DOI: 10.1177/0308022619866377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Stone
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Deirdre Cooke
- School of Allied Health, Australian Catholic University, Brisbane, Australia
- Mater Private Hospital Rehabilitation Unit, Brisbane, Australia
| | - Deborah Morton
- Mater Private Hospital Rehabilitation Unit, Brisbane, Australia
| | - Michael Steele
- School of Allied Health, Australian Catholic University, Brisbane, Australia
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20
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Whitehouse CE, Green J, Giles SM, Rahman R, Coolican J, Eskes GA. Development of the Halifax Visual Scanning Test: A New Measure of Visual-Spatial Neglect for Personal, Peripersonal, and Extrapersonal Space. J Int Neuropsychol Soc 2019; 25:1-11. [PMID: 30990154 DOI: 10.1017/s135561771900002x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Visual-spatial neglect is a common attentional disorder after right-hemisphere stroke and is associated with poor rehabilitation outcomes. The presence of neglect symptoms has been reported to vary across personal, peripersonal, and extrapersonal space. Currently, no measure is available to assess neglect severity equally across these spatial regions and may be missing subsets of symptoms or patients with neglect entirely. We sought to provide initial construct validity for a novel assessment tool that measures neglect symptoms equally for these spatial regions: the Halifax Visual Scanning Test (HVST). METHODS In Study I, the HVST was compared to conventional measures of neglect and functional outcome scores (wheelchair navigation) in 15 stroke inpatients and 14 healthy controls. In Study II, 19 additional controls were combined with the control data from Study I to establish cutoffs for impairment. Patterns of neglect in the stroke group were examined. RESULTS In Study I, performance on all HVST subtests were correlated with the majority of conventional subtests and wheelchair navigation outcomes. In Study II, neglect-related deficits in visual scanning showed dissociations across spatial regions. Four inpatients exhibited symptoms of neglect on the HVST that were not detected on conventional measures, one of which showed symptoms in personal and extrapersonal space exclusively. CONCLUSIONS The HVST appears a useful measure of neglect symptoms in different spatial regions that may not be detected with conventional measures and that correlates with functional wheelchair performance. Preliminary control data are presented and further research to add to this normative database appears warranted.
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Affiliation(s)
| | - Janet Green
- 1Department of Psychology and Neuroscience,Dalhousie University,Nova Scotia
| | - Sarah M Giles
- 2Department of Family Medicine,University of Ottawa,Ottawa,Canada
| | - Rosanna Rahman
- 3Capital and Coast District Health Board,Wellington Regional Hospital,New Zealand
| | | | - Gail A Eskes
- 1Department of Psychology and Neuroscience,Dalhousie University,Nova Scotia
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21
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Mancuso M, Damora A, Abbruzzese L, Navarrete E, Basagni B, Galardi G, Caputo M, Bartalini B, Bartolo M, Zucchella C, Carboncini MC, Dei S, Zoccolotti P, Antonucci G, De Tanti A. A New Standardization of the Bells Test: An Italian Multi-Center Normative Study. Front Psychol 2019; 9:2745. [PMID: 30723446 PMCID: PMC6350444 DOI: 10.3389/fpsyg.2018.02745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/19/2018] [Indexed: 12/01/2022] Open
Abstract
Objective: The Bells Test is a cancelation task that is widely used for the diagnosis of unilateral spatial neglect (USN). With the aim of fostering more reliable use of this instrument, we set out to develop new norms adjusted for the possible influence of age, gender and education. We worked on the original version of the test. Methods: Normative data were collected from 401 healthy participants aged between 20 and 80 years. Individual factors that could affect performance (i.e., gender, age, and years of education) were considered. We computed several indices on the Bells Test including an asymmetry score, an accuracy score and execution time. Multiple regression analyses (for time measures) and generalized linear models (for accuracy measures) were used to check for the influence of individual predictors of performance on the Bells Test. Results: Data indicated a significant influence of age on the accuracy score and execution time variables and a marginally significant effect of education on the accuracy score variable. Wherever appropriate, cut-offs are provided for the three dependent scores on the Bells Test corrected for age and education. Conclusion: Based on a large normative sample, the present study provides new normative data on the Bells Test, which could lead to its reliable use in the diagnosis of USN.
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Affiliation(s)
- Mauro Mancuso
- Tuscany Rehabilitation Clinic, Arezzo, Italy.,National Health Service, Azienda USL Toscana Sud Est, Siena, Italy
| | | | | | - Eduardo Navarrete
- Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | | | | | | | - Brunella Bartalini
- Department of Rehabilitation, Azienda USL Toscana Nord Ovest, Camaiore, Italy
| | | | | | | | - Simona Dei
- National Health Service, Azienda USL Toscana Sud Est, Siena, Italy
| | - Pierluigi Zoccolotti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Centre, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Centre, Santa Lucia Foundation IRCCS, Rome, Italy
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22
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Nardo D, De Luca M, Rotondaro F, Spanò B, Bozzali M, Doricchi F, Paolucci S, Macaluso E. Left hemispatial neglect and overt orienting in naturalistic conditions: Role of high-level and stimulus-driven signals. Cortex 2019; 113:329-346. [PMID: 30735844 DOI: 10.1016/j.cortex.2018.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/08/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022]
Abstract
Deficits of visuospatial orienting in brain-damaged patients affected by hemispatial neglect have been extensively investigated. Nonetheless, spontaneous spatial orienting in naturalistic conditions is still poorly understood. Here, we investigated the role played by top-down and stimulus-driven signals in overt spatial orienting of neglect patients during free-viewing of short videos portraying everyday life situations. In Experiment 1, we assessed orienting when meaningful visual events competed on the left and right side of space, and tested whether sensory salience on the two sides biased orienting. In Experiment 2, we examined whether the spatial alignment of visual and auditory signals modulates orienting. The results of Experiment 1 showed that in neglect patients severe deficits in contralesional orienting were restricted to viewing conditions with bilateral visual events competing for attentional capture. In contrast, orienting towards the contralesional side was largely spared when the videos contained a single event on the left side. In neglect patients the processing of stimulus-driven salience was relatively spared and helped orienting towards the left side when multiple events were present. Experiment 2 showed that sounds spatially aligned with visual events on the left side improved orienting towards the otherwise neglected hemispace. Anatomical scans indicated that neglect patients suffered grey and white matter damages primarily in the ventral frontoparietal cortex. This suggests that the improvement of contralesional orienting associated with visual salience and audiovisual spatial alignment may be due to processing in the relatively intact dorsal frontoparietal areas. Our data show that in naturalistic environments, the presence of multiple meaningful events is a major determinant of spatial orienting deficits in neglect patients, whereas the salience of visual signals and the spatial alignment between auditory and visual signals can counteract spatial orienting deficits. These results open new perspectives to develop novel rehabilitation strategies based on the use of naturalistic stimuli.
