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Aparicio-López C, García-Rudolph A, Rodríguez-Rajo P, Sánchez-Carrión R, Enseñat-Cantallops A, García-Molina A. [Interindividual variability in patients with visuospatial neglect: a retrospective study]. Rev Neurol 2024; 78:327-334. [PMID: 38867681 PMCID: PMC11407465 DOI: 10.33588/rn.7812.2024085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Patients who have suffered a stroke may present with visuospatial neglect (VSN). In clinical practice, different degrees of impairment can be observed among patients with VSN; however, there is no consensus regarding the criteria and tests used to determine them. AIM This study aims to classify patients with VSH based on their level of impairment and to study their response to computerized cognitive training. PATIENTS AND METHODS The sample consisted of 34 patients (19 men and 15 women) with a mean age of 47.59 ± 8.39 years. All patients underwent a neuropsychological exploration protocol composed of specific tests that assess visuospatial attention and others to evaluate multiple cognitive domains. All participants underwent computerized cognitive training consisting of 15 one-hour sessions. RESULTS A cluster analysis was performed that divided the sample into three groups: group 1: mildly affected VSN (n = 17), group 2: moderately affected VSN (n = 11), and group 3: severely affected VSN (n = 6). Statistically significant differences were found in all tests of the visuospatial attention protocol, both in the pre-treatment and post-treatment evaluation. CONCLUSIONS There are different levels of impairment among patients with VSN, differences that persist after applying computerized cognitive training. These results suggest that the evolution of VSN follows a homogeneous pattern linked to the initial level of impairment. These findings, although preliminary, may be relevant to neurorehabilitation professionals.
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Affiliation(s)
- C Aparicio-López
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, España
- Institut Guttmann-Institut Universitari de Neurorrehabilitació-UAB, Badalona, España
| | - A García-Rudolph
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, España
- Institut Guttmann-Institut Universitari de Neurorrehabilitació-UAB, Badalona, España
| | - P Rodríguez-Rajo
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, España
- Institut Guttmann-Institut Universitari de Neurorrehabilitació-UAB, Badalona, España
| | - R Sánchez-Carrión
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, España
- Institut Guttmann-Institut Universitari de Neurorrehabilitació-UAB, Badalona, España
| | - A Enseñat-Cantallops
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, España
- Institut Guttmann-Institut Universitari de Neurorrehabilitació-UAB, Badalona, España
| | - A García-Molina
- Universidad Diego Portales, Santiago de Chile, Chile
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, España
- Institut Guttmann-Institut Universitari de Neurorrehabilitació-UAB, Badalona, España
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Karataş L, Utkan Karasu A, Karataş GK. The effect of offline anosognosia for hemispatial neglect on neglect rehabilitation in patients with subacute and chronic right hemispheric brain injury. A retrospective cohort study. Neuropsychol Rehabil 2024; 34:453-468. [PMID: 37073753 DOI: 10.1080/09602011.2023.2202862] [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: 08/01/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
CLINICAL TRIALS REGISTRATION NUMBER NCT05145855.
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Affiliation(s)
- Levent Karataş
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayça Utkan Karasu
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gülçin Kaymak Karataş
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
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Belger J, Wagner S, Gaebler M, Karnath HO, Preim B, Saalfeld P, Schatz A, Villringer A, Thöne-Otto A. Application of immersive virtual reality for assessing chronic neglect in individuals with stroke: the immersive virtual road-crossing task. J Clin Exp Neuropsychol 2024; 46:254-271. [PMID: 38516790 DOI: 10.1080/13803395.2024.2329380] [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: 06/01/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Neglect can be a long-term consequence of chronic stroke that can impede an individual's ability to perform daily activities, but chronic and discrete forms can be difficult to detect. We developed and evaluated the "immersive virtual road-crossing task" (iVRoad) to identify and quantify discrete neglect symptoms in chronic stroke patients. METHOD The iVRoad task requires crossing virtual intersections and placing a letter in a mailbox placed either on the left or right. We tested three groups using the HTC Vive Pro Eye: (1) chronic right hemisphere stroke patients with (N = 20) and (2) without (N = 20) chronic left-sided neglect, and (3) age and gender-matched healthy controls (N = 20). We analyzed temporal parameters, errors, and head rotation to identify group-specific patterns, and applied questionnaires to measure self-assessed pedestrian behavior and usability. RESULTS Overall, the task was well-tolerated by all participants with fewer cybersickness-induced symptoms after the VR exposure than before. Reaction time, left-sided errors, and lateral head movements for traffic from left most clearly distinguished between groups. Neglect patients committed more dangerous crossings, but their self-rated pedestrian behavior did not differ from that of stroke patients without neglect. This demonstrates their reduced awareness of the risks in everyday life and highlights the clinical relevance of the task. CONCLUSIONS Our findings suggest that a virtual road crossing task, such as iVRoad, has the potential to identify subtle symptoms of neglect by providing virtual scenarios that more closely resemble the demands and challenges of everyday life. iVRoad is an immersive, naturalistic virtual reality task that can measure clinically relevant behavioral variance and identify discrete neglect symptoms.
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Affiliation(s)
- Julia Belger
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sebastian Wagner
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Michael Gaebler
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Patrick Saalfeld
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Anna Schatz
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Arno Villringer
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Berlin School of Mind and Brain, Humboldt University Berlin, Berlin, Germany
| | - Angelika Thöne-Otto
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Grattan ES, Hounshel Smith B, Mullen K, Woodbury ML. Unilateral Spatial Neglect May Not Be Detected by Performance-Based Functional Neglect Assessment. Am J Occup Ther 2024; 78:7802180200. [PMID: 38350038 PMCID: PMC11017738 DOI: 10.5014/ajot.2024.050497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
IMPORTANCE Unilateral spatial neglect (neglect) poststroke is disabling. It is critical that people with neglect are identified so that treatment can be provided to maximize independence. However, there is some evidence to suggest that existing assessments may not adequately measure neglect. It is unclear whether assessments also fail to identify people with neglect entirely. OBJECTIVE To determine whether there are stroke survivors who self-report neglect symptoms that are not detected by therapist-rated assessments and to compare self-report and therapist-ratings. DESIGN Cross-sectional study. SETTING U.S. university research center. PARTICIPANTS Unilateral stroke survivors (N = 133). INTERVENTION Not applicable. OUTCOMES AND MEASURES The Catherine Bergego Scale (CBS) was administered to participants and scored by a trained occupational therapist. The parallel self-evaluation anosognosia form was also administered to participants to self-report and rate neglect symptoms. RESULTS Forty-eight participants (36.1%) were classified as without neglect on the basis of therapist-rated total CBS scores, yet 30 (62.5%) of these 48 participants reported symptoms of neglect on the CBS self-evaluation anosognosia form. There was a significant difference (p < .001) between therapist-rated and self-rated total CBS scores. CONCLUSIONS AND RELEVANCE Our results indicate that many stroke survivors report some level of disability associated with neglect yet do not meet the criteria to be classified as having neglect according to a commonly used therapist-rated performance-based measure. Plain-Language Summary: The findings of this study contribute to the evidence that existing assessments used by occupational therapists to measure performance-based neglect may not always detect neglect symptoms comprehensively in people poststroke. The finding also suggest that we may be missing neglect symptoms entirely. Occupational therapists should consider using various methods to assess for neglect, including patient self-report and comprehensive occupational profiles. Clinicians should also thoroughly screen all clients with stroke for neglect, regardless of lesion location.
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Affiliation(s)
- Emily S Grattan
- Emily S. Grattan, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA; . At the time this research was completed, Grattan was also Research Health Scientist, VA Pittsburgh Healthcare Center, Pittsburgh, PA
| | - Brice Hounshel Smith
- Brice Hounshel Smith, BS, is Research Assistant and Doctor of Occupational Therapy Student, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Katie Mullen
- Katie Mullen, MOT, OTR/L, is Research Occupational Therapist and Doctor of Clinical Science in Occupational Therapy Student, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Michelle L Woodbury
- Michelle L. Woodbury, PhD, OTR/L, is Professor, Department of Health Sciences and Research and Division of Occupational Therapy, Medical University of South Carolina, Charleston
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Hreha K, Singsomphone L, Kaldenberg J, Fielder JP, Watters K, Weden K, Rizzo JR, Roberts P, Wertheimer J, Chen P. Spatial Neglect is Not a Visual Field Defect: A Guide for Clinicians. Arch Phys Med Rehabil 2024; 105:621-626. [PMID: 37552146 DOI: 10.1016/j.apmr.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 08/09/2023]
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Arya KN, Pandian S, Pandey D, Agarwal GG, Chaudhary N. Task-based and Magnified Mirror Therapy for Unilateral Spatial Neglect among post-stroke subjects: Study protocol for a randomized controlled trial. PLoS One 2024; 19:e0296276. [PMID: 38265989 PMCID: PMC10807845 DOI: 10.1371/journal.pone.0296276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Unilateral spatial neglect (USN) is a commonly occurring neurocognitive disability after a stroke. The neglect may affect the motor recovery of the upper and lower limbs and functional performances. Mirror therapy, a simple and economical approach has the potential to reduce the USN and related impairments. AIM The primary objective of this study is to determine the effectiveness of task-based and magnified mirror therapy on the USN and on the motor recovery of the post-stroke subjects. The secondary objective is to investigate the effectiveness of the intervention on the function and disability of the subjects. METHODS In this randomized controlled, assessor-blinded trial, 86 post-stroke subjects will be recruited from the neuro-rehabilitation laboratory of a rehabilitation institute, located in northern India. The participants,aged20 to 80 years, with 1 to 36 months of stroke onset, hemiparesis, and the USN, will be considered eligible for the study. In addition to the conventional rehabilitation, the experimental group(n = 43) will receive 40 sessions (8 weeks) of Task-based and MAGnified Mirror Therapy for Unilateral Spatial Neglect (T-MAGUSN). The control group (n = 43) will undergo a dose-matched conventional program only. The participants will be assessed at baseline, post-intervention and 4-week follow-up using primary (Line Bisection Test, Letter Cancellation Test, and Fugl-Myer Assessment) and secondary (Catherine Bergego Scale, Berg Balance Scale, Functional Ambulation Classification, Modified Rankin Scale) outcome measures. DISCUSSION This proposed study will lead to the development of a novel rehabilitation protocol for the management of USN, aiming to enhance motor and functional recovery. The investigation will consider both the upper and lower limbs for the intervention, reducing the impact of cognitive disability in stroke. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI) as CTRI/2023/05/053184 (www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=74659).
