Catherine Bergego Scale Research Articles

Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study

Purpose: To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home.Methods: A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke, <1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a ‘mixing matrix’ and integrated by ‘following threads’. Finally, a synthesis was written into a vignette.Results: The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants.Conclusion: Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect.Implications for RehabilitationFindings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation.Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient’s own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient’s daily life context.The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying.

Effects of oculo-motor exercise, functional electrical stimulation and proprioceptive neuromuscular stimulation on visual perception of spatial neglect patients.

[Purpose] The purpose of this study was to identify the effects of oculo-motor exercise, functional electrical stimulation (FES), and proprioceptive neuromuscular facilitation (PNF) on the visual perception of spatial neglect patients. [Subjects and Methods] The subjects were randomly allocated to 3 groups: an oculo-motor exercise (OME) group, a FES with oculo-motor exercise (FOME) group, and a PNF with oculo-motor exercise (POME) group. The line bisection test (LBT), motor free visual test (MVPT), and Catherine Bergego Scale (CBS) were used to measure visual perception. These were performed 5 times per week for 6 weeks. [Results] The OME group and POME group showed significant improvements according to the LBT and MVPT results, but the FOME group showed no significant improvement. According to the CBS, all 3 groups showed significant improvements. The OME and POME groups showed improvement over the FOME group in the LBT and MVPT. However, there was no significant difference among the three groups according to the CBS. [Conclusion] These results indicate that oculo-motor exercise and PNF with oculo-motor exercise had more positive effects than FES with oculo-motor exercise on the visual perception of spatial neglect patients.

The Effect of Transcranial Direct Current Stimulation on Neglect Syndrome in Stroke Patients.

ObjectiveTo examine whether transcranial direct current stimulation (tDCS) applied over the posterior parietal cortex (PPC) improves visuospatial attention in stroke patients with left visuospatial neglect.MethodsPatients were randomly assigned to 1 of 3 treatment groups: anodal tDCS over the right PPC, cathodal tDCS over the left PPC, or sham tDCS. Each patient underwent 15 sessions of tDCS (5 sessions per week for 3 weeks; 2 mA for 30 minutes in each session). Outcome measures were assessed before treatment and 1 week after completing the treatment.ResultsFrom pre- to post-treatment, there was an improvement in the motor-free visual perception test (MVPT), line bisection test (LBT), star cancellation test (SCT), Catherine Bergego Scale (CBS), Korean version of Modified Barthel Index (K-MBI), and Functional Ambulation Classification in all 3 groups. Improvements in the MVPT, SCT, and LBT were greater in the anodal and cathodal groups than in the sham group. However, improvements in other outcomes were not significantly different between the 3 groups, although there was a tendency for improved CBS or K-MBI scores in the anodal and cathodal groups, as compared with the sham group.ConclusionThe study results indicated that the facilitatory effect of anodal tDCS applied over the right PPC, and the inhibitory effect of cathodal tDCS applied over the left PPC, improved symptoms of visuospatial neglect. Thus, tDCS could be a successful adjuvant therapeutic modality to recover neglect symptom, but this recovery might not lead to improvements in activities of daily living function and gait function.

The Effect of an Upper Limb Rehabilitation Robot on Hemispatial Neglect in Stroke Patients.