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Affiliation(s)
- Davide Nardo
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Maria De Luca
- Neuropsychology Unit, Santa Lucia Foundation, Rome, Italy
| | - Francesca Rotondaro
- Neuropsychology Unit, Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University, Rome, Italy
| | - Barbara Spanò
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy; Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, East Sussex, UK
| | - Fabrizio Doricchi
- Neuropsychology Unit, Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University, Rome, Italy
| | | | - Emiliano Macaluso
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy; ImpAct Team, Lyon Neuroscience Research Center, Lyon, France
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23
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Bower K, Thilarajah S, Pua YH, Williams G, Tan D, Mentiplay B, Denehy L, Clark R. Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. J Neuroeng Rehabil 2019; 16:3. [PMID: 30612584 PMCID: PMC6322221 DOI: 10.1186/s12984-018-0478-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12 months following rehabilitation discharge. METHODS A prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63 years; median 24 days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars. RESULTS Over 12 months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P < 0.001-0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P < 0.040; IQR-odds ratio(OR) = 1.37-7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P = 0.001-0.018; IQR-OR = 5.28-10.29). CONCLUSIONS Reduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.
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Affiliation(s)
- Kelly Bower
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Shamala Thilarajah
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Sippy Downs, 4556, Australia.,Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Gavin Williams
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Physiotherapy, Epworth HealthCare, Richmond, VIC, 3121, Australia
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Benjamin Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, 3086, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ross Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Sippy Downs, 4556, Australia
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Puig-Pijoan A, Giralt-Steinhauer E, Zabalza de Torres A, Manero Borràs RM, Sánchez-Benavides G, García Escobar G, Pérez Enríquez C, Gómez-González A, Ois Á, Rodríguez-Campello A, Cuadrado-Godía E, Jiménez-Conde J, Peña-Casanova J, Roquer J. Underdiagnosis of Unilateral Spatial Neglect in stroke unit. Acta Neurol Scand 2018; 138:441-446. [PMID: 30058181 DOI: 10.1111/ane.12998] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/16/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Unilateral spatial neglect (USN) is the incapacity to respond to stimuli presented opposite to a dysfunctional cerebral hemisphere. It is usually caused by non-dominant hemisphere lesions, leads to poorer prognosis and might be underdiagnosed. The objectives of the study were to ascertain the presence of USN in acute stroke patients and analyze the possible degree of underdiagnosis in a Stroke Unit. MATERIALS AND METHODS Prospective study of consecutive non-dominant hemisphere stroke patients within a period of 21 months. "Line Bisection" and "Triangles Cancellation" tests were used for USN screening and "Circle Gap Detection Task" to confirm the USN. The results were compared with routine Stroke Unit assessment using the NIHSS to determine the possible degree of underdiagnosis. RESULTS A total of 62 subjects, 38 women (61.29%), mean age of 74.05 (SD 10.5) years, were included. USN was diagnosed in 25 cases (40.3%) but 56% of them were not detected in routine evaluation using the NIHSS. CONCLUSIONS Unilateral spatial neglect, a common cognitive deficit after acute stroke, is greatly underdiagnosed in routine Stroke Unit assessment. The use of simple USN-specific screening tools would improve diagnosis and therefore the possibility of implementing appropriate rehabilitation strategies.
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Affiliation(s)
- Albert Puig-Pijoan
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Eva Giralt-Steinhauer
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rosa Maria Manero Borràs
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Greta García Escobar
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Carmen Pérez Enríquez
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Alejandra Gómez-González
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
| | - Ángel Ois
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Rodríguez-Campello
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godía
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Jiménez-Conde
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Peña-Casanova
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Cotoi A, Mirkowski M, Iruthayarajah J, Anderson R, Teasell R. The effect of theta-burst stimulation on unilateral spatial neglect following stroke: a systematic review. Clin Rehabil 2018; 33:183-194. [PMID: 30370790 DOI: 10.1177/0269215518804018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To evaluate the effectiveness of theta-burst stimulation for the treatment of stroke-induced unilateral spatial neglect. DATA SOURCES: A systematic literature search was conducted from the inception of each database to 30 June 2018 using CINAHL, EMBASE, PubMed, PsycINFO, and Scopus. REVIEW METHODS: Articles were included if theta-burst stimulation was used to treat neglect following a stroke. The additional a priori inclusion criteria were as follows: (1) ⩾3 adult (⩾18 years) participants, (2) ⩾50% stroke population, and (3) peer-reviewed journal articles published in English. Extracted data included study and treatment characteristics, results, and adverse events. RESULTS: Nine studies met the inclusion criteria, generating a total of 148 participants. Eight studies evaluated a continuous stimulation protocol and one study investigated an intermittent stimulation protocol. Overall, both protocols significantly improved neglect severity when compared against placebo or active controls ( P < 0.05). Adding smooth pursuit training to theta-burst stimulation did not improve neglect relative to when the stimulation was delivered alone ( P > 0.05). There was inconsistent reporting of neglect terminology, outcome measures, and adverse events. The treatment characteristics were heterogeneous among the trials. CONCLUSION: This systematic review found that theta-burst stimulation seems to improve post-stroke unilateral spatial neglect, but because the evidence is limited to a few small studies with varied and inconsistent protocols and use of terminology, no firm conclusion on effectiveness can be drawn.
