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De Boi I, Embrechts E, Schatteman Q, Penne R, Truijen S, Saeys W. Assessment and treatment of visuospatial neglect using active learning with Gaussian processes regression. Artif Intell Med 2024; 149:102770. [PMID: 38462272 DOI: 10.1016/j.artmed.2024.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
Visuospatial neglect is a disorder characterised by impaired awareness for visual stimuli located in regions of space and frames of reference. It is often associated with stroke. Patients can struggle with all aspects of daily living and community participation. Assessment methods are limited and show several shortcomings, considering they are mainly performed on paper and do not implement the complexity of daily life. Similarly, treatment options are sparse and often show only small improvements. We present an artificial intelligence solution designed to accurately assess a patient's visuospatial neglect in a three-dimensional setting. We implement an active learning method based on Gaussian process regression to reduce the effort it takes a patient to undergo an assessment. Furthermore, we describe how this model can be utilised in patient oriented treatment and how this opens the way to gamification, tele-rehabilitation and personalised healthcare, providing a promising avenue for improving patient engagement and rehabilitation outcomes. To validate our assessment module, we conducted clinical trials involving patients in a real-world setting. We compared the results obtained using our AI-based assessment with the widely used conventional visuospatial neglect tests currently employed in clinical practice. The validation process serves to establish the accuracy and reliability of our model, confirming its potential as a valuable tool for diagnosing and monitoring visuospatial neglect. Our VR application proves to be more sensitive, while intra-rater reliability remains high.
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Affiliation(s)
- Ivan De Boi
- Faculty of Applied Engineering, Department Electromechanics, Research Group InViLab, University of Antwerp, Groenenborgerlaan 171, Antwerp, 2020, Belgium(1).
| | - Elissa Embrechts
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Quirine Schatteman
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Rudi Penne
- Faculty of Applied Engineering, Department Electromechanics, Research Group InViLab, University of Antwerp, Groenenborgerlaan 171, Antwerp, 2020, Belgium(1)
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
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2
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Embrechts E, Schröder J, Nijboer TCW, van der Waal C, Lafosse C, Truijen S, Saeys W. Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? A prospective longitudinal cohort study. BMC Neurol 2024; 24:37. [PMID: 38254026 PMCID: PMC10801963 DOI: 10.1186/s12883-023-03475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Visuospatial neglect (VSN) has been suggested to limit standing balance improvement post-stroke. However, studies investigating this association longitudinally by means of repeated within-subject measurements early post-stroke are lacking. This prospective longitudinal cohort study evaluates the longitudinal association of egocentric and allocentric VSN severity with 1) standing balance independence and 2) postural control and weight-bearing asymmetry (WBA) during quiet standing, in the first 12 weeks post-stroke. METHODS Thirty-six hemiplegic individuals after a first-ever unilateral stroke were evaluated at weeks 3, 5, 8 and 12 post-stroke. Egocentric and allocentric VSN severity were evaluated using the Broken Hearts Test. The standing unperturbed item of the Berg Balance Scale (BBS-s) was used to clinically evaluate standing independence. Posturographic measures included measures of postural control (mediolateral (ML)/anteroposterior (AP) net center-of-pressure velocities (COPvel)) and WBA during quiet standing. A linear mixed model was used to examine longitudinal associations between egocentric and allocentric VSN, and BBS-s, COPvel-ML, COPvel-AP and WBA within the first 12 weeks post-stroke. RESULTS Egocentric (β = -0.08, 95%CI[-0.15;-0.01], P = .029) and allocentric VSN severity (β = -0.09, 95%CI[-0.15; -0.04], P = .002) were significant independent factors for BBS-s scores in the first 12 weeks post-stroke. Egocentric and allocentric VSN were no significant independent factors for COPvel-ML, COPvel-AP and WBA in the first 12 weeks post-stroke. CONCLUSIONS Allocentric and egocentric VSN severity were significantly associated with decreased standing independence, but not impaired postural control or greater asymmetric weight-bearing, in the early subacute post-stroke phase. This may involve traditional VSN measures being not sensitive enough to detect fine-grained VSN deficits due to a ceiling effect between 5 and 8 weeks post-stroke, once the individual regains standing ability. Future studies may require more sensitive VSN measurements to detect such deficits. Trial registration Clinicaltrials.gov. unique identifier NCT05060458.
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Affiliation(s)
- Elissa Embrechts
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium.