ObjectiveTo investigate the effectiveness of an upper limb rehabilitation robot therapy on hemispatial neglect in stroke patients.MethodsPatients were randomly divided into an upper limb rehabilitation robot treatment group (robot group) and a control group. The patients in the robot group received left upper limb training using an upper limb rehabilitation robot. The patients sat on the right side of the robot, so that the monitor of the robot was located on the patients' left side. In this position, patients could focus continuously on the left side. The control group received conventional neglect treatment, such as visual scanning training and range of motion exercises, administered by occupational therapists. Both groups received their respective therapies for 30 minutes a day, 5 days a week for 3 weeks. Several tests were used to evaluate treatment effects before and after the 3-week treatment.ResultsIn total, 38 patients (20 in the robot group and 18 in the control group) completed the study. After completion of the treatment sessions, both groups showed significant improvements in the Motor-Free Visual Perception Test 3rd edition (MVPT-3), the line bisection test, the star cancellation test, the Albert's test, the Catherine Bergego scale, the Mini-Mental State Examination and the Korean version of Modified Barthel Index. The changes in all measurements showed no significant differences between the two groups.ConclusionThis present study showed that the upper limb robot treatment had benefits for hemispatial neglect in stroke patients that were similar to conventional neglect treatment. The upper limb robot treatment could be a therapeutic option in the treatment of hemispatial neglect after stroke.

A preliminary investigation into the psychometric properties of the Dublin Extrapersonal Neglect Assessment (DENA): A novel screening tool for extrapersonal neglect

Extrapersonal neglect is one clinical manifestation that can occur following stroke. Existing neglect assessment procedures have been criticised for lengthy administration and do not assess how extrapersonal space is affected. This study investigated the psychometric properties of a new, time-efficient screening tool for extrapersonal neglect. Full ethical approval was granted and consent obtained from 50 participants with first-time stroke. Participants were screened for extrapersonal neglect on two consecutive days by two raters using the Dublin Extrapersonal Neglect Assessment (DENA) to test inter-rater reliability. Construct validity of the DENA was investigated by comparing the DENA to the Catherine Bergego Scale (CBS). Additional analyses were calculated between the DENA and the extrapersonal items of the CBS (CBS-E). The kappa statistic, intraclass correlation coefficients (ICCs) and Bland Altman analyses were calculated to determine excellent inter-rater reliability (ICC 0.971, κ = .876) and significant correlation between the DENA and the CBS and CBS-E (ICC 0.870, 0.934, κ = .793, .833, respectively). Bland Altman analyses demonstrated acceptable levels of agreement between the DENA raters, and the DENA and CBS, with no systematic differences evident. The DENA provides clinicians with a quick and psychometrically sound screening tool for extrapersonal neglect to ensure this impairment is addressed in stroke rehabilitation.

뇌졸중 환자의 편측무시 평가를 위한 한국형 캐서린 버지고 척도(K-CBS)의 신뢰도와 타당도 연구

뇌졸중 환자의 편측무시 평가를 위한 한국형 캐서린 버지고 척도(K-CBS)의 신뢰도와 타당도 연구

Anatomical and psychometric relationships of behavioral neglect in daily living

Spatial neglect has been related to both cortical (predominantly at the temporal–parietal junction) and subcortical (predominantly of the superior longitudinal fasciculus) lesions. The objectives of this observational study were to specify the anatomical relationships of behavioral neglect in activities of daily living (N-ADLs), and the anatomical and psychometric relationships of N-ADLs on one hand and components of neglect (peripersonal neglect and personal neglect) and anosognosia on the other. Forty five patients were analyzed for behavioral difficulties in daily living (on the Catherine Bergego scale) and the main components of neglect (using conventional clinical assessments) during the first months post right hemisphere stroke. Voxel-based lesion-symptom mapping was used to identify brain areas within which lesions explained the severity of bias in each assessment (non-parametric permutation test; p<0.01, one tailed). N-ADLs was associated with lesions centered on the posterior part of the superior temporal gyrus and extending to the temporo-parietal junction, temporo-occipital junction and subcortical white matter (including the superior longitudinal fasciculus). Peripersonal neglect resulted from extended cortical lesions centered on the superior temporal gyrus and the inferior parietal gyrus, with subcortical extension. Personal neglect resulted predominantly from lesions centered on the somatosensory cortex and at a lesser degree on the superior temporal sulcus. Anosognosia resulted from lesions of the posterior inferior temporal gyrus and superior temporal gyrus. In anatomic terms, N-ADLs was strongly related to peripersonal neglect, and those relationships were also shown by the psychometric analysis. In conclusions, superior temporal gyrus and superior longitudinal fasciculus lesions have a pivotal role in N-ADLs. N-ADLs is principally related (anatomically and psychometrically) to peripersonal neglect, and at a lesser degree to anosognosia and personal neglect.