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Divya Pandey
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - G. G. Agarwal
- Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India
| | - Neera Chaudhary
- Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Rich TJ, Palmer J. Neglect dyslexia: whole-word and within-word errors with parafoveal and foveal viewing. Exp Brain Res 2023; 241:2655-2668. [PMID: 37773416 PMCID: PMC10635956 DOI: 10.1007/s00221-023-06708-4] [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: 02/28/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Abstract
Patients with left-sided neglect dyslexia often omit whole words positioned on the left, termed whole-word errors, or commit errors on the left-sided letters of words, termed unilateral paralexias. In addition, the errors have been shown to be exacerbated by simultaneously presented distractors, which has been interpreted as a failure of selective attention. In two experiments, we examined the dependency of these error types on parafoveal versus foveal viewing. The first experiment used a paradigm with parafoveal targets and distractors; the second a paradigm with foveal targets and parafoveal distractors. This enabled a separate evaluation of the influences of stimulus position within an egocentric frame, a two-word allocentric frame, and a within-word allocentric frame. First, regarding whole-word errors, we found the expected spatial and distractor effects with parafoveal targets and distractors. With foveal targets and parafoveal distractors, however, the spatial effect was effectively eliminated. Surprisingly, intrusions from the distractor word were common in distractor conditions. This is consistent with an egocentric account and not a two-word allocentric account. Second, we found that unilateral paralexias remained largely consistent regardless of spatial position or the presence of a distractor. Thus, there is a contrast in spatial and distractor effects between whole-word errors and unilateral paralexias. These results are consistent with three distinct deficits: an egocentric deficit across space resulting in whole-word errors, a failure of selective attention that results in whole-word intrusion errors, and a within-word allocentric deficit resulting in unilateral paralexias.
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Affiliation(s)
- Timothy J Rich
- Center for Stroke Rehabilitation Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, USA.
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Brunswick, NJ, USA.
| | - John Palmer
- Department of Psychology, University of Washington, Seattle, WA, USA
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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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Székely O, Ten Brink AF, Mitchell AG, Bultitude JH, McIntosh RD. No short-term treatment effect of prism adaptation for spatial neglect: An inclusive meta-analysis. Neuropsychologia 2023; 189:108566. [PMID: 37149126 DOI: 10.1016/j.neuropsychologia.2023.108566] [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: 09/28/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
Abstract
Despite 25 years of research on the topic, there is still no consensus on whether prism adaptation is an effective therapy for visuospatial neglect. We have addressed this question through a meta-analysis of the most well-controlled studies on the topic. Our main meta-analytic model included studies with a placebo/sham/treatment-as-usual control group from which data from right hemisphere stroke patients and left-sided neglect could be aggregated. The short-term treatment effects on the two commonly used standard tests for neglect, the conventional Behavioural Inattention Test (BIT-C) and cancellation test scores were combined into one random effect model justified by the fact that 89% of the BIT-C score is determined by cancellation tasks. With this approach, we were able to obtain a larger and more homogeneous dataset than previous meta-analyses: sixteen studies including 430 patients. No evidence for beneficial effects of prism adaptation was found. The secondary meta-analysis including data from the Catherine Bergego Scale, a functional measure of activities of daily living, also found no evidence for the therapeutic effects of prism adaptation, although half as many studies were available for this analysis. The results were consistent after the removal of influential outliers, after studies with high risk-of-bias were excluded, and when an alternative measure of effect size was considered. These results do not support the routine use of prism adaptation as a therapy for spatial neglect.
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Affiliation(s)
- Orsolya Székely
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK; Department of Psychology, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK.
| | - Antonia F Ten Brink
- Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 8, 3584, CS Utrecht, the Netherlands; Department of Psychology, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK; Centre for Pain Research, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK
| | - Alexandra G Mitchell
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK; Center of Functionally Integrative Neuroscience, Aarhus University, 1710, Universitetsbyen 3, 8000, Aarhus, Denmark
| | - Janet H Bultitude
- Department of Psychology, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK; Centre for Pain Research, University of Bath, Claverton Down Road, Bath, Somerset, BA2 7AY, UK
| | - Robert D McIntosh
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
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De Renty C, Forelli F, Mazeas J, Kakavas G, Hewett TE, Korakakis V. Knee Loading With Blood Flow Restriction Can Enhance Recovery After Total Knee Arthroplasty. Cureus 2023; 15:e37895. [PMID: 37214015 PMCID: PMC10199744 DOI: 10.7759/cureus.37895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Total knee arthroplasty (TKA) is one of the most performed operations in the world, especially in the elderly. Aging has a significant effect on joint cartilage, muscle strength, and muscle mass. Following a TKA, despite the significant reduction of symptoms and the improvement in mobility, muscle strength and muscle mass recovery remains a significant challenge. Restrictions that arise from the surgical procedure include joint loading, functional activities, and range of motion, along with limitations related to the age of the individual and their previous loading history, these are the significant restrictions, at least in the early stages of rehabilitation. Evidence indicates that blood flow restriction (BFR) training has significant potential to enhance recovery via implementation of low-load or low-intensity exercise. While respecting the indications and contraindications related to BFR application, the optimization of metabolic stress seems to offer a bridging therapy to heavy load while reducing pain and inflammation. Thus, the combination of BFR and low loads may improve muscular recovery (strength and mass), and aerobic training protocols appear to show significant enhancement of multiple cardiopulmonary parameters. Mounting evidence, direct and indirect, indicate that BFR training may have the potential to benefit the pre-operative and post-operative TKA rehabilitation phases and enhance functional recovery and physical abilities in the elderly.
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Affiliation(s)
- Clément De Renty
- Medicine and Research for High-Performance Sports, Centre Départemental de Formation en Activités Sportives (CDFAS), Eaubonne, FRA
| | - Florian Forelli
- Research and Development, Société Française des Masseurs Kinésithérapeutes du Sport (SFMKS) Lab, Pierrefitte sur Seine, FRA
- Orthopedic Surgery, Clinic of Domont, Domont, FRA
- Sport Medicine, Orthosport Rehab Center, Domont, FRA
| | - Jean Mazeas
- Orthopedic Surgery, Clinic of Domont, Domont, FRA
- Sport Medicine, Orthosport Rehab Center, Domont, FRA
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Messé SR, Kasner SE, Cucchiara BL, McGarvey ML, Cummings S, Acker MA, Desai N, Atluri P, Wang GJ, Jackson BM, Weimer J. Derivation and Validation of an Algorithm to Detect Stroke Using Arm Accelerometry Data. J Am Heart Assoc 2023; 12:e028819. [PMID: 36718858 PMCID: PMC9973644 DOI: 10.1161/jaha.122.028819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Early diagnosis is essential for effective stroke therapy. Strokes in hospitalized patients are associated with worse outcomes compared with strokes in the community. We derived and validated an algorithm to identify strokes by monitoring upper limb movements in hospitalized patients. Methods and Results A prospective case-control study in hospitalized patients evaluated bilateral arm accelerometry from patients with acute stroke with lateralized weakness and controls without stroke. We derived a stroke classifier algorithm from 123 controls and 77 acute stroke cases and then validated the performance in a separate cohort of 167 controls and 33 acute strokes, measuring false alarm rates in nonstroke controls and time to detection in stroke cases. Faster detection time was associated with more false alarms. With a median false alarm rate among nonstroke controls of 3.6 (interquartile range [IQR], 2.1-5.0) alarms per patient per day, the median time to detection was 15.0 (IQR, 8.0-73.5) minutes. A median false alarm rate of 1.1 (IQR. 0-2.2) per patient per day was associated with a median time to stroke detection of 29.0 (IQR, 11.0-58.0) minutes. There were no differences in algorithm performance for subgroups dichotomized by age, sex, race, handedness, nondominant hemisphere involvement, intensive care unit versus ward, or daytime versus nighttime. Conclusions Arm movement data can be used to detect asymmetry indicative of stroke in hospitalized patients with a low false alarm rate. Additional studies are needed to demonstrate clinical usefulness.