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Affiliation(s)
- Andreea Cotoi
- 1 Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada
| | - Magdalena Mirkowski
- 1 Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada
| | - Jerome Iruthayarajah
- 1 Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada
| | - Rachel Anderson
- 1 Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada
| | - Robert Teasell
- 1 Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada
- 2 Parkwood Institute, St Joseph's Health Care London, London, ON, Canada
- 3 Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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Pierce J, Saj A. A critical review of the role of impaired spatial remapping processes in spatial neglect. Clin Neuropsychol 2018; 33:948-970. [DOI: 10.1080/13854046.2018.1503722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jordan Pierce
- Department of Neurosciences, University of Geneva, Geneva, Switzerland
| | - Arnaud Saj
- Department of Neurosciences, University of Geneva, Geneva, Switzerland
- Department of Neurology, University Hospital of Geneva, Geneva, Switzerland
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Pitteri M, Chen P, Passarini L, Albanese S, Meneghello F, Barrett AM. Conventional and functional assessment of spatial neglect: Clinical practice suggestions. Neuropsychology 2018; 32:835-842. [PMID: 29975073 PMCID: PMC6188804 DOI: 10.1037/neu0000469] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Spatial neglect (SN) constitutes a substantial barrier to functional recovery after acquired brain injury. However, because of its multimodal nature, no single test can capture all the signs of SN. To provide a clinically feasible solution, we used conventional neuropsychological tests as well as the Catherine Bergego Scale (CBS) via the Kessler Foundation Neglect Assessment Process (KF-NAP). The goal was to add evidence that a global approach should detect better even subtle signs of SN. METHOD Fourteen individuals with lesions located in the right cerebral hemisphere participated in the study. Participants were assessed with a comprehensive battery of neuropsychological tests, comprising a set of visuospatial tests to evaluate several spatial domains. In addition, patients underwent functional assessment with the Barthel Index, the Functional Independence Measure (FIM), and the CBS via KF-NAP. RESULTS The CBS via KF-NAP was associated with the visuospatial paper-based tests (p = .004) as well as the Motor FIM (p = .003), and was more sensitive than the Behavioral Inattention Test-Conventional in detecting SN (p = .014). CONCLUSIONS We showed that the CBS via KF-NAP was able: (a) to detect functional impairment, especially motor, related to SN; (b) to selectively measures spatial rather than nonspatial dysfunctions; and (c) to be highly sensitive in detecting SN signs especially in those patients with mild severity, covering several aspects of SN manifestations. The patient's SN diagnosis based on the CBS via KF-NAP is clinically important and directly relevant to care planning and goal setting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona
| | | | - Laura Passarini
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital Foundation
| | - Silvia Albanese
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital Foundation
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Ogourtsova T, Archambault P, Sangani S, Lamontagne A. Ecological Virtual Reality Evaluation of Neglect Symptoms (EVENS): Effects of Virtual Scene Complexity in the Assessment of Poststroke Unilateral Spatial Neglect. Neurorehabil Neural Repair 2018; 32:46-61. [DOI: 10.1177/1545968317751677] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Unilateral spatial neglect (USN) is a highly prevalent and disabling poststroke impairment. USN is traditionally assessed with paper-and-pencil tests that lack ecological validity, generalization to real-life situations and are easily compensated for in chronic stages. Virtual reality (VR) can, however, counteract these limitations. Objective. We aimed to examine the feasibility of a novel assessment of USN symptoms in a functional shopping activity, the Ecological VR-based Evaluation of Neglect Symptoms (EVENS). Methods. EVENS is immersive and consists of simple and complex 3-dimensional scenes depicting grocery shopping shelves, where joystick-based object detection and navigation tasks are performed while seated. Effects of virtual scene complexity on navigational and detection abilities in patients with (USN+, n = 12) and without (USN−, n = 15) USN following a right hemisphere stroke and in age-matched healthy controls (HC, n = 9) were determined. Results. Longer detection times, larger mediolateral deviations from ideal paths and longer navigation times were found in USN+ versus USN− and HC groups, particularly in the complex scene. EVENS detected lateralized and nonlateralized USN-related deficits, performance alterations that were dependent or independent of USN severity, and performance alterations in 3 USN− subjects versus HC. Conclusion. EVENS’ environmental changing complexity, along with the functional tasks of far space detection and navigation can potentially be clinically relevant and warrant further empirical investigation. Findings are discussed in terms of attentional models, lateralized versus nonlateralized deficits in USN, and tasks-specific mechanisms.
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Affiliation(s)
- Tatiana Ogourtsova
- McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Philippe Archambault
- McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Samir Sangani
- Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Anouk Lamontagne
- McGill University, Montreal, Quebec, Canada
- Jewish Rehabilitation Hospital, Laval, Quebec, Canada
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Abstract
Unilateral spatial neglect is a disabling neurologic deficit, most frequent and severe after right-hemispheric lesions. In most patients neglect involves the left side of space, contralateral to a right-hemispheric lesion. About 50% of stroke patients exhibit neglect in the acute phase. Patients fail to orient, respond to, and report sensory events occurring in the contralateral sides of space and of the body, to explore these portions of space through movements by action effectors (eye, limbs), and to move the contralateral limbs. Neglect is a multicomponent higher-level disorder of spatial awareness, cognition, and attention. Spatial neglect may occur independently of elementary sensory and motor neurologic deficits, but it can mimic and make them more severe. Diagnostic tests include: motor exploratory target cancellation; setting the midpoint of a horizontal line (bisection), that requires the estimation of lateral extent; drawing by copy and from memory; reading, assessing neglect dyslexia; and exploring the side of the body contralateral to the lesion. Activities of daily living scales are also used. Patients are typically not aware of neglect, although they may exhibit varying degrees of awareness toward different components of the deficit. The neural correlates include lesions to the inferior parietal lobule of the posterior parietal cortex, which was long considered the unique neuropathologic correlate of neglect, to the premotor and to the dorsolateral prefrontal cortices, to the posterior superior temporal gyrus, at the temporoparietal junction, to subcortical gray nuclei (thalamus, basal ganglia), and to parietofrontal white-matter fiber tracts, such as the superior longitudinal fascicle. Damage to the inferior parietal lobule of the posterior parietal cortex is specifically associated with the mainly egocentric, perceptual, and exploratory extrapersonal, and with the personal, bodily components of neglect. Productive manifestations, such as perseveration, are not a correlate of posterior parietal cortex damage.
