The effects of prism adaptation on daily life activities in patients with visuospatial neglect: a systematic review

Studies that have investigated prism adaptation (PA) effects on symptoms of visuospatial neglect have primarily used neuropsychological tests as outcome measures. An important question that remains to be answered is whether PA effects translate into improvements in patients’ daily life activities. In the present review, we examined systematically the evidence for the effect of PA treatment on daily life activities in patients with neglect. Two authors independently assessed the methodological quality of 25 intervention and 1 follow-up studies using validated scales. PA effects were evaluated for reading/writing, activities of daily living (ADL) direct tests, ADL questionnaires, and navigation tests. Studies were evaluated as being of excellent (n?=?1), good (n?=?12), fair (n?=?10), or poor (n?=?3) quality. Among the 26 articles, a total of 32 measurements showed significant PA effects (one measurement from a study of excellent quality, 17 from studies of good quality, 10 from studies of fair quality, four from studies of poor quality), whereas non-significant effects were found in 15 measurements (two from a study of excellent quality, three from studies of good quality, eight from studies of fair quality, two from studies of poor quality). There is some evidence suggesting that PA can improve daily functioning, particularly as measured by reading/writing and ADL direct tests. The impact of several variables on PA effects should be investigated further including sample heterogeneity and time since injury.     

Dissociation in the recovery from neglect dyslexia and visuospatial unilateral neglect: a case report

The recovery of the ability to read of a patient affected by persistent visuospatial neglect suggests the functional independence of the two phenomena. Neglect dyslexia seems to be an example of a dissociation between an implicit and explicit knowledge of the characteristics of the stimulus.

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Sommario Il recupero della capacità di lettura in un paziente con persistente neglect visuo-spaziale suggerisce l'indipendenza funzionale dei due fenomeni. La neglect dyslexia sembra costituire un esempio di dissociazione tra conoscenza implicita ed esplicita delle caratteristiche dello stimolo.

     

Deficit of auditory space perception in patients with visuospatial neglect

There have been many studies of visuospatial neglect, but fewer studies of neglect in relation with other sensory modalities. In the present study we investigate the performance of six right brain damaged (RBD) patients with left visual neglect and six RBD patients without neglect in an auditory spatial task. Previous work on sound localisation in neglect patients adopted measure of sound localisation based on directional motor responses (e.g., pointing to sounds) or judgement of sound position with respect to the body midline (auditory midline task). However, these measures might be influenced by non-auditory biases related with motor and egocentric components. Here we adopted a perceptual measure of sound localisation, consisting in a verbal judgement of the relative position (same or different) of two sequentially presented sounds. This task was performed in a visual and in a blindfolded condition. The results revealed that sound localisation performance of visuospatial neglect patients was severely impaired with respect to that of RBD controls, especially when sounds originated in contralesional hemispace. In such condition, neglect patients were always unable to discriminate the relative position of the two sounds. No difference in performance emerged as a function of the visual condition in either group. These results demonstrate a perceptual deficit of sound localisation in patients with visuospatial neglect, suggesting that the spatial deficits of these patients can arise multimodally for the same portion of external space.     

The effect of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke

ObjectiveThis article explores the effects of early cognitive training and rehabilitation for patients with cognitive dysfunction in stroke.MethodsStroke patients have cognitive dysfunction, and the incidence of cognitive dysfunction in stroke patients is six to nine times that of patients without stroke. This article selects 118 patients with stroke in our hospital from August 2017 to August 2019, 42 patients with stroke disorders randomly divided into two groups. Both groups of patients received conventional rehabilitation training, and the observation group performed motion observation therapy in virtual reality equipment based on conventional cognitive training. Analysis of time parameters related to rehabilitation training before and after treatment, and evaluation of standard health effects.ResultsAfter 4 weeks of treatment, the cognitive training time parameters of the two groups were compared. The cognitive reaction time was shorter than that before treatment. After treatment, the scores of cognitive training and rehabilitation effects were significantly lower than those before treatment, and the two scores of the observation group were significantly lower than those of the control group.ConclusionStroke patients receive early cognitive training with the support of computer‐assisted technology to obtain good rehabilitation results.     

Selective deficit of auditory localisation in patients with visuospatial neglect.