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Jonas Schröder
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
| | - Tanja C W 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
| | - Charlotte van der Waal
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
| | - Christophe Lafosse
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
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Moore MJ, Hearne L, Demeyere N, Mattingley JB. Comprehensive voxel-wise, tract-based, and network lesion mapping reveals unique architectures of right and left visuospatial neglect. Brain Struct Funct 2023; 228:2067-2087. [PMID: 37697138 PMCID: PMC10587018 DOI: 10.1007/s00429-023-02702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023]
Abstract
Visuospatial neglect is a common, post-stroke cognitive impairment which is widely considered to be a disconnection syndrome. However, the patterns of disconnectivity associated with visuospatial neglect remain unclear. Here, we had 480 acute stroke survivors [age = 72.8 (SD = 13.3), 44.3% female, 7.5 days post-stroke (SD = 11.3)] undertake routine clinical imaging and standardised visuospatial neglect testing. The data were used to conduct voxel-wise, tract-level, and network-level lesion-mapping analyses aimed at localising the neural correlates of left and right egocentric (body-centred) and allocentric (object-centred) visuospatial neglect. Only minimal anatomical homogeneity was present between the correlates of right and left egocentric neglect across all analysis types. This finding challenges previous work suggesting that right and left visuospatial neglect are anatomically homologous, and instead suggests that egocentric neglect may involve damage to a shared, but hemispherically asymmetric attention network. By contrast, egocentric and allocentric neglect was associated with disconnectivity in a distinct but overlapping set of network edges, with both deficits related to damage across the dorsal and ventral attention networks. Critically, this finding suggests that the distinction between egocentric and allocentric neglect is unlikely to reflect a simple dichotomy between dorsal versus ventral networks dysfunction, as is commonly asserted. Taken together, the current findings provide a fresh perspective on the neural circuitry involved in regulating visuospatial attention, and provide important clues to understanding the cognitive and perceptual processes involved in this common and debilitating neuropsychological syndrome.
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Affiliation(s)
- Margaret Jane Moore
- Queensland Brain Institute, University of Queensland, St. Lucia, QLD, 4072, Australia.
| | - Luke Hearne
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Jason B Mattingley
- Queensland Brain Institute, University of Queensland, St. Lucia, QLD, 4072, Australia
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4
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Moore MJ, Milosevich E, Mattingley JB, Demeyere N. The neuroanatomy of visuospatial neglect: A systematic review and analysis of lesion-mapping methodology. Neuropsychologia 2023; 180:108470. [PMID: 36621594 DOI: 10.1016/j.neuropsychologia.2023.108470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
While visuospatial neglect is commonly associated with damage to the right posterior parietal cortex, neglect is an anatomically heterogenous syndrome. This project presents a systematic review of 34 lesion-mapping studies reporting on the anatomical correlates of neglect. Specifically, the reported correlates of egocentric versus allocentric, acute versus chronic, personal versus extra-personal, and left versus right hemisphere neglect are summarised. The quality of each included lesion-mapping analysis was then evaluated to identify methodological factors which may help account for the reported variance in correlates of neglect. Overall, the existing literature strongly suggests that egocentric and allocentric neglect represent anatomically dissociable conditions and that the anatomy of these conditions may not be entirely homologous across hemispheres. Studies which have compared the anatomy of acute versus chronic neglect have found that these conditions are associated with distinct lesion loci, while studies comparing the correlates of peripersonal/extrapersonal neglect are split as to whether these neglect subtypes are anatomically dissociable. The included studies employed a wide range of lesion-mapping analysis techniques, each producing results of varying quality and generalisability. This review concludes that the reported underlying anatomical correlates of heterogeneous visuospatial neglect vary considerably. Future, high quality studies are needed to investigate patterns of disconnection associated with clearly defined forms of visuospatial neglect in large and representative samples.
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Affiliation(s)
- Margaret Jane Moore
- Queensland Brain Institute, The University of Queensland, St Lucia, Australia.
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Jason B Mattingley
- Queensland Brain Institute, The University of Queensland, St Lucia, Australia; School of Psychology, The University of Queensland, St Lucia, Australia
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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5
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Ten Brink AF, de Haan R, Amelink DR, Holweg AN, Sui J, Bultitude JH. Visuospatial perception is not affected by self-related information. Conscious Cogn 2023; 107:103451. [PMID: 36463796 DOI: 10.1016/j.concog.2022.103451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
Previous research suggests that attention is drawn by self-related information. Three online experiments were conducted to investigate whether self-related stimuli alter visuospatial perceptual judgments. In a matching task, associations were learned between labels ('Yourself'/friend/stranger's name) paired with cues. Cues were coloured outlines (Experiment 1, N = 135), geometric shapes (Experiment 2, N = 102), or coloured gradients (Experiment 3, N = 110). Visuospatial perception bias was measured with a greyscales task. Cues were presented prior to, and/or alongside greyscales. We hypothesized there would be a bias towards the self-related cue. In all experiments, we found a self-related bias in the matching task. Furthermore, there was an overall leftward visuospatial perceptual bias (pseudoneglect). However, we found anecdotal to moderate evidence for the absence of an effect of self-related cues on visuospatial perception judgments. Although self-related stimuli influence how our attention is oriented to stimuli, attention mechanisms that influence perceptual judgements are seemingly not affected by a self-bias.