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Klinke ME, Hjaltason H, Tryggvadóttir GB, Jónsdóttir H. Hemispatial neglect following right hemisphere stroke: clinical course and sensitivity of diagnostic tasks. Top Stroke Rehabil 2017; 25:120-130. [DOI: 10.1080/10749357.2017.1394632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marianne E. Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Haukur Hjaltason
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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31
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Grech M, Stuart T, Williams L, Chen C, Loetscher T. The Mobility Assessment Course for the Diagnosis of Spatial Neglect: Taking a Step Forward? Front Neurol 2017; 8:563. [PMID: 29163331 PMCID: PMC5671563 DOI: 10.3389/fneur.2017.00563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
Spatial neglect after stroke can be a challenging syndrome to diagnose under standard neuropsychological assessment. There is now sufficient evidence that those affected might demonstrate neglect behavior in everyday settings despite showing no signs of neglect during common neglect tasks. This discrepancy is attributed to the simplified and unrealistic nature of common pen and paper based tasks that do not match the demanding, novel, and complex environment of everyday life. As such, increasing task demands under more ecologically valid scenarios has become an important method of increasing test sensitivity. The main aim of the current study was to evaluate the diagnostic utility of the Mobility Assessment Course (MAC), an ecological task, for the assessment of neglect. If neglect becomes more apparent under more challenging task demands the MAC could prove to be more diagnostically accurate at detecting neglect than conventional methods, particularly as the time from initial brain damage increases. Data collected by Guide Dogs of SA/NT were retrospectively analyzed. The Receiver Operating Characteristic (ROC) curve, a measure of sensitivity and specificity, was used to investigate the diagnostic utility of the MAC and a series of paper and pencil tests in 67 right hemisphere stroke survivors. While the MAC proved to be a more sensitive neglect test (74.2%) when compared to the Star Cancellation (43.3%) and Line Bisection (35.7%) tests, this was at the expense of relatively low specificity. As a result, the ROC curve analysis showed no statistically discernable differences between tasks (p > 0.12), or between subacute and chronic groups for individual tasks (p > 0.45). It is concluded that, while the MAC is an ecologically valid alternative for assessing neglect, regarding its diagnostic accuracy, there is currently not enough evidence to suggest that it is a big step forward in comparison to the accuracy of conventional tests.
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Affiliation(s)
- Megan Grech
- School of Psychology, Social Work, and Social Policy, University of South Australia, Adelaide, SA, Australia
| | | | - Lindy Williams
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders University, Adelaide, SA, Australia
| | - Tobias Loetscher
- School of Psychology, Social Work, and Social Policy, University of South Australia, Adelaide, SA, Australia
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32
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Subramanian SK, Feldman AG, Levin MF. Spasticity may obscure motor learning ability after stroke. J Neurophysiol 2017; 119:5-20. [PMID: 28904099 DOI: 10.1152/jn.00362.2017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Previous motor learning studies based on adapting movements of the hemiparetic arm in stroke subjects have not accounted for spasticity occurring in specific joint ranges (spasticity zones), resulting in equivocal conclusions about learning capacity. We compared the ability of participants with stroke to rapidly adapt elbow extension movements to changing external load conditions outside and inside spasticity zones. Participants with stroke ( n = 12, aged 57.8 ± 9.6 yr) and healthy age-matched controls ( n = 8, 63.5 ± 9.1 yr) made rapid 40°-50° horizontal elbow extension movements from an initial (3°) to a final (6°) target. Sixteen blocks (6-10 trials/block) consisting of alternating loaded (30% maximal voluntary contraction) and nonloaded trials were made in one (controls) or two sessions (stroke; 1 wk apart). For the stroke group, the tonic stretch reflex threshold angle at which elbow flexors began to be activated during passive elbow extension was used to identify the beginning of the spasticity zone. The task was repeated in joint ranges that did or did not include the spasticity zone. Error correction strategies were identified by the angular positions before correction and compared between groups and sessions. Changes in load condition from no load to load and vice versa resulted in undershoot and overshoot errors, respectively. Stroke subjects corrected errors in 1-4 trials compared with 1-2 trials in controls. When movements did not include the spasticity zone, there was an immediate decrease in the number of trials needed to restore accuracy, suggesting that the capacity to learn may be preserved after stroke but masked by the presence of spasticity. NEW & NOTEWORTHY When arm movements were made outside, instead of inside, the range affected by spasticity, there was an immediate decrease in the number of trials needed to restore accuracy in response to a change in the external load. This suggests that motor learning processes may be preserved in patients with stroke but masked by the presence of spasticity in specific joint ranges. This has important implications for designing rehabilitation interventions predicated on motor learning principles.