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Affiliation(s)
- Steven R. Messé
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPA
| | - Scott E. Kasner
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPA
| | | | | | | | | | - Nimesh Desai
- Department of SurgeryUniversity of PennsylvaniaPhiladelphiaPA
| | - Pavan Atluri
- Department of SurgeryUniversity of PennsylvaniaPhiladelphiaPA
| | - Grace J. Wang
- Department of SurgeryUniversity of PennsylvaniaPhiladelphiaPA
| | | | - James Weimer
- Department of Computer and Information ScienceUniversity of PennsylvaniaPhiladelphiaPA
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Bode LKG, Sprenger A, Helmchen C, Hauptmann B, Münte TF, Machner B. Combined optokinetic stimulation and cueing-assisted reading therapy to treat hemispatial neglect: A randomized controlled crossover trial. Ann Phys Rehabil Med 2023; 66:101713. [PMID: 36645965 DOI: 10.1016/j.rehab.2022.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hemispatial neglect is a disabling cognitive disorder following stroke and effective therapies are required. OBJECTIVES To evaluate the effects of combined optokinetic stimulation (OKS) and cueing-assisted reading therapy (READ) on the remission of hemispatial neglect following stroke. METHODS Randomized, controlled, two-period, crossover trial conducted at a German neurorehabilitation center. Twenty participants with left neglect following right hemispheric stroke (mean age 66 years (SD 11), mean time since stroke 50 days (SD 33)) finished the trial (12 received OKSREAD first, 8 CONTROL first). The intervention consisted of 15 daily sessions of OKS (20 min) and text reading assisted by a therapist providing cues (20 min). The control treatment was a same-number, same-length neuropsychological treatment not targeting visuospatial attention. Primary outcomes were the change in performance of a customized neuropsychological test battery for neglect (0% worst - 100% best) and a test of neglect-related functional disability (Catherine Bergego Scale, 0 no impairment - 30 severest impairment), assessed before and after each treatment period. Secondary outcomes were performance in the 6 single tests composing the battery (e.g., omissions in text reading, center of cancellation in the Bells test, spatial bias of fixations when freely viewing photographs) and a clinical test of anosognosia. RESULTS Overall performance in the neglect test battery improved slightly more after OKSREAD than after CONTROL (d=6%; p=0.002). The remission of neglect-related functional disability did not differ between treatments (d=-2; p=0.291). Ipsilesional fixation bias during free viewing was the only secondary outcome that was improved by OKSREAD as compared to CONTROL (d= -2.8°; p=0.005). CONCLUSION At the applied intensity, the combined OKSREAD intervention slightly attenuated the ipsilesional attention bias in persons with neglect, but it did not improve neglect-related functional disability, anosognosia, or other neglect symptoms to a clinically meaningful degree. CLINICAL TRIAL REGISTRATION URL: http://www. CLINICALTRIALS gov. Unique identifier: NCT04273620.
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Affiliation(s)
- Lisa Kunkel Genannt Bode
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany; Neurological Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Andreas Sprenger
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany; Department of Psychology II, University of Lübeck, Germany
| | - Christoph Helmchen
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany
| | - Björn Hauptmann
- Neurological Center Segeberger Kliniken, Bad Segeberg, Germany; Department Performance, Neuroscience, Therapy and Health, Medical School Hamburg, Germany
| | - Thomas F Münte
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany
| | - Björn Machner
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Germany.
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Diaz-Segarra N, Steenburgh E, Broadley G, Teale A. Prism adaptation treatment improves spatial neglect after severe traumatic brain injury: A case series. NeuroRehabilitation 2023; 53:403-411. [PMID: 37458051 DOI: 10.3233/nre-230064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKROUND Spatial neglect (SN) after traumatic brain injury (TBI) is common, hindering rehabilitation progress and functional outcomes. Most research has focused on SN treatment after stroke with few published instances of post-TBI SN treated using prism adaptation treatment (PAT) in inpatient rehabilitation. OBJECTIVE This case series characterizes the dose, after-effect, and treatment response of PAT in patients with SN after severe TBI. METHODS Six patients exhibiting severe (n = 2), moderate (n = 2), or mild (n = 2) SN after severe TBI received 5 to 10 PAT sessions during their inpatient rehabilitation stay. Functional improvement in SN was measured by the Catherine Bergego Scale (CBS). RESULTS Patients presented with a mean initial CBS score of 16.8 (range: 8.8-24.3). Prism after-effect was present after PAT. Following 5-10 sessions, the mean CBS score improved by 11.6 points to 5.2 (range: 7.8-21.8); the change in initial versus final CBS scores was significant (P = 0.031). CONCLUSION This study is the first to demonstrate prism after-effect and functional SN improvement in individual patients with TBI. Patients showed a clinically meaningful improvement in mild, moderate, and severe SN following 5 to 10 PAT sessions. Additional studies are needed to assess tolerability, benefit, and optimal PAT dose for SN after TBI.
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Affiliation(s)
- Nicole Diaz-Segarra
- Department of Physical Medicine and Rehabilitation, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Emily Steenburgh
- Department of Occupational Therapy, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Gabrielle Broadley
- Department of Occupational Therapy, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Amy Teale
- James A. Eddy Memorial Foundation Research Institute, Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
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Knoppe K, Schlichting N, Schmidt-Wilcke T, Zimmermann E. Increased scene complexity during free visual exploration reveals residual unilateral neglect in recovered stroke patients. Neuropsychologia 2022; 177:108400. [PMID: 36374721 PMCID: PMC9760574 DOI: 10.1016/j.neuropsychologia.2022.108400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/08/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
Unilateral neglect is a common cognitive syndrome after stroke, which is defined as a spatially specific unawareness of the contralesional space. The syndrome is caused by disruptions of attentional networks in the brain, which impair the patients' ability to direct attention towards the contralesional space. During recovery, patients often learn to compensate by voluntarily directing their attention to the neglected side at the expense of cognitive resources. In this study, we examined the impact of the complexity of visual input on free visual exploration behavior of unilateral neglect and apparently recovered patients. We asked whether increasing scene complexity would allow the detection of residual unilateral neglect in recovered patients by increasing the amount of cognitive resources needed for visual processing and limiting capacities for compensation. Using virtual reality, we analyzed the spatial distribution of gaze of unilateral neglect patients, patients who had, according to conventional diagnostics, recovered from the syndrome, stroke patients with no history of unilateral neglect, and age-matched healthy controls. We manipulated the complexity of an immersive virtual scene presented on head mounted displays. We identified the orientation bias towards the ipsilesional side as a sensitive and specific marker of unilateral neglect, which was present in unilateral neglect and recovered patients but absent in stroke patients with no history of unilateral neglect and controls. Increasing scene complexity exacerbated the orientation shift in unilateral neglect patients and revealed that three out of nine (33%) recovered patients had a high probability of suffering from residual unilateral neglect as estimated by a generalized linear model using the median horizontal gaze position as a predictor.
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Affiliation(s)
- Kira Knoppe
- Institute for Experimental Psychology, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany,St Mauritius Therapieklinik, 40670, Meerbusch, Germany,Corresponding author. Institute for Experimental Psychology, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany.
| | - Nadine Schlichting
- Institute for Experimental Psychology, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Tobias Schmidt-Wilcke
- Institute for Experimental Psychology, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany,Neurocenter, District Hospital Mainkofen, Mainkofen A 3, 94469, Deggendorf, Germany,Institute for Clinical Neuroscience and Medical Psychology, Heinrich Heine University, 40225, Düsseldorf, Germany
| | - Eckart Zimmermann
- Institute for Experimental Psychology, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
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Shida K, Amimoto K, Fukata K, Osaki S, Takahashi H, Makita S. The Effect of Trunk Position on Attentional Disengagement in Unilateral Spatial Neglect. Neurol Int 2022; 14:1036-1045. [PMID: 36548188 PMCID: PMC9780791 DOI: 10.3390/neurolint14040083] [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: 10/26/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Unilateral spatial neglect (USN) causes difficulties in disengaging attention from the right side to unexpected targets on the left. However, the relationship between egocentric spatial position and attentional disengagement remains unclear. Therefore, this study aimed to clarify the relationship between trunk position and attentional disengagement. Thirty-eight patients with early stroke onset were classified as follows: USN (n = 18), right brain damage without USN (n = 10), and left brain damage (n = 10). The primary outcome was reaction time (RT) in the modified Posner task (MPT). The MPT comprised a condition in which the preceding cue and target direction were the same (valid condition) and a condition in which the directions were opposite (invalid condition). RT to the target was calculated. The MPT was performed in three different trunk positions (trunk midline, left, and right). In each group, the RT was compared on the basis of the stimulus conditions and trunk position. The RT was delayed in the valid and invalid left conditions, especially in the invalid left condition. The RT of the trunk right condition was significantly reduced compared with that of trunk midline and left conditions in the invalid left condition. Thus, trunk position influences attentional disengagement. This study contributes to the rehabilitation of patients with neglect symptoms.
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Affiliation(s)
- Kohei Shida
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka 350-1298, Japan
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
- Correspondence: ; Tel.: +81-80-1832-7488
| | - Kazu Amimoto
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka 350-1298, Japan
| | - Shinpei Osaki
- Department of Physical Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
- Department of Rehabilitation, Kansai Electric Power Hospital, 2-1-7, Fukushima, Fukushima-ku, Osaka-shi 553-0003, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka 350-1298, Japan
| | - Shigeru Makita
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka 350-1298, Japan
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16
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Embrechts E, van der Waal C, Anseeuw D, van Buijnderen J, Leroij A, Lafosse C, Nijboer TC, Truijen S, Saeys W. Association between spatial neglect and impaired verticality perception after stroke: A systematic review. Ann Phys Rehabil Med 2022; 66:101700. [PMID: 35963568 DOI: 10.1016/j.rehab.2022.101700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Although most research on spatial neglect (SN) has focused on spatial perception deficits with regard to the lateral (left-right) axis, deficits of spatial perception with regard to the vertical (up-down) axis, such as disturbances in the perception of verticality (e.g., judgement of vertical orientations), have also been suggested. OBJECTIVE We aimed to systematically analyse reported associations between SN and characteristics of verticality perception while considering the time post-stroke. METHODS PubMed, Web of Science, Scopus, PubPsych and PsycArticles databases were searched on May 24, 2022 for articles written in English that evaluated the association between SN and verticality perception (i.e., the subjective visual vertical [SVV], subjective postural vertical [SPV] and subjective haptic vertical [SHV]) in adults after stroke. Left and right SN were considered and had to be assessed using standardized methods. Data were manually extracted, and risk of bias was assessed with the Newcastle-Ottawa Scale. The tilt of the line/chair relative to the gravitational vector and its direction, together with uncertainty (i.e., variability across measurements), were evaluated. RESULTS Thirteen studies were included (431 participants after stroke); at least 191 participants exhibited SN. Mainly the first 3 to 6 months post-stroke were evaluated. SN was associated with SVV misperception, which resulted in larger SVV tilts (mostly in the contralesional direction) and uncertainty in participants with than without SN. SVV tilt magnitudes ranged from a mean/median of -8.9° to -2.3° in SN participants and from -1.6° to 0.6° in non-SN participants, the latter falling within normative ranges. For SPV and SHV measurements, the magnitude of tilt and the uncertainty were insufficiently assessed or results were inconclusive. CONCLUSIONS SN was associated with larger SVV tilts and uncertainty, which suggests that SVV misperception is a key feature of SN. This observation highlights the importance of regular SVV assessment in people with SN in clinical practice. PROSPERO CRD42019127616.