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Affiliation(s)
- Antonia F Ten Brink
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK.
| | - Rebecca de Haan
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Daan R Amelink
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Anniek N Holweg
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Jie Sui
- Department of Psychology, University of Aberdeen, Scotland
| | - Janet H Bultitude
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
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Moore MJ, Driscoll R, Colwell M, Hewitt O, Demeyere N. Aligning formal and functional assessments of Visuospatial Neglect: A mixed-methods study. Neuropsychol Rehabil 2022; 32:2560-2579. [PMID: 34392812 DOI: 10.1080/09602011.2021.1967172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACTThe occurrence of visuospatial neglect acts as a key predictor of recovery outcome following stroke. However, the specific behavioural profiles associated with various neglect subtypes are not well understood. This study aims to identify real-world functional impairments associated with neglect, to determine whether functional impairment profiles differ across patients with egocentric and allocentric neglect, and to investigate how neglect severity predicts functional impairments.Notes from 290 stroke patients' occupational therapy functional assessments were qualitatively and quantitatively analysed in the context of neglect type and severity as reported by the OCS Cancellation Task. Overall, neglect patients had more references to having difficulty initiating tasks, finding items, exhibiting spatial inattention, and having difficulty using both arms than patients without neglect. The proportion of theme references did not differ significantly across patients with egocentric and allocentric neglect. The quantitative severity of egocentric neglect was acted as a significant predictor of reference occurrence over and above stroke severity within difficulty finding items, spatial inattention, body inattention, and upper limb use.This study expands on previous findings by identifying real-world functional impairments differentiating patients with and without neglect. This data provides novel insight into the impact of neglect on functional abilities.
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Affiliation(s)
- Margaret Jane Moore
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Rebecca Driscoll
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Michael Colwell
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Olivia Hewitt
- Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
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7
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Middag-van Spanje M, Schuhmann T, Nijboer T, van der Werf O, Sack AT, van Heugten C. Study protocol of transcranial electrical stimulation at alpha frequency applied during rehabilitation: A randomized controlled trial in chronic stroke patients with visuospatial neglect. BMC Neurol 2022; 22:402. [PMID: 36324088 PMCID: PMC9628038 DOI: 10.1186/s12883-022-02932-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND A frequent post stroke disorder in lateralized attention is visuospatial neglect (VSN). As VSN has a strong negative impact on recovery in general and independence during daily life, optimal treatment is deemed urgent. Next to traditional stroke treatment, non-invasive brain stimulation offers the potential to facilitate stroke recovery as a complementary approach. In the present study, visual scanning training (VST; the current conventional treatment) will be combined with transcranial alternating current stimulation (tACS) to evaluate the additive effects of repeated sessions of tACS in combination with six-weeks VST rehabilitation. METHODS In this double-blind randomized placebo-controlled intervention study (RCT), we will compare the effects of active tACS plus VST to sham (placebo) tACS plus VST, both encompassing 18 VST training sessions, 40 minutes each, during 6 weeks. Chronic stroke patients with VSN (> 6 months post-stroke onset) are considered eligible for study participation. In total 22 patients are needed for the study. The primary outcome is change in performance on a cancellation task. Secondary outcomes are changes in performance on a visual detection task, two line bisection tasks, and three measures to assess changes in activities of daily living. Assessment is at baseline, directly after the first and ninth training session, after the last training session (post training), and 1 week and 3 months after termination of the training (follow-up). DISCUSSION If effective, a tACS-VST rehabilitation program could be implemented as a treatment option for VSN. TRIAL REGISTRATION ClinicalTrials.gov ; registration number: NCT05466487; registration date: July 18, 2022 retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT05466487.
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Affiliation(s)
- Marij Middag-van Spanje
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,InteraktContour, Nunspeet, The Netherlands
| | - Teresa Schuhmann
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht Brain Imaging Centre, Maastricht University, Maastricht, The Netherlands
| | - Tanja Nijboer
- grid.5477.10000000120346234Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands ,grid.7692.a0000000090126352Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Olof van der Werf
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht Brain Imaging Centre, Maastricht University, Maastricht, The Netherlands
| | - Alexander T. Sack
- grid.5012.60000 0001 0481 6099Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht Brain Imaging Centre, Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Centre for Integrative Neuroscience, Faculty of Psychology and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Caroline van Heugten
- Limburg Brain Injury Center, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382School for Mental Health and Neuroscience, Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
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8
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Schuhmann T, Duecker F, Middag-van Spanje M, Gallotto S, van Heugten C, Schrijnemaekers AC, van Oostenbrugge R, Sack AT. Transcranial alternating brain stimulation at alpha frequency reduces hemispatial neglect symptoms in stroke patients. Int J Clin Health Psychol 2022; 22:100326. [PMID: 35990733 PMCID: PMC9364103 DOI: 10.1016/j.ijchp.2022.100326] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background/Objective Non-invasive brain stimulation techniques such as transcranial alternating current stimulation (tACS) may help alleviate attention deficits in stroke patients with hemispatial neglect by modulating oscillatory brain activity. We applied high-definition (HD)-tACS at alpha frequency over the contralesional hemisphere to support unilateral oscillatory alpha activity and correct for the pathologically altered attention bias in neglect patients. Methods We performed a within-subject, placebo-controlled study in which sixteen stroke patients with hemispatial neglect underwent 10 Hz (alpha) as well as sham (placebo) stimulation targeting the contralesional posterior parietal cortex. Attentional bias was measured with a computerized visual detection paradigm and two standard paper-and-pencil neglect tests. Results We revealed a significant shift of attentional resources after alpha-HD-tACS, but not sham tACS, toward the ipsilateral and thus contralesional hemifield leading to a reduction in neglect symptoms, measured with a computerized visual detection paradigm and a widely used standard paper and pencil neglect tests. Conclusions We showed a significant alpha-HD-tACS-induced shift of attentional resources toward the contralesional hemifield, thus leading to a reduction in neglect symptoms. Importantly, HD-tACS effects persisted after the stimulation itself had ended. This tACS protocol, based on intrinsic oscillatory processes, may be an effective and well-tolerated treatment option for neglect.