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Affiliation(s)
- Sandeep K Subramanian
- Département de Neurosciences, Université de Montréal , Montreal, Quebec , Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital (research site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal) , Laval, Quebec , Canada
| | - Anatol G Feldman
- Département de Neurosciences, Université de Montréal , Montreal, Quebec , Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital (research site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal) , Laval, Quebec , Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University , Montreal, Quebec , Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital (research site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal) , Laval, Quebec , Canada
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33
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Grattan ES, Woodbury ML. Do Neglect Assessments Detect Neglect Differently? Am J Occup Ther 2017; 71:7103190050p1-7103190050p9. [PMID: 28422631 DOI: 10.5014/ajot.2017.025015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We determined whether various assessment tools detect neglect differently by administering a battery of assessments to people with stroke. METHOD We conducted a case series study and administered five neglect assessments (paper-and-pencil, functional, virtual reality) to participants poststroke. RESULTS Twelve participants (6 men, 6 women) with stroke completed the assessment battery, which required approximately 2 hr to administer (over one to two sessions). All participants demonstrated neglect on three or more assessments. Functional assessments and the virtual reality assessment detected neglect more frequently than the paper-and-pencil assessments. Participants performed differently on the paper-and-pencil assessments and functional assessments. CONCLUSION Because neglect is complex, detection may depend largely on the assessment administered.
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Affiliation(s)
- Emily S Grattan
- Emily S. Grattan, PhD, OTR/L, is Postdoctoral Scholar, Department of Health Science and Research, Medical University of South Carolina, Charleston;
| | - Michelle L Woodbury
- Michelle L. Woodbury, PhD, OTR/L, is Associate Professor, Department of Health Science and Research, Division of Occupational Therapy, Medical University of South Carolina, Charleston, and Research Health Scientist, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
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Alt Murphy M, Baniña MC, Levin MF. Perceptuo-motor planning during functional reaching after stroke. Exp Brain Res 2017; 235:3295-3306. [PMID: 28803362 PMCID: PMC5649389 DOI: 10.1007/s00221-017-5058-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/04/2017] [Indexed: 11/28/2022]
Abstract
In healthy young adults, reaching movements are planned such that the initial grasp position on the object is modulated based on the final task goal. This perceptuo-motor coupling has been described as the end-state comfort effect. This study aimed to determine the extent to which visuo-perceptual and motor deficits, but not neglect, due to stroke impact end-state comfort measured as the grasp-height effect. Thirty-four older adults (17 controls, 17 chronic stroke) performed a functional goal-directed two-sequence task with each arm, consisting of reaching and moving a cylindrical object (drain plunger) from an initial to four target platform heights, standardized to body height, in a block randomized sequence. Arm motor impairment (Fugl-Meyer Assessment) and visual–perceptual deficits (Motor-Free Visual Perception Test) were assessed in stroke subjects, and arm and trunk kinematics were assessed in all subjects. The primary outcome measure of the grasp-height effect was the relationship between the grasp heights used at the home position and the final target platform heights. Mixed model analysis was used for data analysis. The grasp-height effect was present in all participants, but decreased in stroke subjects with visuo-perceptual impairments compared to controls. In stroke subjects with sensorimotor impairments alone, indicated by altered kinematics, the grasp-height effect was comparable to controls. This first study examining the grasp-height effect in individuals with stroke provides new knowledge of the impact of visuo-perceptual deficits on movement planning and execution, which may assist clinicians in selecting more effective treatment strategies to improve perceptuo-motor skills and enhance motor recovery.
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Affiliation(s)
- Margit Alt Murphy
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, Plan 3, 41345, Gothenburg, Sweden. .,Center for Interdisciplinary Research in Rehabilitation (CRIR), McGill University, Montreal, QC, Canada.
| | - Melanie C Baniña
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), McGill University, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), McGill University, Montreal, QC, Canada
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Cerrato A, Ponticorvo M. Enhancing Neuropsychological Testing with Gamification and Tangible Interfaces: The Baking Tray Task. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/978-3-319-59773-7_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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36
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Trejo-Gabriel-Galan JM, Rogel-Melgosa V, Gonzalez S, Sedano J, Villar JR, Arenaza-Basterrechea N. Rehabilitation of hemineglect of the left arm using movement detection bracelets activating a visual and acoustic alarm. J Neuroeng Rehabil 2016; 13:79. [PMID: 27590188 PMCID: PMC5009713 DOI: 10.1186/s12984-016-0191-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemineglect is frequent after right hemisphere stroke and prevents functional independence, but effective rehabilitation interventions are lacking. Our objective was to determine if a visual-acoustic alarm in the hemineglect arm activated by a certain discrepancy in movement of both hands can enhance neglect arm use in five tasks of daily living. METHODS In this pre-post intervention study 9 stroke patients with residual hemineglect of the arm were trained for 7 days in five bimanual tasks of daily living: carrying a tray, button fastening, cutting food with knife and fork, washing the face with both hands and arm sway while walking. This was done through motion sensors mounted in bracelets on both wrists that compared movement between them. When the neglect-hand movement was less than a limit established by two fuzzy logic based classifiers, a visual-acoustic alarm in the neglect-hand bracelet was activated to encourage its use in the task. RESULTS Both motion and function of the neglect hand improved during the seven days of training when visual-acoustic alarms were active but a worsening to baseline values occurred on day 8 and day 30 when alarms where switched off. Improvement was limited to vision-dependent tasks. CONCLUSIONS Neglect-hand improvement with this approach is limited to bimanual activities in which an object is manipulated under vision control, but no short or long term learning happens.
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Affiliation(s)
| | - V Rogel-Melgosa
- Hospital Universitario de Burgos, Ave. Islas Baleares 3, 09006, Burgos, Spain
| | - S Gonzalez
- Instituto Tecnológico de Castilla y León, Burgos, Spain
| | - J Sedano
- Instituto Tecnológico de Castilla y León, Burgos, Spain
| | - J R Villar
- Computer Science Department, Universidad de Oviedo, Oviedo, Spain
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37
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Grattan ES, Lang CE, Birkenmeier R, Holm M, Rubinstein E, Van Swearingen J, Skidmore ER. Examining the Feasibility, Tolerability, and Preliminary Efficacy of Repetitive Task-Specific Practice for People With Unilateral Spatial Neglect. Am J Occup Ther 2016; 70:7004290020p1-8. [PMID: 27294994 DOI: 10.5014/ajot.2016.019471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the feasibility, tolerability, and preliminary efficacy of repetitive task-specific practice for people with unilateral spatial neglect (USN). METHOD People with USN ≥6 mo poststroke participated in a single-group, repeated-measures study. Attendance, total repetitions, and satisfaction indicated feasibility and pain indicated tolerability. Paired t tests and effect sizes were used to estimate changes in upper-extremity use (Motor Activity Log), function (Action Research Arm Test), and attention (Catherine Bergego Scale). RESULTS Twenty participants attended 99.4% of sessions and completed a high number of repetitions. Participants reported high satisfaction and low pain, and they demonstrated small, significant improvements in upper-extremity use (before Bonferroni corrections; t = -2.1, p = .04, d = .30), function (t = -3.0, p < .01, d = .20), and attention (t = -3.4, p < .01, d = -.44). CONCLUSION Repetitive task-specific practice is feasible and tolerable for people with USN. Improvements in upper-extremity use, function, and attention may be attainable.