Cognitive rehabilitation with right hemifield eye-patching for patients with sub-acute stroke and visuo-spatial neglect: A randomized controlled trial

Objective: To assess whether, following a right-hemisphere stroke, the combined administration of computer-based cognitive rehabilitation and right hemifield eye-patching in patients with visuo-spatial neglect is more effective than computer-based cognitive rehabilitation alone.Methods: Twelve patients were randomized into two treatment groups: a single treatment group (n = 7) and a combination treatment group (n = 5). In both cases, the treatment consisted of a mean number of 15 sessions, each lasting 1 hour. Visuo-spatial neglect was assessed using a specific exploration protocol (Bell Cancellation Test, Figure Copying of Odgen, Line Bisection, Baking Tray Task and Reading Task). The functional effects of the treatment were assessed using the Catherine Bergego Scale.Results: Significant between-group differences were observed when comparing the pre- and post-treatment scores for the Reading Task. No differences were observed in either group in the Catherine Bergego Scale administered at baseline and at the final intervention.Conclusion: The results obtained do not allow one to conclude that the combination treatment with cognitive rehabilitation and right hemifield eye-patching is more effective than cognitive rehabilitation alone. Although partial improvement in the performance of neuropsychological tests was observed, this improvement is not present at functional level.

Effects of combining mental practice with electromyogram-triggered electrical stimulation for stroke patients with unilateral neglect.

[Purpose] The aim of this study was to investigate the effect of mental practice combined with electromyogram-triggered electrical stimulation on neglect and activities of daily living in stroke patients with unilateral neglect. [Subjects and Methods] Thirty-three stroke patients with unilateral neglect were recruited from a local university hospital, and were divided into two groups. The experimental group received an intervention consisting of mental practice combined with electromyogram-triggered electrical stimulation on the neglected side, while the control group received cyclic electrical stimulation at the same site. In addition, both groups received an identical intervention of conventional occupational and physical therapy. [Results] After the intervention, the experimental group showed a statistically significant improvement in the line bisection test result, star cancellation test result, and Catherine Bergego Scale scores. The control group showed a significant improvement only in the line bisection test result. [Conclusion] These data suggest that mental practice combined with electromyogram-triggered electrical stimulation is an effective, novel treatment for reducing unilateral neglect in stroke patients.

Severity of Spatial Neglect During Acute Inpatient Rehabilitation Predicts Community Mobility After Stroke

To examine whether stroke survivors with more severe spatial neglect duringtheir acute inpatient rehabilitation had poorer mobility after returning to their communities. A prospective observational study. Acute inpatient rehabilitation and follow-up in the community. Thirty-one consecutive stroke survivors with right-brain damage (women, n= 15 [48.4%]), with the mean (standard deviation) age of 60 ± 11.5 years, were included in the study if they demonstrated spatial neglect within 2 months after stroke. Spatial neglect was assessed with the Behavioral Inattention Test (BIT) (range, 0-146 [a lower score indicates more severity]) and the Catherine Bergego Scale (range, 0-30 [a higher score indicates more severity]). A score of the Behavioral Inattention Test<129 or of the Catherine Bergego Scale >0 defined the presence of spatial neglect. The outcome measure is community mobility, defined by the extent and frequency of traveling within the home and in the community, and is assessed with the University of Alabama at Birmingham Study of Aging Life-Space Assessment (range, 0-120 [a lower score indicates less mobile]). This measure was assessed after participants returned home≥6 months after stroke. The covariates were age, gender, functional independence at baseline; follow-up interval; and depressed mood, which may affect the relationship between spatial neglect and community mobility. A lower Behavioral Inattention Test score was a significant predictor of a lower Life-Space Assessment score after controlling for all the covariates (β= 0.009 [95% confidence interval, 0.008-0.017]); P= .020). The proportion of participants unable to travel independently beyond their homes was 0%, 27.3%, and 72.7% for those with mild, moderate, and severe acute neglect, respectively (Catherine Bergego Scale range, 1-10, 11-20, and 21-30, respectively). Our result indicates that acute spatial neglect has a negative impact on regaining of functional mobility in the community. Specific screening and treatment of spatial neglect during acute stroke care may be necessary to improve long-term mobility recovery.

