Abstract
Unilateral visual neglect from right hemispheric stroke is a condition that reduces a person's ability to attend to and process stimuli in their left visual field, resulting in neglect and inattention to the left side of their environment. This perceptual processing deficit can negatively affect individuals' daily living which in turn reduces functional independence. Musical Neglect Training (MNT) has been developed based on previous research evidence to improve left visual field processing. Two individuals with persistent chronic unilateral visual neglect participated in this study. Participants underwent six individual MNT sessions. Active MNT was used involving exercises on musical equipment (tone bars) to complete musical patterns emphasizing attentional focus toward the neglect visual field. Two standardized assessments (Albert's and Line Bisection Test) were used. The assessments were administered immediately before and after each of the 6 MNT sessions to assess the within-session effect of MNT. Follow-up testing was done 1 week after their 6th session to examine the longer-lasting effects of MNT. Paired t-test and Wilcoxon signed rank test were used to examine results. Both participants showed significant improvement pre vs. posttest on the Albert's Test but not on the Line Bisection Test. The current study presents the positive potential of MNT for patients with chronic persistent visual neglect. In particular, effects were shown for exploratory visuomotor neglect (Albert's test), but not for egocentric perceptive neglect (Line Bisection Test), and substantiated for within-session effects only. The predictable auditory stimulus patterns associated with object sequences (tone bars) to provide feedback, direct spatial attention and orientation, and initiate intention for movement into the neglect field may offer specific advantages to reduce persistent perceptual attention deficits.
Highlights
Unilateral visual neglect caused by right hemispheric stroke is a condition that reduces a person’s ability to attend to and process stimuli in the left visual field
Azouvi et al [6] reviewed and classified a number of different rehabilitation techniques and treatments for visual neglect based on theoretical basis, such as top-down mechanism, bottom-up mechanism, modulation of inhibitory processes [e.g., transcranial magnetic stimulation [TMS] and transcranial direct current stimulation [tDCS]], and increasing arousal
Participant 1 was a 62 years old female who sustained an ischemic stroke 26 month prior to entering the study. Her stroke was located in the right internal capsule and medial right temporal lobe resulting in left hemiparesis and loss of attention on the left side with decreased functional performance in activities of daily living
Summary
Unilateral visual neglect caused by right hemispheric stroke is a condition that reduces a person’s ability to attend to and process stimuli in the left visual field. Research has shown that musical stimulation may be able to improve attention and perception in the left visual field [18] Based on those early data, Musical Neglect Training (MNT) has been developed for patients with unilateral visual neglect [19, 20]. Patterns should be well-known to the participants (such as familiar melodies or octave scales) to drive the attentional search to find and complete all musical events via active playing [21] This structure is intended to take advantage of the inherent perceptual structure of sequence completion in musical patterns and facilitate the spatial orientation and exploration toward the neglect side. Bernardi et al [23] used playing a music scale on the keyboard with decreasing range into the neglect field Both studies tried to exercise perceptual-attentional and motorintentional deficits by asking subjects to complete musical patterns whose lengths was increasingly extended into the visual neglect field. This study was intended to add to the currently limited data base of MNT in chronic persistent neglect and to investigate carry-over effects from training 1 week after training completion
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