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Affiliation(s)
- Emily S Grattan
- Emily S. Grattan, PhD, OTR/L, is Postdoctoral Scholar, Department of Health Science and Research, Medical University of South Carolina, Charleston;
| | - Catherine E Lang
- Catherine E. Lang, PT, PhD, is Professor, Program in Physical Therapy and Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Rebecca Birkenmeier
- Rebecca Birkenmeier, OTD, OTR/L, is Assistant Professor, Program of Occupational Therapy, Maryville University, St. Louis, MO
| | - Margo Holm
- Margo Holm, PhD, OTR/L, is Professor Emerita, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Elaine Rubinstein
- Elaine Rubinstein, PhD, is Lecturer, Department of Psychology, Chatham University, and Senior Service Fellow, Office of Mine Safety and Health Research, Bruceton Research Center, National Institute for Occupational Safety and Health, Pittsburgh, PA
| | - Jessie Van Swearingen
- Jessie Van Swearingen, PT, PhD, is Associate Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth R Skidmore
- Elizabeth R. Skidmore, PhD, OTR/L, is Associate Professor and Chair, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Azouvi P. The ecological assessment of unilateral neglect. Ann Phys Rehabil Med 2016; 60:186-190. [PMID: 26830087 DOI: 10.1016/j.rehab.2015.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
Conventional paper-and-pencil tests of unilateral neglect are of limited ecological validity. To address this issue, a number of assessment procedures have been proposed to provide clinicians and researchers with more ecologically valid assessments of unilateral neglect, which may be useful to plan rehabilitation and to measure the generalization of the effects of rehabilitation to daily life. We present here an overview of the different assessment measures available in the literature. The most widely used scales are the Behavioural Inattention Test (BIT), the semi-structured scales for assessment of personal and extra-personal neglect, the Subjective Neglect Questionnaire, the Baking Tray Task, the wheelchair obstacle course, the ADL-based neglect battery, and the Catherine Bergego Scale (CBS). The CBS is probably, to date, the most widely used behavioural assessment instrument for unilateral neglect. It has been found to be reliable, valid, and sensitive to change during rehabilitation. It also enables the assessment of awareness of the consequences of unilateral neglect in daily life skills.
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Affiliation(s)
- Philippe Azouvi
- AP-HP, hôpital Raymond-Poincaré, service de médecine physique et de réadaptation, 92380 Garches, France; EA 4047 HANDIReSP, université Versailles - Saint-Quentin, UFR des sciences de la santé - Simone-Veil, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France.
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Klinke ME, Hjaltason H, Hafsteinsdóttir TB, Jónsdóttir H. Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study. Disabil Rehabil 2016; 38:2429-44. [DOI: 10.3109/09638288.2015.1130176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marianne E. Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Haukur Hjaltason
- Neurological Department, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thóra B. Hafsteinsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Linder SM, Rosenfeldt AB, Bay RC, Sahu K, Wolf SL, Alberts JL. Improving Quality of Life and Depression After Stroke Through Telerehabilitation. Am J Occup Ther 2015; 69:6902290020p1-10. [PMID: 26122686 DOI: 10.5014/ajot.2015.014498] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the effects of home-based robot-assisted rehabilitation coupled with a home exercise program compared with a home exercise program alone on depression and quality of life in people after stroke. METHOD A multisite randomized controlled clinical trial was completed with 99 people<6 mo after stroke who had limited access to formal therapy. Participants were randomized into one of two groups, (1) a home exercise program or (2) a robot-assisted therapy+home exercise program, and participated in an 8-wk home intervention. RESULTS We observed statistically significant changes in all but one domain on the Stroke Impact Scale and the Center for Epidemiologic Studies Depression Scale for both groups. CONCLUSION A robot-assisted intervention coupled with a home exercise program and a home exercise program alone administered using a telerehabilitation model may be valuable approaches to improving quality of life and depression in people after stroke.
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Affiliation(s)
- Susan M Linder
- Susan M. Linder, PT, DPT, NCS, is Physical Therapist and Research Scientist, Department of Biomedical Engineering and Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH
| | - Anson B Rosenfeldt
- Anson B. Rosenfeldt, PT, DPT, MBA, is Physical Therapist, Department of Biomedical Engineering and Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH
| | - R Curtis Bay
- R. Curtis Bay, PhD, is Biostatistician, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ
| | - Komal Sahu
- Komal Sahu, MPH, OTR/L, is Occupational Therapist, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Steven L Wolf
- Steven L. Wolf, PhD, PT, FAPTA, FAHA, is Physical Therapist and Professor, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, and Senior Research Scientist, Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
| | - Jay L Alberts
- Jay L. Alberts, PhD, is Vice Chair, Health Enablement Technology, Neurological Institute, and Staff, Department of Biomedical Engineering and Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH;
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Klinke ME, Zahavi D, Hjaltason H, Thorsteinsson B, Jónsdóttir H. "Getting the Left Right": The Experience of Hemispatial Neglect After Stroke. QUALITATIVE HEALTH RESEARCH 2015; 25:1623-1636. [PMID: 25563629 DOI: 10.1177/1049732314566328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We used a phenomenological approach to gain insight into the experiences of self, other, and world in patients with hemispatial neglect within the first month following stroke. Comprehensive descriptions of circumstances were conjoined with open-ended interviews of 12 participants. The neglect experience was captured in the overarching theme, "getting the left right," which encompasses the two subthemes of (a) surreal awareness of the left and (b) emergence of a different world. Patients had unclear perceptions of their own body and surroundings, their attention was brittle, and they encountered bewildering reactions from other people. They simultaneously pursued the ineffable neglected space and searched for coherence. The vulnerability, loss, and conflicting perceptions that patients with neglect face should be acknowledged and alleviation sought. Facilitating methods should provide additional opportunities for patients to communicate their experiences. We underscore the importance of readjusting the current approaches of neglect and emphasizing meaningfulness in professional guidance.