Functional assessment of region-specific neglect: are there differential behavioural consequences of peripersonal versus extrapersonal neglect?

Background. Region-specific types of neglect (peripersonal and extrapersonal) have been dissociated, yet, differential behavioural consequences are unknown. Objective. The aim of the current study was to investigate behavioural consequences at the level of basic activities of daily living of region-specific neglect, using the Catherine Bergego Scale (CBS). Methods. 118 stroke patients were screened within the first two weeks after admission to the rehabilitation center for inpatient rehabilitation. Results. Patients with peripersonal neglect and patients with neglect for both regions had significantly higher total score on the CBS compared to nonneglect patients. Total scores for patients with extrapersonal neglect were comparable to non-neglect patients. ADL impairments were found across activities (e.g., looking towards one side, forgetting body parts, colliding) for both patients with peripersonal neglect and patients with neglect for both regions. Patients with extrapersonal neglect were only impaired on the item on way finding. Conclusions. When diagnosing neglect, it is relevant to distinguish the type of region-specific neglect and, where needed, to adjust the rehabilitation program accordingly. As the CBS is not developed to typically measure ADL in extrapersonal neglect, it would be of importance to add other (instrumental) activities that heavily rely on processing information in farther space.

Recovery from Neglect after Right Hemisphere Stroke

Favourable outcome after cerebrovascular stroke is associated with early admission to rehabilitation, small lesion size and minor cognitive impairment. The aim of the present study was to explore factors associated with the amelioration of neglect after right hemisphere stroke. Twenty-one consecutive eligible right hemisphere stroke patients in one rehabilitation center were assessed and followed for 6 months. The neglect syndrome was assessed by the conventional subtests of the Behavioural Inattention Test (BIT) and by the Catherine Bergego Scale (CBS) before and after the 3-week rehabilitation and at 6-month follow-up. The manifestations of extinction, pusher syndrome and depression were evaluated. Recovery from neglect was strongly associated with early rehabilitation and the initial severity of neglect. Intensive treatment yielded recovery in severe or moderate visual neglect long after the first two to three months after stroke. Even chronic patients with sufficient cognitive and psychological capacity improved with intensive rehabilitation. Tactile extinction was common in these patients but was not associated with recovery. Manifestations of pusher syndrome hampered amelioration of visual neglect in acute and sub-acute stroke patients, whereas depression did not prevent recovery from neglect. Intensive rehabilitation promotes recovery from neglect in the acute phase after right hemisphere stroke. A comprehensive program later, in sub-acute or chronic phase, may also be effective especially in those patients who have not received intensive multi-professional rehabilitation soon after the stroke.

Presence of Motor-Intentional Aiming Deficit Predicts Functional Improvement of Spatial Neglect With Prism Adaptation