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Affiliation(s)
- Teresa Schuhmann
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands
| | - Felix Duecker
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands
| | - Marij Middag-van Spanje
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands.,InteraktContour, Nunspeet, the Netherlands
| | - Stefano Gallotto
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands.,EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine of Geneva, University of Geneva, Geneva, Switzerland
| | - Caroline van Heugten
- Limburg Brain Injury Center, the Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience (FPN), Maastricht University, the Netherlands.,School for Mental Health and Neuroscience, Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University Medical Center, the Netherlands
| | - Anne-Claire Schrijnemaekers
- Adelante Rehabilitation Centre, Department of Brain Injury, Hoensbroek, the Netherlands.,Mondriaan Mental Health Centre, Department of Adult Psychiatry, Heerlen, the Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alexander T Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht University, Maastricht, the Netherlands.,Centre for Integrative Neuroscience, Faculty of Psychology and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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9
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Turgut N, Jansen AL, Nielsen J, Heber I, Eling P, Hildebrandt H. Repeated application of the covert shift of attention task improves endogenous but not exogenous attention in patients with unilateral visuospatial inattention. Brain Cogn 2021; 151:105732. [PMID: 33895466 DOI: 10.1016/j.bandc.2021.105732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most neglect treatment studies focus on automatic re-orientation procedures, assuming a deficit in automatic processes. We compare an automatic- and a controlled procedure, using the endogenous and exogenous variants of Posner's covert shift of attention task. METHOD In two experiments, neglect patients and patients with a right hemispherical stroke without neglect performed three blocks of Posner's covert shift of attention task (Posner Task) on two days. In Study 1 we used endogenous cues, in Study 2, exogenous cues. RESULTS In the endogenous task, neglect patients improved significantly with valid left-sided cues between block 1 and 2 on Day 1, subsequently showing a plateauing. They also showed a gradual improvement on invalid trials on both days. In the exogenous condition, all participants responded only increasingly faster on trials with a long stimulus onset asynchrony. Practicing on both tasks led to fewer omissions for left-sided targets, minimally in the exogenous and clearly in the endogenous condition. CONCLUSION In line with prior neuroanatomical studies, our study shows that practicing an endogenous, but not an exogenous, visuospatial attention task leads to significant improvements in neglect patients, especially for invalid trials, suggesting that neglect treatments based on top-down strategies should be given more attention.
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Affiliation(s)
- Nergiz Turgut
- Instituto de Neurociencias, Universidad San Francisco de Quito, Quito, Ecuador
| | - Anna-Lena Jansen
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Jörn Nielsen
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany; Department of Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Ines Heber
- Department of Neurological Rehabilitation, Median Klinik Wilhelmshaven, Wilhelmshaven, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Helmut Hildebrandt
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.
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Vestito L, Trombini M, Mori L, Dellepiane S, Trompetto C, Morando M, Bandini F. Improved visuospatial neglect after tDCS and computer-assisted cognitive training in Posterior Cortical Atrophy: a single-case study. Neurocase 2021; 27:57-63. [PMID: 33332244 DOI: 10.1080/13554794.2020.1862242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Visuospatial neglect (VN) frequently occurs in Posterior Cortical Atrophy (PCA) and requires specific rehabilitation. In this single-case study, we investigated the efficacy of a computer-assisted cognitive training (CCT) alone or coupled with multiple sessions of anodal transcranial direct-current stimulation (A-tDCS) over the right posterior parietal cortex in improving left VN symptoms in a patient with PCA. The digital ReMoVES platform was used for both VN assessment and training. We found a significant improvement after CCT combined with A-tDCS within the limits of a single-case, our results suggest, for the first time, the usefulness of this combined approach in a neurodegenerative disorder.
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Affiliation(s)
| | - Marco Trombini
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Laura Mori
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Silvana Dellepiane
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Morando
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Fabio Bandini
- Department of Neurology, San Paolo Hospital, Savona, Italy
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11
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Gorsler A, Grittner U, Külzow N, Rackoll T. Blinding in electric current stimulation in subacute neglect patients with current densities of 0.8 A/m 2: a cross-over pilot study. BMC Res Notes 2021; 14:35. [PMID: 33494832 PMCID: PMC7836170 DOI: 10.1186/s13104-020-05421-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 12/11/2020] [Indexed: 12/14/2022] Open
Abstract
Objective Neglect after stroke is a disabling disorder and its rehabilitation is a major challenge. Transcranial direct current stimulation (tDCS) seems to be a promising adjuvant technique to improve standard care neglect therapy. Since electric fields are influenced by age-related factors, higher current densities are probably needed for effective treatment in aged stroke patients. Validation of treatment efficacy requires sham-controlled experiments, but increased current densities might comprise blinding. Therefore, a pilot study was conducted to test sham adequacy when using current density of 0.8 A/m2. Whether especially neglect patients who mainly suffer from perceptual and attentional deficits are able to differentiate beyond chance active from sham tDCS was investigated in a randomized cross-over design (active/sham stimulation) in 12 early subacute patients with left-sided hemineglect. Stimulation (0.8 A/m2) was performed simultaneous to standard care neglect therapy. Results Odds ratio of correct guessing an atDCS condition compared to wrongly judge an atDCS condition as sham was 10.00 (95%CI 0.65–154.40, p = 0.099). However, given the small sample size and high OR, although likely somewhat overestimated, results require careful interpretation and blinding success in neglect studies with current densities of 0.8 A/m2 should be further confirmed.