Possible auditory deficits in neglect were examined by comparing the performance of four right brain-damaged (RBD) patients with left visuospatial neglect, versus four RBD patients without neglect, in three auditory tasks. The first task required speeded discrimination of sound elevation, by moving a central lever up or down according to the vertical position of a peripheral target sound, regardless of its side. The other two auditory tasks were non-spatial, requiring either speeded pitch discrimination (moving the central lever up for high pitch, down for low pitch) or speeded target detection. Neglect patients' performance was impaired with respect to RBD controls only when the auditory task required spatial coding of the target sound (the up/down spatial discrimination). This demonstrates a selective deficit of auditory space perception in neglect patients. This auditory spatial deficit was more pronounced for left than right sounds. Since auditory space perception was impaired in the vertical dimension, the observed deficit cannot be attributed to a systematic rightward shift in sound localisation. Instead, the results suggest increased spatial uncertainty in sound localisation by neglect patients, particularly for auditory targets on the contralesional side. These findings are related to multimodal coding of space in the parietal cortex, which was damaged in the neglect patients, but not in the RBD controls.     

Dissociation between egocentric and allocentric visuospatial and tactile neglect in acute stroke

Previous investigations provide evidence for distinction between egocentric (viewer-centered) and allocentric (stimulus- or object-centered) hemispatial neglect. However, it has not been determined whether this dissociation is modality-independent or modality-specific. We identify the incidence of egocentric and allocentric neglect in visual and tactile modalities, as well as the frequency of their co-occurrences in each modality. One-hundred patients with acute, right supratentorial ischemic stroke were administered tests for egocentric and allocentric hemispatial neglect in visual (n=98) and tactile (n=58) modalities. The visual test consisted of a page of 30 circles; 10 with no gap, 10 with a gap on the right side, and 10 with a gap on the left. Patients were asked to circle all complete circles and cross out all circles with gaps. A tactile version consisted of the same stimulus types presented as raised circles. Patients were asked to explore the board of circles with their dominant hand and report whether each circle had a gap. To determine the presence of egocentric or allocentric neglect, each test was analyzed for a significantly higher number of errors on the contralesional versus ipsilesional side of the page/board, or of the stimulus, using the Chi square analysis. On the visual test, 17 patients exhibited egocentric neglect; four exhibited allocentric neglect; and only two exhibited both. In the tactile modality, 19 exhibited egocentric neglect; one exhibited allocentric neglect; and none demonstrated both. Only four patients showed egocentric neglect on both visual and tactile tests. We found one patient with bilateral lesions who showed left egocentric visual neglect and right allocentric tactile neglect. These data provide strong evidence that egocentric and allocentric neglect are distinct syndromes that often dissociate and likely reflect damage to different brain areas. They also show that selective egocentric or allocentric neglect can occur in visual or tactile modalities.     

Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation

Background –  Subthreshold depression (sD) and cognitive impairment but not demented (CIND) in stroke patients are associated with poorer rehabilitative outcomes. Their diagnosis can easily be operationalized using validated scales.
Aim –  The aim of the study was to ascertain the prevalence of depressive symptoms and cognitive impairment in stroke patients during three crucial stages of the rehabilitative process, viz. upon admission, upon planned discharges from rehabilitation hospitals and at 6 months post-stroke, using validated scales like the Geriatric Depression Scale and Abbreviated Mental Test (recommended by the British Geriatric Society). Their baseline risk factors were also ascertained.
Results –  On admission, the prevalence of depressive symptoms and cognitive impairment was 60% and 54% respectively. The prevalence upon planned discharges and 6 months post-stroke, respectively, of depressive symptoms was 38% and 34% and that of impaired cognition was 33% and 40%. Baseline independent correlates at 6 months post-stroke depressive symptoms were: recurrent stroke (OR 3.34); on admission cognitive impairment (OR 4.78) and ADL dependence (OR 5.28). And that of cognitive impairment were: increasing age (OR 8.07); post-stroke dysphagia (OR 4.58); on admission cognitive impairment (OR 23.95) and on admission depressive symptoms (OR 3.50).
Conclusions –  Continuous screening and appropriate intervention, especially at baseline, would significantly decrease the burden posed by stroke patients with such psychological impairments in the community.     