Background. Spatial neglect is a debilitating disorder for which there is no agreed on course of rehabilitation. The lack of consensus on treatment may result from systematic differences in the syndrome's characteristics, with spatial cognitive deficits potentially affecting perceptual-attentional “Where” or motor-intentional “Aiming” spatial processing. Heterogeneity of response to treatment might be explained by different treatment impacts on these dissociated deficits: prism adaptation, for example, might reduce Aiming deficits without affecting Where spatial deficits. Objective. Here, we tested the hypothesis that classifying patients by their profile of Where-versus-Aiming spatial deficit would predict response to prism adaptation and specifically that patients with Aiming bias would have better recovery than those with isolated Where bias. Methods. We classified the spatial errors of 24 subacute right stroke survivors with left spatial neglect as (1) isolated Where bias, (2) isolated Aiming bias, or (3) both. Participants then completed 2 weeks of prism adaptation treatment. They also completed the Behavioral Inattention Test and Catherine Bergego Scale (CBS) tests of neglect recovery weekly for 6 weeks. Results. As hypothesized, participants with only Aiming deficits improved on the CBS, whereas those with only Where deficits did not improve. Participants with both deficits demonstrated intermediate improvement. Conclusion. These results support behavioral classification of spatial neglect patients as a potential valuable tool for assigning targeted, effective early rehabilitation.

Effects of Constraint-Induced Therapy Combined With Eye Patching on Functional Outcomes and Movement Kinematics in Poststroke Neglect

OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk-arm kinematics in stroke patients with neglect syndrome. METHOD. Twenty-four participants were recruited and randomly allocated to three intervention groups. All participants received intervention 2 hr/day, 5 days/wk, for 3 wk. Outcome measures included the Catherine Bergego Scale, eye movement, and trunk-arm kinematic analysis. RESULTS. The CIT + EP and CIT groups demonstrated larger improvements in functional performance than the control group. The CIT group showed better performance with left fixation points than the CIT+EP group and shorter reaction time than the control group. The CIT + EP group improved more in preplanned control and leftward trunk shift than the other two groups. CONCLUSION. CIT + EP and CIT were more effective interventions than conventional treatment of patients with neglect syndrome in daily functional performance.

Abstract WMP87: Effectiveness of Mirror Therapy in Stroke Patients with Unilateral Neglect- A Randomized Controlled Trial

Specific Aims: To study the effectiveness of mirror therapy and limb activation vs limb activation alone in the treatment of stroke patients with unilateral neglect. Significance: Hemi spatial neglect is a major disability after stroke. There are no effective therapies available so far. This study is a randomized controlled trial and has been carried out since January 2011 in Stroke Unit &amp; College of Physiotherapy, Christian Medical College &amp; Hospital. All stroke patients with thalamic and parietal lobe lesions and unilateral neglect after 48 hours of stroke were included in the study. Approach: Patients were randomized to treatment and control groups. Treatment group was given mirror therapy with limb activation and the control group received only limb activation. The treatment sessions were 1-2 hours/day for 5 days/week, for 4 weeks period. Unilateral neglect and outcome measures were assessed using picture identification task, star cancellation &amp; line bisection tests, Catherine Bergego scale &amp; Functional Independence Measure (FIM). The outcome was documented by a blinded assessor at 6 months. Fishers exact test &amp; independent t-test was used (SPSS version 16.0) for statistical analysis. The mean difference in baseline scores &amp; at follow-up was compared between the two groups. Innovation: Twenty five patients were enrolled; analysis was confined to 23 patients (14 in treatment group &amp; 9 in control group; 2 patients died). The treatment group performed better in the picture identification task (treatment group: mean difference 4.9 confidence interval (CI): 3.9-5.8) vs control group (2.1, CI: 1.4-2.8; p&lt;0.001). The mean change in the star cancellation score in the treatment group was 31.5 (CI: 24.4-38.6) vs control group 14.3 (CI: 7.7-20.9); p=0.001. The mean change in line bisection test was 11.0 (CI: 9.0-13.1) in the treatment group vs 6.7 (CI: 4.3-9.2); p=0.008 in the control group. The proportion of patients with no neglect in Catherine Bergego scale in the treatment group was 12 (85.7%) vs 0 (0%); p=&lt;0.001 in the control group. Three patients (21.4%) were independent in FIM in the treatment group vs. 0 (0%); p=0.25 in the control group. Mirror therapy with limb activation is effective in improving unilateral neglect in stroke patients in this ongoing trial.