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Affiliation(s)
- Elissa Embrechts
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands.
| | - Charlotte van der Waal
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Dorine Anseeuw
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Jessica van Buijnderen
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Améline Leroij
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Christophe Lafosse
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Tanja Cw 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
| | - 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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17
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Vilimovsky T, Chen P, Hoidekrova K, Slavicek O, Harsa P. Prism Adaptation Treatment Predicts Improved Rehabilitation Responses in Stroke Patients with Spatial Neglect. Healthcare (Basel) 2022; 10:healthcare10102009. [PMID: 36292456 PMCID: PMC9601909 DOI: 10.3390/healthcare10102009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 01/07/2023] Open
Abstract
Spatial neglect (SN) impedes functional recovery after stroke, leading to reduced rehabilitation gains and slowed recovery. The objective of the present study was to investigate whether integrating prism adaptation treatment (PAT) into a highly intensive rehabilitation program eliminates the negative impact of spatial neglect on functional and motor recovery. We examined clinical data of the 355 consecutive first-time stroke patients admitted to a sub-acute inpatient neurorehabilitation program that integrated PAT. The 7-item Motor Functional Independence Measure, Berg Balance Scale, and Motor Activity Log were used as main outcome measures. We found that 84 patients (23.7%) had SN, as defined by a positive score on the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process (KF-NAP®). Although 71 patients (85%) received PAT, the presence of SN at baseline, regardless of PAT completion, was associated with lower functional independence, higher risk of falls, and a lower functional level of the affected upper limb both at admission and at discharge. The severity of SN was associated with inferior rehabilitation outcomes. Nonetheless, patients with SN who received PAT had similar rehabilitation gains compared to patients without SN. Thus, the present study suggests that integrating PAT in an intensive rehabilitation program will result in improved responses to regular therapies in patients with SN.
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Affiliation(s)
- Tomas Vilimovsky
- Department of Psychiatry, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
- Correspondence:
| | - Peii Chen
- Kessler Foundation, West Orange, NJ 07052, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ 07101, USA
| | - Kristyna Hoidekrova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
- Rehabilitation Center Kladruby, 257 62 Kladruby, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Ondrej Slavicek
- Department of Informatics and Mathematics in Transport, Faculty of Transport Engineering, University of Pardubice, 532 10 Pardubice, Czech Republic
| | - Pavel Harsa
- Department of Psychiatry, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
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18
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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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19
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Barrett AM, Goedert KM, Carter AR, Chaudhari A. Spatial neglect treatment: The brain's spatial-motor Aiming systems. Neuropsychol Rehabil 2022; 32:662-688. [PMID: 33941021 PMCID: PMC9632633 DOI: 10.1080/09602011.2020.1862678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/29/2020] [Indexed: 10/21/2022]
Abstract
Animal and human literature supports spatial-motor "Aiming" bias, a frontal-subcortical syndrome, as a core deficit in spatial neglect. However, spatial neglect treatment studies rarely assess Aiming errors. Two knowledge gaps result: spatial neglect rehabilitation studies fail to capture the impact on motor-exploratory aspects of functional disability. Also, across spatial neglect treatment studies, discrepant treatment effects may also result from sampling different proportions of patients with Aiming bias. We review behavioural evidence for Aiming spatial neglect, and demonstrate the importance of measuring and targeting Aiming bias for treatment, by reviewing literature on Aiming spatial neglect and prism adaptation treatment, and presenting new preliminary data on bromocriptine treatment. Finally, we review neuroanatomical and network disruption that may give rise to Aiming spatial neglect. Because Aiming spatial neglect predicts prism adaptation treatment response, assessment may broaden the ability of rehabilitation research to capture functionally-relevant disability. Frontal brain lesions predict both the presence of Aiming spatial neglect, and a robust response to some spatial neglect interventions. Research is needed that co-stratifies spatial neglect patients by lesion location and Aiming spatial neglect, to personalize spatial neglect rehabilitation and perhaps even open a path to spatial retraining as a means of promoting better mobility after stroke.
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Affiliation(s)
- A M Barrett
- Neurorehabilitation Division, Emory Brain Health Center, and Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health System, Decatur, GA, USA
| | - Kelly M Goedert
- Department of Psychology, Seton Hall University, South Orange, NJ, USA
| | - Alexandre R Carter
- Neurorehabilitation Division, Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
- Program in Occupational Therapy, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Amit Chaudhari
- Department of Neurology, University of California Irvine, Irvine, CA, USA
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20
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Meidian AC, Wahyuddin, Amimoto K. Rehabilitation interventions of unilateral spatial neglect based on the functional outcome measure: A systematic review and meta-analysis. Neuropsychol Rehabil 2022; 32:764-793. [PMID: 33106080 DOI: 10.1080/09602011.2020.1831554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
ABSTRACTThis review aimed to examine the bottom-up and top-down rehabilitation intervention effectiveness based on the functional outcome measure as immediate effect and long-term effect for unilateral spatial neglect conditions. The RCT studies were collected by searching in three databases J-Stage, PubMed, and PEDro from 2008 through 2018. The studies which used the following instruments: BI, CBS, FMA, and FIM, as the functional outcome with the PEDro score of six and above, were eligible for inclusion. A total of 492 participants in 13 studies included from 291 studies initially identified. The meta-analysis for overall ES revealed that BI and CBS had a significant mean of SMD = 0.65 (95% CI, 0.23-1.07; p = 0.003; I2 = 65%), and SMD = -0.23 (95% CI, -0.45 to -0.01; p = 0.04; I2 = 35%) respectively, while FMA and FIM had an insignificant mean of SMD = 0.14 (95% CI, -0.08-0.37; p = 0.22; I2 = 0%), and SMD = -0.22 (95% CI, -0.69-0.25; p = 0.37; I2 = 0%) respectively. Based on the results, although indicated the heterogeneity representation across studies, it showed that the top-down intervention approach of high-frequency rTMS was more effective in enhancing the functional abilities and ADL of unilateral spatial neglect patients on the immediate effects but not necessarily in the long-term effects.
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Affiliation(s)
- Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Faculty of Physiotherapy, Esa Unggul University, Jakarta, Indonesia
| | - Wahyuddin
- Faculty of Physiotherapy, Esa Unggul University, Jakarta, Indonesia
| | - Kazu Amimoto
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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21
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Imura T, Mitsutake T, Hori T, Tanaka R. Predicting the prognosis of unilateral spatial neglect using magnetic resonance imaging in patients with stroke: A systematic review. Brain Res 2022; 1789:147954. [DOI: 10.1016/j.brainres.2022.147954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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22
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Stein C, Bunker L, Chu B, Leigh R, Faria A, Hillis AE. Various tests of left neglect are associated with distinct territories of hypoperfusion in acute stroke. Brain Commun 2022; 4:fcac064. [PMID: 35386220 PMCID: PMC8977645 DOI: 10.1093/braincomms/fcac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/18/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Hemispatial neglect is among the most disabling consequences of right hemisphere stroke. However, there is no consensus on the optimal assessments to identify neglect. We hypothesized that different tests for neglect given the same day (i) detect distinct aspects and types of neglect, (ii) are sensitive to different cognitive functions (beyond spatially specific processing) and (iii) are associated with distinct regions of hypoperfusion. We examined data from 135 participants with acute, right-hemispheric ischaemic stroke who received an MRI and neglect testing within 48 h of acute infarct in a cross-sectional study. The volume of infarct was calculated on diffusion-weighted imaging. We also scored severity and location of fluid-attenuated inversion recovery hyperintense vessels in six areas (anterior cerebral artery territory, posterior cerebral artery territory and four within the middle cerebral artery territory) to estimate the volume and location of hypoperfusion in acute stroke. Neglect tests included gap detection, scene copy, line bisection, line cancellation, oral reading and picture description. We found strong correlations between tests that evaluated viewer-centred processing, as well as strong correlations between tests that evaluated stimulus-centred processing. The error rate on different tests was associated with hypoperfusion in different vascular territories, even after controlling for the volume of an infarct. Our results confirm that it is essential to administer a battery of different tests of hemispatial neglect to capture various deficits in attention and spatially specific processing that underlies neglect. Our results also show the potential usefulness of hyperintense vessel ratings as an indication of dysfunction beyond the infarct, as the ratings (and not infarct volume) were highly associated with many clinical deficits. Finally, results underscore that diverse types of neglect are clinically important in acute stroke, as they reflect different areas of hypoperfused tissue, which may be salvageable in the absence of infarct in those areas. As such, neglect batteries may be useful for detecting patients with cortical hypoperfusion who are candidates for reperfusion therapies.