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Affiliation(s)
- Marianne E Klinke
- University of Iceland, Reykjavik, Iceland The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Haukur Hjaltason
- University of Iceland, Reykjavik, Iceland The National University Hospital of Iceland, Reykjavik, Iceland
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Cunningham LJ, O'Rourke K, Finlay C, Gallagher M. A preliminary investigation into the psychometric properties of the Dublin Extrapersonal Neglect Assessment (DENA): A novel screening tool for extrapersonal neglect. Neuropsychol Rehabil 2015; 27:349-368. [DOI: 10.1080/09602011.2015.1084334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chen P, Goedert KM, Shah P, Foundas AL, Barrett AM. Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment. Brain Imaging Behav 2015; 8:346-58. [PMID: 22941243 DOI: 10.1007/s11682-012-9200-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prism adaptation treatment (PAT) is a promising rehabilitative method for functional recovery in persons with spatial neglect. Previous research suggests that PAT improves motor-intentional "aiming" deficits that frequently occur with frontal lesions. To test whether presence of frontal lesions predicted better improvement of spatial neglect after PAT, the current study evaluated neglect-specific improvement in functional activities (assessment with the Catherine Bergego Scale) over time in 21 right-brain-damaged stroke survivors with left-sided spatial neglect. The results demonstrated that neglect patients' functional activities improved after two weeks of PAT and continued improving for four weeks. Such functional improvement did not occur equally in all of the participants: Neglect patients with lesions involving the frontal cortex (n = 13) experienced significantly better functional improvement than did those without frontal lesions (n = 8). More importantly, voxel-based lesion-behavior mapping (VLBM) revealed that in comparison to the group of patients without frontal lesions, the frontal-lesioned neglect patients had intact regions in the medial temporal areas, the superior temporal areas, and the inferior longitudinal fasciculus. The medial cortical and subcortical areas in the temporal lobe were especially distinguished in the "frontal lesion" group. The findings suggest that the integrity of medial temporal structures may play an important role in supporting functional improvement after PAT.
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Affiliation(s)
- Peii Chen
- Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA,
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Stein MS, Kilbride C, Reynolds FA. What are the functional outcomes of right hemisphere stroke patients with or without hemi-inattention complications? A critical narrative review and suggestions for further research. Disabil Rehabil 2015; 38:315-28. [PMID: 25893401 PMCID: PMC4720036 DOI: 10.3109/09638288.2015.1037865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: There is widespread acceptance that patients demonstrating neglect/hemi-inattention (HI) following right hemisphere stroke (RHS) underachieve functionally compared to their counterparts without neglect. However, empirical evidence for this view needs examination. The purpose of this review is to critically appraise relevant studies that compared outcomes from RHS patients with/without hemi-attention and suggest more robust follow-up research. Method: Twelve studies published in 1995–2013 were critically reviewed. Two independent reviewers appraised design features including sample representation, assessment and data analysis methods. Strengths and limitations were highlighted. Results: Results were largely inconsistent. Considerable heterogeneity within patient groups and across studies complicated interpretation. Evidence suggested average group disparity in scores between patients with and without HI at discharge but the cause of functional disparity could not be attributed specifically to HI from the data and modelling results available. Conclusion: The relationship between HI status and functional recovery warrants further investigation in studies with stronger methodology to ensure rigour and robustness in the results. Pending further research, HI status should not be regarded as a key predictor of functional recovery or rehabilitation potential in patients with RHSs. This group should continue to receive appropriate therapeutic intervention aimed at maximising their functional recovery post-stroke.Implications for Rehabilitation Findings from this review demonstrate a paucity of evidence to support the presence of hemi-inattention as a key predictor of functional recovery in patients with right hemisphere stroke; as such, practitioners should take this into consideration when planning rehabilitation programmes of their patients. In the initial months following right hemisphere stroke, there are wide-ranging differences in the rate and amount of functional recovery in patients, with and without hemi-inattention. Practitioners should not limit the aspirations of their patients based on the presence or absence of hemi-inattention. This review has identified a number of measurement limitations in commonly employed assessment tools for hemi-inattention and overall functional recovery. As such, practitioners should take the limitations of specific measures into account when interpreting the results contextually and with respect to their patients’ situation.
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Affiliation(s)
| | - Cherry Kilbride
- a Department of Clinical Sciences , Brunel University , London , UK
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Abstract
PURPOSE Loss of independent community ambulation is one of the most disabling consequences of stroke. The aim of this study was to investigate the association of multiple personal and post-stroke factors with community ambulation in persons between 1- and 3-year post-stroke. METHODS This was a cross-sectional study of 40 community-dwelling stroke patients, >18 years, between 1- and 3-year post-stroke. The main outcome measures used were self-report community ambulation questionnaire, demographic information, 10-M Walk Test, Timed Up and Go test, Activities-Specific Balance Confidence Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Trail-Making Test-Part B, Single Letter Cancellation Test. RESULTS Age, number of medications and use of a walking aid were found to be significantly associated with community ambulation (p ≤ 0.05). Gait speed, walking balance and balance self-efficacy were also found to be significantly associated with community ambulation (p ≤ 0.05). Balance self-efficacy was the only factor independently associated with community ambulation post-stroke (p ≤ 0.05). CONCLUSION Balance self-efficacy may be a significant determinant in the attainment of independent community ambulation post-stroke. This suggests that physical aspects such as gait speed and walking balance should not be considered in isolation when addressing community ambulation post-stroke. IMPLICATIONS FOR REHABILITATION Balance self-efficacy may play a significant role in the attainment of independent community ambulation in a chronic stroke population. Physiotherapy interventions addressing community ambulation post-stroke should consider methods for improving balance self-efficacy in chronic stroke, such as self management programmes.