Effect of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation on Visuospatial Neglect in Patients With Acute Stroke: A Double-Blind, Sham-Controlled Trial

ObjectiveTo compare the therapeutic effect of low- and high-frequency repetitive transcranial magnetic stimulation (rTMS) of the posterior parietal cortex (PPC) in patients with acute stroke with visuospatial neglect. DesignThis study was a prospective, double-blind, sham-controlled trial. Data are presented from 27 patients (15 men, 12 women; mean age, 67.0y) randomly assigned to receive 10 sessions of low-frequency (1Hz) rTMS over the nonlesioned PPC, high-frequency (10Hz) rTMS over the lesioned PPC, or sham stimulation. SettingNational university hospital. ParticipantsPatients (N=27) diagnosed with visuospatial neglect after stroke. InterventionTen sessions of rTMS over a 2-week period. Main Outcome MeasuresThe severity of visuospatial neglect was assessed pre- and posttreatment using the Motor-Free Visual Perception Test, line bisection test, star cancellation test, and Catherine Bergego Scale. ResultsWhen comparing the differences in the Motor-Free Visual Perception Test, line bisection test, star cancellation test, Catherine Bergego Scale, and Korean-Modified Barthel Index (K-MBI) scores before and after treatment according to group, we found that changes in the line bisection test and K-MBI scores were significantly different between 3 groups. In the post hoc analysis, the improvement in the line bisection test score in the high-frequency rTMS group was statistically significant compared with that in the sham stimulation group (high vs sham P=.03, low vs sham P=.09, high vs low P=.58), and the improvements in the K-MBI scores of the 2 rTMS groups were statistically significant compared with those in the sham stimulation group (high vs sham P<.01, low vs sham P=.02, high vs low P=.75). ConclusionsThese results indicate that high-frequency rTMS is effective in the treatment of visuospatial neglect in patients with acute stroke.

Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment

Prism adaptation treatment (PAT) is a promising rehabilitative method for functional recovery in persons with spatial neglect. Previous research suggests that PAT improves motor-intentional "aiming" deficits that frequently occur with frontal lesions. To test whether presence of frontal lesions predicted better improvement of spatial neglect after PAT, the current study evaluated neglect-specific improvement in functional activities (assessment with the Catherine Bergego Scale) over time in 21 right-brain-damaged stroke survivors with left-sided spatial neglect. The results demonstrated that neglect patients' functional activities improved after two weeks of PAT and continued improving for four weeks. Such functional improvement did not occur equally in all of the participants: Neglect patients with lesions involving the frontal cortex (n = 13) experienced significantly better functional improvement than did those without frontal lesions (n = 8). More importantly, voxel-based lesion-behavior mapping (VLBM) revealed that in comparison to the group of patients without frontal lesions, the frontal-lesioned neglect patients had intact regions in the medial temporal areas, the superior temporal areas, and the inferior longitudinal fasciculus. The medial cortical and subcortical areas in the temporal lobe were especially distinguished in the "frontal lesion" group. The findings suggest that the integrity of medial temporal structures may play an important role in supporting functional improvement after PAT.

Functional Assessment of Spatial Neglect: A Review of the Catherine Bergego Scale and an Introduction of the Kessler Foundation Neglect Assessment Process

Spatial neglect is a debilitating poststroke neurocognitive disorder associated with prolonged hospitalization and poor rehabilitation outcomes. The literature suggests a high prevalence of this disorder, but clinicians have difficulty reliably identifying affected survivors. This discrepancy may result from suboptimal use of validated neglect assessment procedures. In this article, we suggest use of a validated assessment tool that is sensitive to identification of neglect and its functional consequences – the Catherine Bergego Scale (CBS). We provide detailed item-by-item instructions for observation and scoring – the Kessler Foundation Neglect Assessment Process (KF-NAP). Rehabilitation researchers may be able to use the CBS via the KF-NAP to measure ecological outcomes and specific, separable perceptual-attentional and motor-exploratory spatial behaviors.