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Affiliation(s)
- Colin Stein
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Bunker
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brian Chu
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Richard Leigh
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andreia Faria
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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23
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Development of stimulus-driven attention test for unilateral spatial neglect - Accuracy, reliability, and validity. Neurosci Lett 2022; 772:136461. [PMID: 35041906 DOI: 10.1016/j.neulet.2022.136461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/07/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022]
Abstract
We developed a simple method to assess stimulus-evoked attention function in unilateral spatial neglect (USN), and examined its accuracy, reliability, and validity. Thirty-one patients with USN and sixteen patients with right hemisphere damage without USN were given a task of reading Japanese characters that suddenly appeared on a display, and a reading or touching task of red Japanese characters that are arranged on the display. The sensitivity and specificity were calculated from the measurement results, and the cutoff value was calculated using the receiver operating characteristic curve. Area under the curve was used to evaluate the discriminatory ability. Reliability was calculated by the intraclass correlation coefficient using the test-retest method. Validity was assessed by correlating the scores of the new method with the scores of the traditional assessment, the behavioral inattention test, and the Catherine Bergego Scale. This new method was able to detect left USN with the same level of accuracy as the conventional assessment and showed moderate or better reliability. In addition, a moderate correlation was found with the conventional assessment, and a higher correlation was observed with items related to perception and cognition in daily life.
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Hreha K, Barrett AM, Gillen RW, Gonzalez-Snyder C, Masmela J, Chen P. The Implementation Process of Two Evidence-Based Protocols: A Spatial Neglect Network Initiative. FRONTIERS IN HEALTH SERVICES 2022; 2:839517. [PMID: 36925858 PMCID: PMC10012810 DOI: 10.3389/frhs.2022.839517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022]
Abstract
Introduction Spatial neglect, a neurocognitive disorder of lateralized spatial attention, is prevalent among stroke survivors especially in inpatient rehabilitation facilities (IRFs). The ultimate goal of the project was to improve spatial neglect care in inpatient rehabilitation and trained as many OTs as possible using both tools in their regular practices as the means to achieve our overall objective. Therefore, we conducted a project aimed at implementing two evidence-based protocols, one for assessment (KF-NAP®) and the other for treatment (KF-PAT®), and share the implementation process, which included barriers and facilitators identified during and after the process, and implementation outcomes. Methods Sixteen IRFs were involved. The Knowledge-To-Action Cycle was used to describe the process of knowledge inquiry (training), translating knowledge (implementation) and evaluating the use of knowledge in clinical practice (outcomes). Barriers and strategies were reported using the Consolidated Framework for Implementation Research and identified through a survey, after the study concluded. Results Thirty-two therapists at the participating sites were trained to some level of the KF-NAP and KF-PAT. Throughout the project and also once after it finished, different barriers were identified by researchers and clinicians, who then determined together actions to eliminate or minimize the barriers. For example, multiple sites reported: "not having time to train other staff at their hospital due to high patient volume and other responsibilities." Discussion The project shared our implementation process which demonstrated the importance of using implementation methods and incorporating a researcher-clinician partnership, not only for knowledge generation but also knowledge translation. Frequent communications and exchanging information with stakeholders at different levels, may be determinant to the success of each implementation phase. Further research is needed.
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Affiliation(s)
- Kimberly Hreha
- Division of Occupational Therapy Doctorate, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, United States
| | - A M Barrett
- Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, United States.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert W Gillen
- Neuropsychology Department, Sunnyview Rehabilitation Hospital, Schenectady, NY, United States
| | - Chris Gonzalez-Snyder
- Division of In-Patient Rehabilitation, Select Medical, Mechanicsburg, PA, United States
| | - Jenny Masmela
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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Hougaard BI, Knoche H, Jensen J, Evald L. Spatial Neglect Midline Diagnostics From Virtual Reality and Eye Tracking in a Free-Viewing Environment. Front Psychol 2021; 12:742445. [PMID: 34912268 PMCID: PMC8667868 DOI: 10.3389/fpsyg.2021.742445] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose: Virtual reality (VR) and eye tracking may provide detailed insights into spatial cognition. We hypothesized that virtual reality and eye tracking may be used to assess sub-types of spatial neglect in stroke patients not readily available from conventional assessments. Method: Eighteen stroke patients with spatial neglect and 16 age and gender matched healthy subjects wearing VR headsets were asked to look around freely in a symmetric 3D museum scene with three pictures. Asymmetry of performance was analyzed to reveal group-level differences and possible neglect sub-types on an individual level. Results: Four out of six VR and eye tracking measures revealed significant differences between patients and controls in this free-viewing task. Gaze-asymmetry between-pictures (including fixation time and count) and head orientation were most sensitive to spatial neglect behavior on a group level analysis. Gaze-asymmetry and head orientation each identified 10 out of 18 (56%), compared to 12 out of 18 (67%) for the best conventional test. Two neglect patients without deviant performance on conventional measures were captured by the VR and eyetracking measures. On the individual level, five stroke patients revealed deviant gaze-asymmetry within-pictures and six patients revealed deviant eye orientation in either direction that were not captured by the group-level analysis. Conclusion: This study is a first step in using VR in combination with eye tracking measures as individual differential neglect subtype diagnostics. This may pave the way for more sensitive and elaborate sub-type diagnostics of spatial neglect that may respond differently to various treatment approaches.
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Affiliation(s)
- Bastian I Hougaard
- Department of Architecture and Media Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture and Media Technology, Aalborg University, Aalborg, Denmark
| | | | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
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Barrett AM. Spatial Neglect and Anosognosia After Right Brain Stroke. Continuum (Minneap Minn) 2021; 27:1624-1645. [PMID: 34881729 PMCID: PMC9421660 DOI: 10.1212/con.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke. RECENT FINDINGS Stroke and occupational therapy practice guidelines stress a quality standard for spatial neglect assessment and treatment to reduce adverse outcomes for patients, their families, and society. Neurologists may attribute poor outcomes associated with spatial neglect to stroke severity. However, people with spatial neglect are half as likely to return to home and community, have one-third the community mobility, and require 3 times as much caregiver supervision compared with similar stroke survivors. Multiple randomized trials support a feasible first-line rehabilitation approach for spatial neglect: prism adaptation therapy; more than 20 studies reported that this treatment improves daily life independence. Evidence-based treatment of anosognosia is not as developed; however, treatment for this problem is also available. SUMMARY This article guides neurologists' assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.
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Chen P, Diaz-Segarra N, Hreha K, Kaplan E, Barrett AM. Prism Adaptation Treatment Improves Inpatient Rehabilitation Outcome in Individuals With Spatial Neglect: A Retrospective Matched Control Study. Arch Rehabil Res Clin Transl 2021; 3:100130. [PMID: 34589681 PMCID: PMC8463461 DOI: 10.1016/j.arrct.2021.100130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To determine whether prism adaptation treatment (PAT) integrated into the standard of care improves rehabilitation outcome in patients with spatial neglect (SN). Design Retrospective matched control study based on information extracted from June 2017-September 2019. Setting Inpatient rehabilitation. Participants Patients from 14 rehabilitation hospitals scoring >0 on the Catherine Bergego Scale (N=312). The median age was 69.5 years, including 152 (49%) female patients and 275 (88%) patients with stroke. Interventions Patients were matched 1:1 by age (±5 years), FIM score at admission (±2 points), and SN severity using the Catherine Bergego Scale (±2 points) and classified into 2 groups: treated (8-12 daily sessions of PAT) vs untreated (no PAT). Main Outcome Measures FIM and its minimal clinically important difference (MCID) were the primary outcome variables. Secondary outcome was home discharge. Results Analysis included the 312 matched patients (156 per group). FIM scores at discharge were analyzed using repeated-measures analyses of variance. The treated group showed reliably higher scores than the untreated group in Total FIM, F=5.57, P=.020, partial η2=0.035, and Cognitive FIM, F=19.20, P<.001, partial η2=0.110, but not Motor FIM, F=0.35, P=.553, partial η2=0.002. We used conditional logistic regression to examine the odds ratio of reaching MCID in each FIM score and of returning home after discharge. No reliable difference was found between groups in reaching MCID or home discharge. Conclusions Patients with SN receiving PAT had better functional and cognitive outcomes, suggesting that integrating PAT into the standard of care is beneficial. However, receiving PAT may not determine home discharge.