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Affiliation(s)
- Anna Gorsler
- Kliniken Beelitz GmbH, Neurologische Rehabilitationsklinik, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Germany. .,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Nadine Külzow
- Kliniken Beelitz GmbH, Neurologische Rehabilitationsklinik, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Germany
| | - Torsten Rackoll
- QUEST Center for Transforming Biomedical Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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12
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Embrechts E, Van Criekinge T, Schröder J, Nijboer T, Lafosse C, Truijen S, Saeys W. The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review. Ann Phys Rehabil Med 2020; 64:101449. [PMID: 33152521 DOI: 10.1016/j.rehab.2020.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although previous narrative reviews have highlighted a potential association between visuospatial neglect (VSN) and balance disorders, to what extent different areas of balance and mobility could be affected is still unclear. OBJECTIVES This systematic review updates previous literature findings and systematically reviews sitting balance, standing balance and mobility outcomes. METHODS PubMed, Web of Science, ScienceDirect, Naric-Rehabdata, PEDro and the Cochrane Trials Library were systematically searched. Methodological quality was assessed by the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The association between VSN and sitting balance, standing balance and mobility (walking, stair climbing/descending and transfers) was investigated. RESULTS In total, 48 studies were included (4595 stroke survivors): at least 1319 (29%) showed symptoms of VSN. VSN was associated with less independence during sitting, with an asymmetric posture toward the affected body side. For standing balance, we revealed a significant negative association between VSN and mediolateral stability and weight shifting, whereas only activities of daily living-related VSN was associated with weight-bearing asymmetry during static stance. While walking, patients with VSN laterally deviated from their path. Results were inconclusive regarding other aspects of mobility. The association between VSN and balance/mobility seemed to decrease over time. CONCLUSIONS Despite great heterogeneity in results, this study suggests that stroke survivors with VSN show specific deviations in posture and movement in the mediolateral direction. Although the association between VSN and balance/mobility has been extensively investigated, explanatory studies evaluating underlying mechanisms of the frequently present association are lacking. Future studies should address this by combining clinical and instrumented assessment of balance and gait performance, preferably longitudinally to investigate the associations over time.
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Affiliation(s)
- Elissa Embrechts
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium.
| | - Tamaya Van Criekinge
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Jonas Schröder
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Tanja Nijboer
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Christophe Lafosse
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Steven Truijen
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Wim Saeys
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
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13
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Moore MJ, Demeyere N. Dissociating spatial attention from neglect dyslexia: A single case study. Cortex 2020; 130:246-256. [PMID: 32688274 DOI: 10.1016/j.cortex.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/18/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
Word-centred neglect dyslexia is generally thought to be caused by a visuospatial neglect-like attentional deficit which impacts orientation-canonical representations of visual stimuli. However, the relationship between word-centred neglect dyslexia and more general attentional processes is not well described. Here, we investigated the impact of attentional load manipulations within a case of word-centred neglect dyslexia. This study presents data from a single case, Patient CD, who exhibited ipsilesional word-centred neglect dyslexia in conjunction with severe, contralesional allocentric neglect. CD demonstrated an intact ability to name all letters in visually presented words, but committed neglect dyslexia errors when subsequently asked to read the same word as a whole. The severity of patient CD's neglect dyslexia was not found to be impacted by attentional manipulations. We found no effect of exposure time or visual crowding on the frequency of neglect dyslexia errors. This absence of an apparent, right-lateralised perceptual deficit, comorbid left-lateralised object-centred neglect, and insensitivity to attentional load manipulations suggests that the deficit underlying word-centred neglect dyslexia is not related to broad visuo-spatial attention. These findings suggest that neglect dyslexia and domain-general visuospatial neglect may not be as related as previously asserted.
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Affiliation(s)
- Margaret J Moore
- University of Oxford, Department of Experimental Psychology, Radcliffe Observatory Quarter, Oxford, United Kingdom.