系统化康复治疗对脑卒中偏瘫患者功能恢复的影响

目的探讨系统化康复治疗对脑卒中偏瘫患者肢体运动功能和日常生活活动(ADL)能力的影响。方法 84例脑卒中患者随机分为康复组和对照组,分别于治疗前及治疗后60 d对两组患者采用简化Fugl-Meyer量表(FMA)和Barthel指数(BI)来评定患者运动功能及ADL能力。结果治疗前,两组患者的FMA评分和BI评分差异均无显著统计学意义(P>0.05);治疗后,两组患者的FMA评分和BI评分与治疗前比较,均有明显改善(P<0.05)。结论系统化康复治疗对脑卒中偏瘫患者的肢体运动功能和ADL能力的恢复具有显著促进作用。     

Hypnosis meets neuropsychology: simulating visuospatial neglect in healthy participants

Neglect patients are not aware of stimuli in the contralesional space. We aimed to simulate neglect-like behaviour in healthy participants, by asking them to orient their visuospatial attention in two conditions: non-hypnotic suggestion and post-hypnotic suggestion. Results showed that directing visuospatial attention to one side of space caused neglect of stimuli in the opposite side of space, but only when participants were under post-hypnotic suggestion. Furthermore, directing visuospatial attention to the right side of space caused more neglect of left-sided stimuli than directing visuospatial attention to the left side of space did for right-sided stimuli. We propose that post-hypnotic suggestion can be a useful tool for (de)activating neurocognitive mechanisms underlying visuospatial awareness, a function that is fundamental for our survival. The use of post-hypnotic suggestion could be applied to the study of many domains of cognitive neurosciences (e.g., neurocognitive rehabilitation).     

Low‐frequency rTMS of the unaffected hemisphere in stroke patients: A systematic review

The aim of this review was to summarize the evidence for the effectiveness of low‐frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the unaffected hemisphere in promoting functional recovery after stroke. We performed a systematic search of the studies using LF‐rTMS over the contralesional hemisphere in stroke patients and reviewed the 67 identified articles. The studies have been gathered together according to the time interval that had elapsed between the stroke onset and the beginning of the rTMS treatment. Inhibitory rTMS of the contralesional hemisphere can induce beneficial effects on stroke patients with motor impairment, spasticity, aphasia, hemispatial neglect and dysphagia, but the therapeutic clinical significance is unclear. We observed considerable heterogeneity across studies in the stimulation protocols. The use of different patient populations, regardless of lesion site and stroke aetiology, different stimulation parameters and outcome measures means that the studies are not readily comparable, and estimating real effectiveness or reproducibility is very difficult. It seems that careful experimental design is needed and it should consider patient selection aspects, rTMS parameters and clinical assessment tools. Consecutive sessions of rTMS, as well as the combination with conventional rehabilitation therapy, may increase the magnitude and duration of the beneficial effects. In an increasing number of studies, the patients have been enrolled early after stroke. The prolonged follow‐up in these patients suggests that the effects of contralesional LF‐rTMS can be long‐lasting. However, physiological evidence indicating increased synaptic plasticity, and thus, a more favourable outcome, in the early enrolled patients, is still lacking. Carefully designed clinical trials designed are required to address this question. LF rTMS over unaffected hemisphere may have therapeutic utility, but the evidence is still preliminary and the findings need to be confirmed in further randomized controlled trials.     

A rehabilitation program based on music practice for patients with unilateral spatial neglect: a single-case study

Two major limitations of unilateral spatial neglect (USN) rehabilitation methods are actually reported: a lack of long-term efficiency and a lack of generalization to daily life. The aim of our case study was to underline how a multisensory method–music practice-could avoid these limitations. Mrs BV suffered from a chronic severe USN. She had rehabilitation sessions of music practice over 8 weeks. An improvement of her USN was found on paper-pencil tests but also in daily activities. Benefits subsisted 4 months after rehabilitation. Music practice seemed to avoid the major limitations of USN rehabilitations and could represent a promising tool.     

