Abstract
BackgroundHemineglect is frequent after right hemisphere stroke and prevents functional independence, but effective rehabilitation interventions are lacking. Our objective was to determine if a visual-acoustic alarm in the hemineglect arm activated by a certain discrepancy in movement of both hands can enhance neglect arm use in five tasks of daily living.MethodsIn this pre-post intervention study 9 stroke patients with residual hemineglect of the arm were trained for 7 days in five bimanual tasks of daily living: carrying a tray, button fastening, cutting food with knife and fork, washing the face with both hands and arm sway while walking. This was done through motion sensors mounted in bracelets on both wrists that compared movement between them. When the neglect-hand movement was less than a limit established by two fuzzy logic based classifiers, a visual-acoustic alarm in the neglect-hand bracelet was activated to encourage its use in the task.ResultsBoth motion and function of the neglect hand improved during the seven days of training when visual-acoustic alarms were active but a worsening to baseline values occurred on day 8 and day 30 when alarms where switched off. Improvement was limited to vision-dependent tasks.ConclusionsNeglect-hand improvement with this approach is limited to bimanual activities in which an object is manipulated under vision control, but no short or long term learning happens.
Highlights
Hemineglect is frequent after right hemisphere stroke and prevents functional independence, but effective rehabilitation interventions are lacking
In visual-spatial hemineglect patients with a lesion of the right cerebral hemisphere are not aware of objects in the left visual field despite not having a visual deficit. When it encompasses left limbs, as well as lacking awareness of them, the patient does not use the left arm in spite of not having paralysis
There is insufficient evidence to recommend a particular rehabilitation strategy for neglect as shown by a Cochrane review that found no efficacy of rehabilitation interventions in reducing disability [8, 9]. In this pre-post intervention pilot study, Trejo-Gabriel-Galan et al Journal of NeuroEngineering and Rehabilitation (2016) 13:79 we studied if a visual-acoustic alarm in the hemineglect arm activated by its reduced movement relative to the contralateral arm could increase neglect arm use in five tasks of daily living
Summary
Hemineglect is frequent after right hemisphere stroke and prevents functional independence, but effective rehabilitation interventions are lacking. In visual-spatial hemineglect ( known as hemiinattention) patients with a lesion of the right cerebral hemisphere are not aware of objects in the left visual field despite not having a visual deficit. When it encompasses left limbs, as well as lacking awareness of them, the patient does not use the left arm in spite of not having paralysis. Trejo-Gabriel-Galan et al Journal of NeuroEngineering and Rehabilitation (2016) 13:79 we studied if a visual-acoustic alarm in the hemineglect arm activated by its reduced movement relative to the contralateral arm could increase neglect arm use in five tasks of daily living. We used triaxial accelerometers, previously employed to measure upper limb movement after stroke [10, 11]
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