| | - Nele Demeyere
- University of Oxford, Department of Experimental Psychology, Radcliffe Observatory Quarter, Oxford, United Kingdom
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14
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Cox JA, Aimola Davies AM. Keeping an eye on visual search patterns in visuospatial neglect: A systematic review. Neuropsychologia 2020; 146:107547. [PMID: 32610098 DOI: 10.1016/j.neuropsychologia.2020.107547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022]
Abstract
Patients with visuospatial neglect exhibit a failure to detect, respond, or orient towards information located in the side of space opposite to their brain lesion. To extend our understanding of the underlying cognitive processes involved in neglect, some studies have used eye movement measurements to complement behavioural data. We provide a qualitative synthesis of studies that have used eye-tracking in patients with neglect, with a focus on highlighting the utility of examining eye movements and reporting what eye-tracking has revealed about visual search patterns in these patients. This systematic review includes twenty studies that met the eligibility criteria. We extracted information pertaining to patient characteristics (e.g., age, type of stroke, time since stroke), neglect test(s) used, type of stimuli (e.g., static, dynamic), eye-tracker specifications (e.g., temporal and spatial resolution), and eye movement measurements (e.g., saccade amplitude, fixation duration). Five key themes were identified. First, eye-tracking is a useful tool to complement pen-and-paper neglect tests. Second, the lateral asymmetrical bias in eye movement patterns observed during active exploration also occurred while at rest. Third, the lateral asymmetrical bias was evident not only in the horizontal plane but also in the vertical plane. Fourth, eye movement patterns were modulated by stimulus- and task-related factors (e.g., visual salience, local perceptual features, image content, stimulus duration, presence of distractors). Fifth, measuring eye movements in patients with neglect is useful for determining and understanding other cognitive impairments, such as spatial working memory. To develop a fuller, and a more accurate, picture of neglect, future research would benefit from eye movement measurements.
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15
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Fabius J, Ten Brink AF, Van der Stigchel S, Nijboer TCW. The relationship between visuospatial neglect, spatial working memory and search behavior. J Clin Exp Neuropsychol 2020; 42:251-262. [PMID: 31900083 DOI: 10.1080/13803395.2019.1707779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Visuospatial neglect (VSN) is characterized by a lateralized attentional deficit in the visual domain. In addition, patients with VSN might have an impairment in the temporary storage of spatial information in working memory (spatial working memory; SWM) that, like VSN, could impair systematic searching behavior. Several studies have demonstrated either SWM impairments or impaired searching behavior in VSN patients. Here, we related SWM performance to search behavior in patients with and without VSN. We assessed SWM using a novel task in a group of 182 stroke patients (24 with VSN, 158 without) and 65 healthy controls. We related SWM performance to available stroke-related and cognitive data. Patients with VSN exhibited lower SWM performance than patients without VSN and healthy controls. Additional control analyses indicated that differences in SWM performance are specific to visuospatial processing, instead of e.g. verbal working memory or the general level of physical disability. Last, we related SWM performance to visual search performance on cancellation tasks, one where their cancellation markings remained visible and another one where their prior cancellations markings were invisible to the patient and therefore patients had to remember which targets they had canceled. SWM performance correlated with search organization. Together, these results from a large sample of stroke patients corroborate the findings of earlier studies, while excluding several alternative explanations: SWM impairment is a part of the neglect syndrome, and SWM impairments are related to search behavior.
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Affiliation(s)
- Jasper Fabius
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Antonia F Ten Brink
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Department of Psychology, University of Bath, Bath, UK
| | - Stefan Van der Stigchel
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Tanja C W Nijboer
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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16
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Zebhauser PT, Vernet M, Unterburger E, Brem AK. Visuospatial Neglect - a Theory-Informed Overview of Current and Emerging Strategies and a Systematic Review on the Therapeutic Use of Non-invasive Brain Stimulation. Neuropsychol Rev 2019; 29:397-420. [PMID: 31748841 PMCID: PMC6892765 DOI: 10.1007/s11065-019-09417-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/27/2019] [Indexed: 01/12/2023]
Abstract
Visuospatial neglect constitutes a supramodal cognitive deficit characterized by reduction or loss of spatial awareness for the contralesional space. It occurs in over 40% of right- and 20% of left-brain-lesioned stroke patients with lesions located mostly in parietal, frontal and subcortical brain areas. Visuospatial neglect is a multifaceted syndrome - symptoms can be divided into sensory, motor and representational neglect - and therefore requires an individually adapted diagnostic and therapeutic approach. Several models try to explain the origins of visuospatial neglect, of which the "interhemispheric rivalry model" is strongly supported by animal and human research. This model proposes that allocation of spatial attention is balanced by transcallosal inhibition and both hemispheres compete to direct attention to the contralateral hemi-space. Accordingly, a brain lesion causes an interhemispheric imbalance, which may be re-installed by activation of lesioned, or deactivation of unlesioned (over-activated) brain areas through noninvasive brain stimulation. Research in larger patient samples is needed to confirm whether noninvasive brain stimulation can improve long-term outcomes and whether these also affect activities of daily living and discharge destination.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany.,Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar der Technischen Universität, Munich, Germany
| | - Marine Vernet
- Section on Neurocircuitry, Laboratory of Brain and Cognition, NIMH/NIH, Bethesda, MD, USA
| | - Evelyn Unterburger
- Division of Neuropsychology, Universitätsklinik Zürich USZ, Frauenklinikstrasse 26, Zurich, Switzerland
| | - Anna-Katharine Brem
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany. .,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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17
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Svaerke KW, Omkvist KV, Havsteen IB, Christensen HK. Computer-Based Cognitive Rehabilitation in Patients with Visuospatial Neglect or Homonymous Hemianopia after Stroke. J Stroke Cerebrovasc Dis 2019; 28:104356. [PMID: 31495672 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/20/2019] [Accepted: 08/14/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The purpose of this pilot study was to investigate the feasibility and effects of computer-based cognitive rehabilitation (CBCR) in patients with symptoms of visuospatial neglect or homonymous hemianopia in the subacute phase following stroke. METHOD A randomized, controlled, unblinded cross-over design was completed with early versus late CBCR including 7 patients in the early intervention group (EI) and 7 patients in the late intervention group (LI). EI received CBCR training immediately after inclusion (m = 19 days after stroke onset) for 3 weeks and LI waited for 3 weeks after inclusion before receiving CBCR training for 3 weeks (m = 44 days after stroke onset). RESULTS CBCR improved visuospatial symptoms after stroke significantly when administered early in the subacute phase after stroke. The same significant effect was not found when CBCR was administered later in the rehabilitation. The difference in the development of the EI and LI groups during the first 3 weeks was not significant, which could be due to a lack of statistical power. CBCR did not impact mental well-being negatively in any of the groups. In the LI group, the anticipation of CBCR seemed to have a positive impact of mental well-being. CONCLUSION CBCR is feasible and has a positive effect on symptoms in patients with visuospatial symptoms in the subacute phase after stroke. The study was small and confirmation in larger samples with blinded outcome assessors is needed.