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Key Words
- Brain injury
- CBS, Catherine Bergego Scale
- CMS, Centers for Medicare and Medicaid Services
- IRB, institutional review board
- KF-NAP, Kessler Foundation Neglect Assessment Process
- KF-PAT, Kessler Foundation Prism Adaptation Treatment
- LOS, length of stay
- List of abbreviations: ANOVA, analysis of variance
- MCID, minimal clinically important difference
- Neurorehabilitation
- OR, odds ratio
- OT, occupational therapist
- Outcome
- PAT, prism adaptation treatment
- RCT, randomized controlled trial
- Rehabilitation
- SN, spatial neglect
- Stroke rehabilitation
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Affiliation(s)
- Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ
| | - Nicole Diaz-Segarra
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ.,Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, West Orange, NJ
| | - Kimberly Hreha
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Emma Kaplan
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - A M Barrett
- Department of Neurology, Emory University School of Medicine, Atlanta, GA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, US Department of Veterans Affairs, Decatur, GA
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Gillen RW, Fusco-Gessick B, Harmon EY. How We Assess Spatial Neglect Matters: Prevalence of Spatial Neglect as Measured by the Catherine Bergego Scale and Impact on Rehabilitation Outcomes. Am J Phys Med Rehabil 2021; 100:443-449. [PMID: 33538488 DOI: 10.1097/phm.0000000000001710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence and functional impact of unilateral spatial neglect on right hemisphere stroke patients in an inpatient rehabilitation facility using a multidimensional, functionally based behavioral measure (Catherine Bergego Scale [CBS]). DESIGN This was a retrospective cohort study of 742 consecutive admissions of patients with right hemispheric stroke to an inpatient rehabilitation facility. Spatial neglect was assessed using the CBS. Functional impact of neglect was measured by hospital length of stay, Functional Independence Measure change per day, discharge destination, and number of falls. RESULTS As measured by the CBS, 86% of the right hemisphere stroke patients had symptoms of spatial neglect. Moderate and severe neglect was associated with less Functional Independence Measure change per day and lower rates of community discharge. The presence of neglect was not significantly associated with fall rate or length of hospital stay after controlling for admission Functional Independence Measure scores and age. The "difficulty looking left" CBS item had the strongest relationship with total CBS scores and effectively predicted Functional Independence Measure change per day and discharge destination. CONCLUSIONS Using a sensitive measure, the CBS, rates of spatial neglect are extremely high in right hemisphere stroke patients entering inpatient rehabilitation. Both identification and determination of neglect severity are extremely important given their significant relationship to rehabilitation outcomes and discharge destinations. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to (1) describe why carefully assessing spatial neglect in right hemisphere stroke patients is important; (2) identify multiple dimensions of spatial neglect assessed by the Catherine Bergego Scale and how this approach differs from traditional paper and pencil assessment methods; and (3) describe the relationship between spatial neglect as measured by the Catherine Bergego Scale and functional outcomes of right hemisphere stroke patients in inpatient rehabilitation settings. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Robert W Gillen
- From the Department of Neuropsychology, Sunnyview Rehabilitation Hospital, Schenectady, New York
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Chen P, Lander V, Noce N, Hreha K. Prism adaptation treatment for spatial neglect post brain tumour removal: A case report. Hong Kong J Occup Ther 2021; 33:25-29. [PMID: 33815021 PMCID: PMC8008371 DOI: 10.1177/1569186120921472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose/aim: Spatial neglect is caused by damage to neural networks critical for spatial attention. Spatial neglect without proper treatment impedes rehabilitation outcomes. Prism adaptation treatment, a visuomotor protocol, has been used with stroke survivors with spatial neglect to improve function. This case report explored the feasibility and potential effects of prism adaptation treatment in an individual with spatial neglect after glioblastoma removal. Methods Feasibility was designed and tested to include acceptability and implementation. Exploratory aim on the effectiveness of the intervention was determined using the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process, star cancellation, line bisection and scene copying. Results The patient reported favouring the treatment. Eight sessions, one session a day, were completed over two weeks. The patient’s spatial neglect symptoms reduced on all assessments. Conclusion Prism adaptation treatment was feasible and effective; however, further research is needed to understand the complete benefits of prism adaptation treatment in this population.
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Chen P, Zanca J, Esposito E, Barrett AM. Barriers and Facilitators to Rehabilitation Care of Individuals With Spatial Neglect: A Qualitative Study of Professional Views. Arch Rehabil Res Clin Transl 2021; 3:100122. [PMID: 34179758 PMCID: PMC8212009 DOI: 10.1016/j.arrct.2021.100122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify barriers and facilitators to achieving optimal inpatient rehabilitation outcome among individuals with spatial neglect (SN). Design Cross-sectional, semistructured focus group discussions. Setting Rehabilitation hospitals. Participants A total of 15 occupational therapists and 14 physical therapists treating patients with SN on 3 campuses of a rehabilitation hospital system (N=29). Six focus group sessions were conducted and audio-recorded for transcription. Interventions Not applicable. Main Outcome Measures Not applicable. Results Participants identified several patient-related characteristics that posed barriers to treatment, including the symptoms of SN itself, cognitive issues, physical weakness, comorbidities, and reduced therapy engagement. Supportive family members were considered a key facilitator, but lack of preparedness to assume caregiving roles, poor understanding of SN and rehabilitation goals, and inadequate levels of involvement were family-related barriers to successful treatment. Participants expressed that having resources and technologies available at their center to support SN treatment facilitated positive outcomes and perceived limited staff knowledge and skills and poor interclinician communication as barriers to treatment. At the health care system level, barriers included a lack of responsive measures of SN progress and insurer-related issues. Strong continuity of care between transitions was considered an important factor for enabling effective treatment. Conclusions Barriers and facilitators to the current practice of SN care were identified from occupational and physical therapists’ point of view. Opportunities exist to promote identified facilitators and minimize barriers to improve SN rehabilitation. The present study makes a unique contribution in identifying specific needs for innovative interventions that involve family support and training, promotion of interdisciplinary collaboration, development of interprofessional vocabulary, and continuous treatment and follow-up assessment for SN through care transitions.
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Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Jeanne Zanca
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Emily Esposito
- Department of Psychology, University of California, Riverside, California, United States
| | - A M Barrett
- Department of Neurology, Emory University, Atlanta, Georgia, United States.,Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Decatur, Georgia, United States
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Park JH. The effects of robot-assisted left-hand training on hemispatial neglect in older patients with chronic stroke: A pilot and randomized controlled trial. Medicine (Baltimore) 2021; 100:e24781. [PMID: 33655943 PMCID: PMC7939197 DOI: 10.1097/md.0000000000024781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Even though a variety of rehabilitative technique have been implemented to ameliorate neglect symptoms of patients with stoke, the effects of limb activation using a robotic device are still unknown. The purpose of this study was to investigate the effects of the robot-assisted hand training on hemispatial neglect of older patients with chronic stroke. METHODS The participants were randomly allocated to the experimental group (EG) receiving robot-assisted left-hand training (n = 12) or the control group (CG) receiving conventional treatments for neglect symptoms (n = 12). All participants received 20 sessions for 4-week. To examine the effects on hemispatial neglect, the line bisection test (LBT), the Albert test, and the Catherine Bergego Scale (CBS) were utilized. The outcome measures were analyzed before and after the 20 training sessions. RESULTS After the intervention, improvements in the LBT, the Albert test, and the CBS were found in the EG whereas there were significant improvements in the LBT and the CBS but not the Albert test in the CG. In addition, the EG showed a significantly greater gain in all outcome measures compared to the CG (p < .05). CONCLUSIONS These results indicate that robot-assisted hand training was beneficial to improving the hemispatial neglect of elderly person with chronic stroke compared to the conventional treatments. Robot-assisted limb activation might be useful to ameliorate hemispatial neglect of the elderly with chronic stroke.
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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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Vilimovsky T, Chen P, Hoidekrova K, Petioky J, Harsa P. Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial. PLoS One 2021; 16:e0245425. [PMID: 33481828 PMCID: PMC7822563 DOI: 10.1371/journal.pone.0245425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/01/2021] [Indexed: 11/21/2022] Open
Abstract
Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.
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Affiliation(s)
- Tomas Vilimovsky
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peii Chen
- Kessler Foundation, West Orange, NJ, United States of America
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States of America
| | - Kristyna Hoidekrova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Rehabilitation Center Kladruby, Kladruby, Czech Republic
- Department of Kinanthropology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jakub Petioky
- Rehabilitation Center Kladruby, Kladruby, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Harsa
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Harvey M, Learmonth G, Rossit S, Chen P. Editorial for special issue on neglect rehabilitation. Neuropsychol Rehabil 2021; 32:629-639. [PMID: 33467990 DOI: 10.1080/09602011.2021.1873150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It is clear already that in current and future years more people will suffer from stroke, whether related to COVID-19 or not, and given its prevalence, many more people's lives will be affected by neglect. Here we hope to have contributed to its possible amelioration with highlights of the latest thinking on neglect diagnosis, prevalence and treatment.
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Affiliation(s)
- Monika Harvey
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Gemma Learmonth
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | | | - Peii Chen
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Brunswick, NJ, USA
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Esposito E, Shekhtman G, Chen P. Prevalence of spatial neglect post-stroke: A systematic review. Ann Phys Rehabil Med 2020; 64:101459. [PMID: 33246185 DOI: 10.1016/j.rehab.2020.10.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/18/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Spatial neglect (SN) impedes stroke rehabilitation progress, slows functional recovery, and increases caregiver stress and burden. The estimation of SN prevalence varies widely across studies. BACKGROUND We aimed to establish the prevalence of SN based on the injured cerebral hemisphere, recovery stage post-stroke, and diagnostic methodology. MATERIALS AND METHODS All journal articles published up to February 27, 2019 from CINAHL, PsycINFO, PubMed and Web of Science were searched. We selected original research articles that described observational studies, included both individuals with left brain damage (LBD) and those with right brain damage (RBD) post-stroke, and reported specific diagnostic methods for SN. All authors reached consensus for the final selection of 41 articles. Time post-stroke, patient selection criteria, study setting, SN diagnostic methods were extracted. RESULTS A total of 6324 participants were included: 3411 (54%) with RBD and 2913 (46%) with LBD. Without considering time post-stroke or diagnostic methods, the occurrence rate of SN was 29% (38% after RBD and 18% after LBD). Using ecological assessments resulted in higher prevalence than using tests not directly related to daily life activities (53% vs. 24%). Using methods based on a single-cutoff criterion led to lower occurrence of SN than using multi-test methods (27% vs. 33%). The prevalence decreased from the acute to chronic stage post-stroke. CONCLUSIONS The estimated prevalence of SN after unilateral stroke is 30%. SN is more common after RBD than after LBD, but SN after LBD is still quite common. Using ecological assessments and multi-test methods to detect SN is preferred to using a single-cutoff criterion of a test that is not directly related to daily function. The decrease in SN prevalence over time is evident, but the exact prevalence in later stages cannot be estimated. More research is needed to better understand chronic SN.