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Affiliation(s)
- Sarah Durcan
- a Stroke Rehabilitation Team, Baggot Street Community Hospital , Dublin , Ireland and
| | - Evelyn Flavin
- a Stroke Rehabilitation Team, Baggot Street Community Hospital , Dublin , Ireland and
| | - Frances Horgan
- b School of Physiotherapy, Royal College of Surgeons in Ireland , Dublin , Ireland
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Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility. Arch Phys Med Rehabil 2015; 96:1458-66. [PMID: 25862254 DOI: 10.1016/j.apmr.2015.03.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. DESIGN Inception cohort. SETTING Inpatient rehabilitation facility (IRF). PARTICIPANTS Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP). INTERVENTIONS Usual and standard IRF care. MAIN OUTCOME MEASURES The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition. RESULTS The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. CONCLUSIONS Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS.
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47
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Impaired visual sensitivity within the ipsilesional hemifield following parietal lobe damage. Cortex 2013; 49:158-71. [DOI: 10.1016/j.cortex.2011.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 04/12/2011] [Accepted: 07/21/2011] [Indexed: 11/18/2022]
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48
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Chen P, Hreha K, Fortis P, Goedert KM, Barrett AM. Functional assessment of spatial neglect: a review of the Catherine Bergego scale and an introduction of the Kessler foundation neglect assessment process. Top Stroke Rehabil 2012; 19:423-35. [PMID: 22982830 PMCID: PMC3445290 DOI: 10.1310/tsr1905-423] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Spatial neglect is a debilitating poststroke neurocognitive disorder associated with prolonged hospitalization and poor rehabilitation outcomes. The literature suggests a high prevalence of this disorder, but clinicians have difficulty reliably identifying affected survivors. This discrepancy may result from suboptimal use of validated neglect assessment procedures. In this article, we suggest use of a validated assessment tool that is sensitive to identification of neglect and its functional consequences - the Catherine Bergego Scale (CBS). We provide detailed item-by-item instructions for observation and scoring - the Kessler Foundation Neglect Assessment Process (KF-NAP). Rehabilitation researchers may be able to use the CBS via the KF-NAP to measure ecological outcomes and specific, separable perceptual-attentional and motor-exploratory spatial behaviors.
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Affiliation(s)
- Peii Chen
- Kessler Foundation Research Center, West Orange, New Jersey
- Department of Physical Medicine & Rehabilitation, University of Medicine and Dentistry of New Jersey – New Jersey Medical School (UMDNJ-NJMS), Newark, New Jersey
- Graduate School of Biomedical Sciences, UMDNJ-NJMS, Newark, New Jersey
| | - Kimberly Hreha
- Kessler Institute for Rehabilitation, West Orange, New Jersey
- Department of Occupational Therapy, Columbia University, New York, New York
- Movement Science and Education/Kinesiology Program, Teachers College, Columbia University, New York, New York
| | - Paola Fortis
- Center for Neurocognitive Rehabilitation, University of Trento, Rovereto (TN), Italy
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Kelly M. Goedert
- Department of Psychology, Seton Hall University, South Orange, New Jersey
| | - Anna M. Barrett
- Kessler Foundation Research Center, West Orange, New Jersey
- Department of Physical Medicine & Rehabilitation, University of Medicine and Dentistry of New Jersey – New Jersey Medical School (UMDNJ-NJMS), Newark, New Jersey
- Graduate School of Biomedical Sciences, UMDNJ-NJMS, Newark, New Jersey
- Kessler Institute for Rehabilitation, West Orange, New Jersey
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49
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Leibovitch FS, Vasquez BP, Ebert PL, Beresford KL, Black SE. A short bedside battery for visuoconstructive hemispatial neglect: Sunnybrook Neglect Assessment Procedure (SNAP). J Clin Exp Neuropsychol 2012; 34:359-68. [DOI: 10.1080/13803395.2011.645016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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50
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Ogourtsova T, Korner-Bitensky N, Leh SE, Eskes G, Ptito A. Superior colliculi involvement in poststroke unilateral spatial neglect: a pilot study. Top Stroke Rehabil 2012; 18:770-85. [PMID: 22436314 DOI: 10.1310/tsr1806-770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The neural mechanisms underlying unilateral spatial neglect (USN) are unclear. The superior colliculi (SC) may be involved in USN expression, and the spatial summation effect (SSE), where reaction times to bilateral stimuli are faster than to unilateral, may be a behavioral index of SC function. We determined the feasibility of investigating SC contribution to poststroke USN using the SSE in 3 groups. METHODS Seven participants with left near-extrapersonal space USN (USN+) following right hemisphere stroke, 10 without (USN-), and 10 controls were tested under binocular/monocular (right eye patched) conditions while responding to unilateral/bilateral stimuli. Control and USN- groups completed the SSE paradigm. RESULTS Most USN+ participants were unable to initiate the SSE paradigm due to poor visual fi xation and demonstrated higher contrast sensitivity for left-sided stimuli. Controls showed an SSE (under both viewing conditions) while the USN- showed an abnormal SSE whereby reaction times to bilateral stimuli were faster than to unilateral-left but not to unilateral-right stimuli (under both binocular/monocular conditions). CONCLUSION This study is the fi rst to investigate SC contribution in poststroke USN using the SSE; we identifi ed higher contrast sensitivity to left-sided stimuli and poor fi xation in the USN+ group. These fi ndings suggest avenues for research that may lead to novel rehabilitation interventions.
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Affiliation(s)
- Tatiana Ogourtsova
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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