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18
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Bosma MS, Nijboer TCW, Caljouw MAA, Achterberg WP. Impact of visuospatial neglect post-stroke on daily activities, participation and informal caregiver burden: A systematic review. Ann Phys Rehabil Med 2019; 63:344-358. [PMID: 31200080 DOI: 10.1016/j.rehab.2019.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age<65 versus≥65 years. METHODS PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. RESULTS Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age≥65), and 2 on caregiver burden (1 study with mean age≥65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences. CONCLUSIONS AND IMPLICATIONS VSN has a negative impact not only on patients' independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice. SYSTEMATIC REVIEW REGISTRATION NO PROSPERPO Registration No. CRD42018087483.
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Affiliation(s)
- Martine S Bosma
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands; Zorggroep Florence, Laan van Vredenoord 1, 2289 DA, Rijswijk, 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; Utrecht university, department of experimental psychology, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Monique A A Caljouw
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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19
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JEE H, PARK J. Gender Comparisons of Asymmetric Lateralization in Neurodegenerative Disorder Patients via E-Pen Based Cognitive Assessment System. Iran J Public Health 2019; 48:289-298. [PMID: 31205883 PMCID: PMC6556190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The clinical gender-dependent characteristics of visuospatial neglect between men and women have not been elucidated in Korean patients with cognitive impairment. The goal of this study was to observe the asymmetric lateralization in patients using a novel e-pen based cognitive assessment system. METHODS A total of 31 patients, 16 men and 15 women, with early stage hemispheric cerebral dysfunction were recruited for the assessment of unilateral neglect suing a novice paper-and-pencil based electronic evaluation system from a rehabilitation center of Inha University hospital in 2016. Results were assessed for degrees of deviations, and numbers of neglected lines. Degree of deviation was assessed using the positions and distances from the horizontal line centers. Effect sizes were calculated to assess proximities between the assessed results. RESULTS Comparatively greater left and rightward biasness for the right-sided and left-sided horizontal lines were observed for the male patients, respectively. Moreover, greater degree of left to rightward biasness was observed as the horizontal lines shortened in both groups. However, the magnitude of biasness in female patients showed comparatively less directional bias, indicating greater prevalence for the center of mass effect in male patients. CONCLUSION Gender difference in visuospatial neglect seems to exist with less accuracy in recognition for the bisecting center for the female and asymmetrical lateralization and magnitude of deviation for the male patients.
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Affiliation(s)
- Haemi JEE
- Department of Sports and Health Care, Namseoul University, Cheonan-si, Korea
| | - Jaehyun PARK
- Department of Information and Communication, Inha University, Incheon, Korea,Corresponding Author:
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20
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Ohmatsu S, Takamura Y, Fujii S, Tanaka K, Morioka S, Kawashima N. Visual search pattern during free viewing of horizontally flipped images in patients with unilateral spatial neglect. Cortex 2019; 113:83-95. [PMID: 30620921 DOI: 10.1016/j.cortex.2018.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/12/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
Eye tracking is an effective tool for identifying behavioural aspects of unilateral spatial neglect (USN), which is a common neurological syndrome that develops after a right hemisphere lesion. Here, we attempted to elucidate how the neglect symptom affects the symmetry of the gaze pattern, by performing an analysis of gaze distribution during the free viewing of a pair of horizontally flipped images. Based on their Behavioural Inattention Test (BIT) scores, 41 patients with right-hemisphere damage were classified into those with USN (n = 27) and those without USN (right hemisphere damaged - RHD; n = 14). Eye movement was recorded while the patients viewed six pairs of horizontally flipped images on a computer display. A pair of flipped images has both similar and consistent elements, as well as a reversed spatial location of objects (right-left). We calculated the gaze distribution, extent of gaze shift, total gaze distance, and gaze velocity in each direction. Our results demonstrated a significantly larger rightward gaze shift in the USN group, which showed a significant correlation with the BIT score. More importantly, the extent of gaze shift and total gaze distance were similarly modulated by the contents of the displayed images in both the USN and RHD groups. Our findings suggest that analyses of gaze distribution during the free viewing of a pair of horizontally flipped images have the potential to precisely reveal neglect behaviour, and our results provide important implications for rehabilitation.