脑卒中后吞咽障碍的康复治疗研究

目的探讨脑卒中后吞咽障碍康复治疗的疗效。方法31例脑卒中后吞咽障碍患者随机分为康复治疗组(17例)和对照组(14例)。两组患者脑卒中基础治疗相同,治疗组同时进行早期吞咽康复治疗,每日3次,连续3周。采用吞咽X线透视检查法(VFSS)对两组患者治疗前后吞咽障碍进行评分,并检查血钠、钾、白蛋白水平及吸入性肺炎发生情况。结果治疗组治疗后VFSS评分(7.2±2.1)比治疗前(4.0±1.9)及对照组(4.7±2.1)明显提高(均P<0.01);吞咽障碍恢复13例(76.5%),明显高于对照组(2例,14.3%)(P<0.01)。治疗组和对照组治疗前后血钠、钾、白蛋白含量及吸入性肺炎发生率的差异无显著性(均P>0.05)。结论吞咽障碍康复治疗对于脑卒中后吞咽障碍有明显疗效。     

Nuanced effects of music interventions on rehabilitation outcomes after stroke: a systematic review

Background: Music is affordable and easily integrated in rehabilitation exercises, and has demonstrated different effects on the brain. We hypothesized that music interventions could improve rehabilitation outcomes after stroke.

Objective: the aim of our review is to determine the effectiveness of different types of music interventions according to the rehabilitation objectives after stroke.

Method: A systematic review of randomized controlled trials, clinical controlled trials and cross-over design performed on PubMed and PEDro in May 2018. All of these studies focus on acute, sub-acute or chronic stroke rehabilitation with music or rhythmic auditory stimulation intervention in adults during clinical outcomes. Two independent reviewers extracted the data and assessed the risk of bias before bringing it together.

Results: Twenty-seven studies were included and analyzed. Our review found positive effects on physical status (upper-limb activity; gait parameters, balance), on cognition (neglect, attention, communication) and mood. The analysis of the quality of the evidence showed that a majority of the studies had a high risk of bias.

Conclusion: Focusing on high to moderate level evidence, our review highlighted that rhythmic auditory stimulation has a positive effect on gait and balance; that receptive music therapy improves mood as well as some cognitive functions; that there is not enough evidence to determine the effectiveness of active music therapy and melodic intonation therapy. High-quality trials with large samples would be necessary to further assess and/or recommend these interventions.     

The aftermath of rehabilitation for patients with severe stroke

OBJECTIVE: The study evaluates the aftermath of stroke in patients with very severe disability after their first ever stroke and dismissed after rehabilitation. MATERIALS AND METHODS: Sixty-nine inpatients were studied, who were highly disabled at discharge with a Functional Independence Measure (FIM) score in the range of 18-39. Their rehabilitation program had lasted 60 days. The degree of functional independence was measured by means of the FIM at the beginning of treatment, at discharge and at follow-up. The data collected were examined by using parametric and distribution-free statistical methods. The role of age in the process of recovery was also evaluated. RESULTS: All patients were discharged home after 2 months. At 6 month follow-up, 15 patients (21.7%) were lost, 27 (39.1%) had died and 27 (39.1%) lived at home. Among stroke survivors a clear trend toward an improvement was detected during the 6 months observation period. Indeed, the third quartile changed from 33 to 63 and a patient approached to independence (FIM 87). None underwent a rehabilitation program at home beside the relatives' assistance. CONCLUSIONS: Highly disabled stroke patients are probably to undergo unfavourable outcome but unexpected recovery cannot be ruled-out on the basis of cut-off parameters measured after the acute phase of stroke. Multivariate statistical methods can identify factors which can interfere with functional recovery but are error-prone in setting individual prognosis. Moreover the recovery process may develop in a long period of time. Taking into consideration the spontaneous recovery observed during the follow-up period after the dismissal from rehabilitation ward, a suitable rehabilitation at home might be fruitful in these patients, who should not be considered as "lost".     

Prolonged muscular flaccidity: frequency and association with unilateral spatial neglect after stroke

The frequency of prolonged muscular flaccidity (PMF) was examined in a series of stroke patients in chronic phase suffering from hemiplegia with minimal spontaneous recovery (MSR). The results indicated that in such a population with poor motor recovery, PMF was significantly more frequent than spasticity. PMF was found to be associated with left-sided hemiplegia and unilateral spatial neglect. The minimal spontaneous recovery of the series of stroke patients we studied could be dependent on the interaction of three negative prognostic factors: left sided hemiplegia, unilateral spatial neglect and prolonged muscular flaccidity.