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Affiliation(s)
- Emily Esposito
- Department of Psychology, University of California, Riverside, 900, University avenue, Riverside, CA, USA
| | - Grigoriy Shekhtman
- Centre for Stroke Rehabilitation Research, Kessler Foundation, 1199, Pleasant Valley Way, West Orange, NJ, USA; Department of Psychology, Seton Hall University, 400, South Orange avenue, South Orange, NJ, USA
| | - Peii Chen
- Centre for Stroke Rehabilitation Research, Kessler Foundation, 1199, Pleasant Valley Way, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, 183, South Orange avenue, Newark, NJ, USA.
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Van Vleet T, Bonato P, Fabara E, Dabit S, Kim S, Chiu C, Bisogno AL, Merzenich M, Corbetta M, DeGutis J. Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect. Ann Neurol 2020; 88:747-758. [DOI: 10.1002/ana.25862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas Van Vleet
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Boston MA USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Eric Fabara
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Sawsan Dabit
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Sarah‐Jane Kim
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Christopher Chiu
- Department of Psychology University of Massachusetts Boston MA USA
| | - Antonio Luigi Bisogno
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
| | - Michael Merzenich
- Department of Research and Development Posit Science Inc San Francisco CA USA
- School of Medicine University of California San Francisco CA USA
| | - Maurizio Corbetta
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
- Department of Neurology, Radiology Neuroscience Washington University School of Medicine St. Louis MO USA
- Venetian Institute of Molecular Medicine, VIMM Padova Italy
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
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Abdou A, Pilkar R, Chen P, Yue G, Barrett A. Improved stability of long-duration sitting in spatial neglect after a single session of prism adaptation. Neurocase 2020; 26:201-210. [PMID: 32600098 DOI: 10.1080/13554794.2020.1786134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Spatial neglect after right brain stroke affects balance, and improvements in sitting balance after prism adaptation have been demonstrated using short-duration center of pressure (CoP) data. We present long-duration (5 min) CoP and trunk muscles electromyography recordings of a 61-year-old man with left-sided spatial neglect, before and after a single session of prism adaptation. His CoP-derived measures showed improved balance and postural stability in both the anterior-posterior and medial-lateral directions after prism adaptation. Concurrently, asymmetry in neuromuscular activations was reduced. The findings suggest that improved sitting balance may be associated with more symmetrical activation of trunk muscles after prism adaptation.
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Affiliation(s)
- Andrew Abdou
- Burke Rehabilitation Hospital , White Plains, NY, USA.,Department of Physical Medicine & Rehabilitation, Montefiore Medical Center , Bronx, NY, USA.,The Arthur S. Abramson Department of Rehabilitation Medicine, Albert Einstein College of Medicine , Bronx, NY, USA
| | - Rakesh Pilkar
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation , West Orange, NJ, USA.,eDepartment of Physical Medicine & Rehabilitation, Rutgers - New Jersey Medical School , Newark, NJ, USA
| | - Peii Chen
- eDepartment of Physical Medicine & Rehabilitation, Rutgers - New Jersey Medical School , Newark, NJ, USA.,Center for Stroke Rehabilitation Research, Kessler Foundation , West Orange, NJ, USA
| | - Guang Yue
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation , West Orange, NJ, USA.,eDepartment of Physical Medicine & Rehabilitation, Rutgers - New Jersey Medical School , Newark, NJ, USA
| | - A Barrett
- Department of Neurology, Emory School of Medicine , Atlanta, GA, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center , Decatur, GA, USA
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Checketts M, Mancuso M, Fordell H, Chen P, Hreha K, Eskes GA, Vuilleumier P, Vail A, Bowen A. Current clinical practice in the screening and diagnosis of spatial neglect post-stroke: Findings from a multidisciplinary international survey. Neuropsychol Rehabil 2020; 31:1495-1526. [PMID: 32691688 DOI: 10.1080/09602011.2020.1782946] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spatial neglect has profound implications for quality of life after stroke, yet we lack consensus for screening/diagnosing this heterogeneous syndrome. Our first step in a multi-stage research programme aimed to determine which neglect tests are used (within four categories: cognitive, functional, neurological and neuroimaging/neuromodulation), by which stroke clinicians, in which countries, and whether choice is by professional autonomy or institutional policy. 454 clinicians responded to an online survey: 12 professions (e.g., 39% were occupational therapists) from 33 countries (e.g., 38% from the UK). Multifactorial logistic regression suggested inter-professional differences but fewer differences between countries (Italy was an outlier). Cognitive tests were used by 82% (particularly by psychologists, cancellation and drawing were most popular); 80% used functional assessments (physiotherapists were most likely). 20% (mainly physicians, from Italy) used neuroimaging/ neuromodulation. Professionals largely reported clinical autonomy in their choices. Respondents agreed on the need for a combined approach to screening and further training. This study raises awareness of the translation gap between theory and practice. These findings lay an important foundation to subsequent collaborative action between clinicians, researchers and stroke survivors to reach consensus on screening and diagnostic measures. The immediate next step is a review of the measures' psychometric properties.
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Affiliation(s)
- Matthew Checketts
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
| | - Mauro Mancuso
- Physical and Rehabilitative Medicine Unit, National Health Service, Grosseto, Italy
| | - Helena Fordell
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Division for Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Gail A Eskes
- Department of Psychology and Neuroscience & Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Patrik Vuilleumier
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Fundamental Neurosciences & Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Andy Vail
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
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Evald L, Wilms I, Nordfang M. Assessment of spatial neglect in clinical practice: A nationwide survey. Neuropsychol Rehabil 2020; 31:1374-1389. [PMID: 32573333 DOI: 10.1080/09602011.2020.1778490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study was part of a nationwide, anonymous, open Internet survey conducted amongst healthcare professionals in Denmark on the assessment and treatment of spatial neglect (SN). The objective was to describe knowledge and practices in the assessment of SN in current clinical practice across different healthcare sectors and professions. Data included the perceived prevalence, assessment methods and observations, subtypes and differential diagnostics of SN. A total of 525 professionals participated in the survey. The vast majority (81.5%) reported that assessment of SN was provided by their workplace. The median of perceived prevalence of SN was 35% (IQR 22-51) but major differences were found between professions. Occupational therapists and psychologists appeared to be most involved in assessment, whilst nursing staff and speech therapists were least involved. Subjective observations were the most common assessment method (90%). Conversely, systematic ADL observations, paper-and-pencil tests, confrontational tests and computerized tests were less common. The survey revealed large differences in the assessment methods and awareness of various aspects of SN symptoms (subtypes and differential diagnostics) between different healthcare professions. The results emphasize the need for international multidisciplinary clinical guidelines on how to assess SN and distinguish between different subtypes and differential diagnoses.
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Affiliation(s)
- Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Inge Wilms
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Maria Nordfang
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Hreha K, 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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41
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Hreha K, Rich T, Wong J. A One-Year Follow-Up Study on Community Dwelling Multiple Stroke Survivors with Spatial Neglect. Occup Ther Health Care 2020; 34:48-61. [PMID: 32153228 DOI: 10.1080/07380577.2020.1737894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assessed nine participants, who sustained multiple strokes and had spatial neglect, one year after participation in a prior trial on whether Prism Adaptation Treatment (PAT) was a feasible and effective treatment for spatial neglect remediation compared to standard care. The objectives were to: (1) describe the sample, (2) measure the degree of spatial neglect symptoms if present, and (3) determine group differences in motor and spatial performance. Three (60%) participants from the PAT group and two (50%) from the comparison group still displayed spatial neglect. A series of two-way mixed ANOVAs exploring group (PAT vs. comparison of standard care) and time effects (pretest vs. posttest vs. follow-up) found a main effect of time for all participants on the Kessler Foundation Neglect Assessment (F(1,2) = 30.28, p<.001), Functional Independence Measure (F(1,2) = 16.998, p<.001), and star cancelation (F(1,2) = 11.077, p<.001). An interaction effect of time*prism was observed when assessing the line bisection test (F(1,2) = 6.986, p = .008), suggesting that the PAT group performed significantly better on this test. Additional research should be completed with a larger sample in order to better understand the PAT long term effects as well as develop clinical recommendations for occupational therapy practitioners.
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Affiliation(s)
- Kimberly Hreha
- Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
| | - Timothy Rich
- Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
| | - Jennifer Wong
- Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
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Machner B, von der Gablentz J, Göttlich M, Heide W, Helmchen C, Sprenger A, Münte TF. Behavioral deficits in left hemispatial neglect are related to a reduction of spontaneous neuronal activity in the right superior parietal lobule. Neuropsychologia 2020; 138:107356. [PMID: 31972231 DOI: 10.1016/j.neuropsychologia.2020.107356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/21/2019] [Accepted: 01/18/2020] [Indexed: 12/24/2022]
Abstract
Focal brain lesions may induce dysfunctions in distant brain regions leading to behavioral impairments. Based on this concept of 'diaschisis', spatial neglect following stroke has been related to structural damage of the right-lateralized ventral attention network (VAN) and disrupted inter-hemispheric functional connectivity (FC) in the bilateral dorsal attention network (DAN). We questioned whether neglect-related behavioral deficits may be determined by local dysfunction of a specific region within these brain networks. We investigated acute right-hemisphere stroke patients with left hemispatial neglect using resting-state functional MRI, neuropsychological tests of spatial attention and clinical assessment of neglect-related functional disability. In addition to conventional FC analyses between different cortical regions of interest (ROIs) in the DAN/VAN, we extracted the fractional amplitude of low frequency fluctuations (fALFF) from each ROI as a marker of regional spontaneous neuronal activity. Although DAN regions (as opposed to the VAN regions) were largely spared from structural brain damage, they exhibited a significant reduction of inter-hemispheric FC. However, significant fMRI-behavior correlations were revealed specifically for the fALFF of one DAN-ROI in the right superior parietal lobule (SPL): the smaller the fALFF in the right posterior intraparietal sulcus, the more severe the patient's pathological attention bias and neglect-related functional impairment. In line with 'diaschisis', our findings confirm a crucial role of the non-lesioned but dysfunctional right SPL for the emergence of spatial neglect and its behavioral consequences. They further support targeting the SPL dysfunction by non-invasive brain stimulation in neglect rehabilitation.