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Affiliation(s)
- Satoko Ohmatsu
- Graduate School of Health Sciences, Kio University, Nara, Japan; Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - Yusaku Takamura
- Graduate School of Health Sciences, Kio University, Nara, Japan; Murata Hospital, Osaka, Japan
| | - Shintaro Fujii
- Graduate School of Health Sciences, Kio University, Nara, Japan; Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Kohei Tanaka
- Shizuoka Rehabilitation Hospital, Shizuoka, Japan
| | - Shu Morioka
- Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Noritaka Kawashima
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.
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21
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Kamtchum-Tatuene J, Allali G, Saj A, Bernati T, Sztajzel R, Pollak P, Momjian-Mayor I, Kleinschmidt A. An exploratory cohort study of sensory extinction in acute stroke: prevalence, risk factors, and time course. J Neural Transm (Vienna) 2016; 124:483-494. [PMID: 27942884 PMCID: PMC5357267 DOI: 10.1007/s00702-016-1663-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/01/2016] [Indexed: 12/01/2022]
Abstract
Most studies on sensory extinction have focused on selected patients with subacute and chronic right hemisphere lesions. In studies conducted on acute stroke patients, risk factors and time course were not evaluated. Our aim was to determine the prevalence, risk factors, and time course of sensory extinction in the acute stroke setting. Consecutive patients with acute stroke were tested for tactile, visual, auditory, and auditory-tactile cross-modal extinction, as well as for peripersonal visuospatial neglect (PVN). Tests were repeated at 2, 7, 15, 30, and 90 days after initial examination. A multivariable logistic regression analysis was performed to test the association between sensory extinction and demographic and clinical risk factors. Seventy-three patients (38.4% women) were recruited: 64 with ischemic stroke and nine with haemorrhagic stroke. Mean age was 62.3 years (95% CI 58.8–65.7), mean NIHSS score was 1.6 (95% CI 1.2–2.1), and mean time to first examination was 4.1 days (95% CI 3.5–4.8). The overall prevalence of all subtypes of sensory extinction was 13.7% (95% CI 6.8–23.8). Tactile extinction was the most frequent subtype with a prevalence of 8.2% (95% CI 3.1–17.0). No extinction was found beyond 15 days after the first examination. After adjustment for age, sex, lesion side, type of stroke, time to first examination and stroke severity, a lesion volume ≥2 mL (adjusted OR = 38.88, p = 0.04), and presence of PVN (adjusted OR = 24.27, p = 0.04) were independent predictors of sensory extinction. The insula, the putamen, and the pallidum were the brain regions most frequently involved in patients with sensory extinction. Extinction is a rare and transient phenomenon in patients with minor stroke. The presence of PVN and lesion volume ≥2 mL are independent predictors of sensory extinction in acute stroke.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland. .,Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE, UK.
| | - Gilles Allali
- Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.,Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Arnaud Saj
- Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.,Neurology and Cognitive Imaging Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thérèse Bernati
- Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland
| | - Roman Sztajzel
- Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland
| | - Pierre Pollak
- Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland
| | | | - Andreas Kleinschmidt
- Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland
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Norton DJ, Jaywant A, Gallart-Palau X, Cronin-Golomb A. Normal discrimination of spatial frequency and contrast across visual hemifields in left-onset Parkinson's disease: evidence against perceptual hemifield biases. Vision Res 2014; 107:94-100. [PMID: 25498374 DOI: 10.1016/j.visres.2014.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
Individuals with Parkinson's disease (PD) with symptom onset on the left side of the body (LPD) show a mild type of left-sided visuospatial neglect, whereas those with right-onset (RPD) generally do not. The functional mechanisms underlying these observations are unknown. Two hypotheses are that the representation of left-space in LPD is either compressed or reduced in salience. We tested these hypotheses psychophysically. Participants were 31 non-demented adults with PD (15 LPD, 16 RPD) and 17 normal control adults (NC). The spatial compression hypothesis was tested by showing two sinusoidal gratings, side by side. One grating's spatial frequency (SF) was varied across trials, following a staircase procedure, whereas the comparison grating was held at a constant SF. While fixating on a central target, participants estimated the point at which they perceived the two gratings to be equal in SF. The reduced salience hypothesis was tested in a similar way, but by manipulating the contrast of the test grating rather than its SF. There were no significant differences between groups in the degree of bias across hemifields for SF discrimination or for contrast discrimination. Results did not support either the spatial compression hypothesis or the reduced salience hypothesis. Instead, they suggest that at this perceptual level, LPD do not have a systematically biased way of representing space in the left hemifield that differs from healthy individuals, nor do they perceive stimuli on the left as less salient than stimuli on the right. Neglect-like syndrome in LPD instead presumably arises from dysfunction of higher-order attention.
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Affiliation(s)
- Daniel J Norton
- Department of Psychological and Brain Sciences, Boston University, USA
| | - Abhishek Jaywant
- Department of Psychological and Brain Sciences, Boston University, USA
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