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Affiliation(s)
- Björn Machner
- Department of Neurology, University of Lübeck, Lübeck, Germany.
| | | | - Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Wolfgang Heide
- Department of Neurology, General Hospital Celle, Celle, Germany
| | | | - Andreas Sprenger
- Department of Neurology, University of Lübeck, Lübeck, Germany; Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany; Department of Psychology, University of Lübeck, Lübeck, Germany
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Luvizutto GJ, Fogaroli MO, Theotonio RM, Moura Neto ED, Nunes HRDC, Bazan R. Norm scores of cancelation and bisection tests for unilateral spatial neglect: data from a Brazilian population. Clinics (Sao Paulo) 2020; 75:e1468. [PMID: 32401966 PMCID: PMC7196728 DOI: 10.6061/clinics/2019/e1468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/07/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Unilateral spatial neglect (USN) results in a consistent and exaggerated spatial asymmetry in the processing of information about the body or space due to an acquired brain injury. There are several USN tests for clinical diagnosis, but none of them are validated in Brazil. The aim was to obtain normative values from a healthy sample in Brazil and to evaluate the effects of demographic variables on USN tests. METHODS This was a cross-sectional study performed with 150 neurologically healthy individuals. USN was evaluated using the line cancelation (LC), star cancelation (SC), and line bisection (LB) tests in the A3 (29.7 x 42.0 cm) sheet format. RESULTS In LC, 143 participants had 0 omissions, and the occurrence of failure was significantly associated with aging (OR=1.1[1.02-1.2]; p=0.012). In SC, 145 participants had fewer than 1 omission, and the occurrence of failure was significantly associated with aging (OR=1.07[1.03-1.11]; p<0.001). In LB, deviations were the lowest for those with the highest level of education (r=0.20; p=0.015), and the deviation was 9.5 mm. CONCLUSION The cutoff points presented in this study may be indicative of USN, but due to performance differences based on age, we suggest using different norm scores for different age groups. These norm scores can be used in the clinic immediately for USN diagnosis.
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Affiliation(s)
- Gustavo José Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG, BR
| | - Marcelo Ortolani Fogaroli
- Neurocirurgia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR
| | - Rodolfo Mazeto Theotonio
- Servico de Atencao e Referencia em Alcool e Drogas (SARAD), Hospital das Clinicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR
| | - Eduardo de Moura Neto
- Pos Graduacao em Educacao Fisica, Biomecanica e Controle Motor, Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG, BR
| | | | - Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Univesidade Paulita (UNESP), Botucatu, SP, BR
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Fortis P, Ronchi R, Velardo V, Calzolari E, Banco E, Algeri L, Spada MS, Vallar G. A home-based prism adaptation training for neglect patients. Cortex 2020; 122:61-80. [DOI: 10.1016/j.cortex.2018.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/25/2018] [Accepted: 09/02/2018] [Indexed: 11/15/2022]
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45
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Saj A, Cojan Y, Assal F, Vuilleumier P. Prism adaptation effect on neural activity and spatial neglect depend on brain lesion site. Cortex 2019; 119:301-311. [DOI: 10.1016/j.cortex.2019.04.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/07/2019] [Accepted: 04/29/2019] [Indexed: 11/27/2022]
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Labreche T, Wild B, Dalton K, Leat SJ. Post-stroke visual midline shift syndrome. Clin Exp Optom 2019; 103:290-295. [PMID: 31321827 DOI: 10.1111/cxo.12944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 03/13/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022] Open
Abstract
The state of research on the topic of visual midline shift syndrome following a cerebrovascular accident is unknown. A scoping review was conducted using the search terms of 'visual midline shift' (or equivalent) and 'cerebrovascular accident' (or equivalent). Articles were selected from eight academic and one grey literature database, and went through two levels of review, as per Arksey and O'Malley, before being deemed acceptable for inclusion. Of the 931 abstracts reviewed, 27 articles met the criteria for inclusion. Data extracted from the selected articles included terminology and definition, symptoms, underlying pathophysiology, duration, assessment method, and management of visual midline shift syndrome following cerebrovascular accident. There is agreement on the existence of a midline shift following a cerebrovascular accident resulting in poor posture and imbalance. Much uncertainty exists in the literature regarding terminology, underlying pathophysiology, assessment method and management of this condition. Further research is required.
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Affiliation(s)
- Tammy Labreche
- Waterloo School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Benjamin Wild
- Waterloo School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Kristine Dalton
- Waterloo School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Susan J Leat
- Waterloo School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
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47
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Chen P, Motisi SE, Cording C, Ward I, Jasey NN. Impact of eliminating visual input on sitting posture and head position in a patient with spatial neglect following cerebral hemorrhage: a case report. Physiother Theory Pract 2019; 37:852-861. [PMID: 31319732 DOI: 10.1080/09593985.2019.1645252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Spatial neglect is a neurocognitive syndrome. Affected individuals pay little or insufficient attention to the space contralateral to the injured cerebral hemisphere, often resulting in or exacerbating disability following an acquired brain injury. Eliminating visual input may increase attention toward the contralesional side of space, and improve symptoms of spatial neglect; however this has never been examined in a clinical setting. Objective: In this case report, we observed an individual demonstrate immediate and spontaneous postural changes once visual input was eliminated. Methods: The patient, a 53-year-old female, was admitted to a rehabilitation hospital after hemorrhagic stroke affecting her right basal ganglia and surrounding regions in the frontal lobe. She exhibited left-sided spasticity, severe right gaze preference, and stark rightward postural deviation. Neck passive range of motion was normal. Visual field integrity was inconclusive due to poor communication and impaired cognitive function. Contraversive pushing was ruled out. Results:Once visual input was eliminated by applying a blindfold, the patient turned to the left spontaneously, had more buttock contact on the left, and placed more weight toward the left side in a sitting posture. However, she returned to rightward deviation three minutes after blindfold removal. In addition, the patient's rehabilitation team reported that she was able to participate in more therapy activities with binocular occlusion than with eyes open. Conclusion: Binocular occlusion appeared to demonstrate an immediate, albeit transient, improvement in postural symmetry. The results warrant further research and exploration in clinical applicability.
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Affiliation(s)
- Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, Newark, NJ, USA
| | | | | | - Irene Ward
- Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, Newark, NJ, USA.,Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Neil N Jasey
- Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, Newark, NJ, USA.,Kessler Institute for Rehabilitation, West Orange, NJ, USA
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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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Abstract
PURPOSE OF REVIEW Spatial neglect is asymmetric orienting and action after a brain lesion, causing functional disability. It is common after a stroke; however, it is vastly underdocumented and undertreated. This article addresses the implementation gap in identifying and treating spatial neglect, to reduce disability and improve healthcare costs and burden. RECENT FINDINGS Professional organizations published recommendations to implement spatial neglect care. Physicians can lead an interdisciplinary team: functionally relevant spatial neglect assessment, evidence-based spatial retraining, and integrated spatial and vision interventions can optimize outcomes. Research also strongly suggests spatial neglect adversely affects motor systems. Spatial neglect therapy might thus "kick-start" rehabilitation and improve paralysis recovery. Clinicians can implement new techniques to detect spatial neglect and lead interdisciplinary teams to promote better, integrated spatial neglect care. Future studies of brain imaging biomarkers to detect spatial neglect, and real-world applicability of prism adaptation treatment, are needed.
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Affiliation(s)
- A M Barrett
- Stroke Rehabilitation Research, Kessler Foundation, East Hanover, NJ, USA.
| | - K E Houston
- Harvard Medical School, Department of Ophthalmology, Spaulding Rehabilitation Hospital, Boston, MA, USA
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50
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Machner B, Könemund I, von der Gablentz J, Bays PM, Sprenger A. The ipsilesional attention bias in right-hemisphere stroke patients as revealed by a realistic visual search task: Neuroanatomical correlates and functional relevance. Neuropsychology 2019; 32:850-865. [PMID: 30321035 PMCID: PMC6237270 DOI: 10.1037/neu0000493] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Right-hemisphere stroke may cause an ipsilesional attention bias and left hemispatial neglect. Computerized time-limited tasks are more sensitive than conventional paper-pencil tests in detecting these spatial attention deficits. However, their frequency in the acute stage of stroke, the neuroanatomical basis and functional relevance for patients' everyday life are unclear. METHOD A realistic visual search task is introduced, in which eye movements are recorded while the patient searches for paperclips among different everyday objects on a computer display. The "desk task" performance of 34 acute right-hemisphere stroke patients was compared to established paper-pencil tests for neglect and the Posner reaction time task, and finally correlated to structural brain lesions. RESULTS Most of the patients, even those without clinical neglect signs and with normal paper-pencil test performance, exhibited a clear ipsilesional attention bias in the desk task. This bias was highly correlated to the left-right asymmetry in the Posner task and to neglect-related functional impairment scores. Lesion-symptom mapping revealed task-specific differences: deficits in the desk task were associated with lesions of the superior temporal gyrus, contralesional unawareness in the Posner task with ventral frontal cortex lesions and paper-pencil cancellation bias with damage to the inferior parietal lobe. Neglect behavior was further associated with distinct frontoparietal white matter tract disconnections (inferior longitudinal fasciculus, superior longitudinal fasciculus, arcuate). CONCLUSIONS Results from the novel desk task indicate a functional relevance of spatial attention deficits in right-hemisphere stroke patients, even if they are "subclinical." This should be considered especially in patients without obvious clinical neglect signs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Paul M Bays
- Department of Psychology, University of Cambridge
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