Theta burst stimulation reduces disability during the activities of daily living in spatial neglect

Left-sided spatial neglect is a common neurological syndrome following right-hemispheric stroke. The presence of spatial neglect is a powerful predictor of poor rehabilitation outcome. In one influential account of spatial neglect, interhemispheric inhibition is impaired and leads to a pathological hyperactivity in the contralesional hemisphere, resulting in a biased attentional allocation towards the right hemifield. Inhibitory transcranial magnetic stimulation can reduce the hyperactivity of the contralesional, intact hemisphere and thereby improve spatial neglect symptoms. However, it is not known whether this improvement is also relevant to the activities of daily living during spontaneous behaviour. The primary aim of the present study was to investigate whether the repeated application of continuous theta burst stimulation trains could ameliorate spatial neglect on a quantitative measure of the activities of daily living during spontaneous behaviour. We applied the Catherine Bergego Scale, a standardized observation questionnaire that can validly and reliably detect the presence and severity of spatial neglect during the activities of daily living. Eight trains of continuous theta burst stimulation were applied over two consecutive days on the contralesional, left posterior parietal cortex in patients suffering from subacute left spatial neglect, in a randomized, double-blind, sham-controlled design, which also included a control group of neglect patients without stimulation. The results showed a 37% improvement in the spontaneous everyday behaviour of the neglect patients after the repeated application of continuous theta burst stimulation. Remarkably, the improvement persisted for at least 3 weeks after stimulation. The amelioration of spatial neglect symptoms in the activities of daily living was also generally accompanied by significantly better performance in the neuropsychological tests. No significant amelioration in symptoms was observed after sham stimulation or in the control group without stimulation. These results provide Class I evidence that continuous theta burst stimulation is a viable add-on therapy in neglect rehabilitation that facilitates recovery of normal everyday behaviour.

Using the Catherine Bergego Scale (CBS) in Rehabilitation of Spatial Neglect: Kessler-CBS Process (P02.033)

Objective: To introduce the Kessler-CBS Process, a detailed item-by-item instruction for reliably administering a validated functional neglect assessment to stroke survivors. Background Spatial neglect is a debilitating post-stroke neurocognitive disorder, associated with longer hospitalization and worse rehabilitation outcomes. However, clinicians have difficulty reliably identifying affected survivors, even when using validated neglect assessment procedures. CBS is the only published tool assessing performance in personal, peri-personal (within arm9s reach) and extra-personal spaces, as well as in both perceptual and motor domains. Our team at the Kessler Foundation Research Center has used the CBS in our rehabilitation research on spatial neglect since 2008. However, we encountered implementation obstacles in reliably administering and scoring this instrument, and thus developed the K-CBS Process to standardize spatial neglect diagnosis and enhance stroke care. Design/Methods: Rehabilitation researchers, physiatrists, and occupational therapists (OTs) drafted a detailed manual for using and scoring the CBS, reviewed videos of the actual CBS administration by OTs, and refined the manual in four iterative cycles over three years. The K-CBS Process constrained key features of examiners9 structured observations. Results: The K-CBS Process uses two forms: Form A contains the table of the scale and instructions for calculating the final score and assigning the severity of spatial neglect; Form B provides item by item instructions for how to make observations. Conclusions: Research confirms the validity and value of the CBS as an outcome measure, and it has the unique attribute of potentially separating function in different brain-behavior networks supporting different spatial processing stages. The Kessler-CBS Process may improve the CBS, making it more reliable for detecting spatial neglect and its functional consequences, and may help clinicians to assign neglect treatments. Routinely identifying post-stroke spatial neglect fulfills national post-stroke rehabilitation guidelines and may enhance the quality of care and improve rehabilitation outcomes for these patients. Supported by: The Kessler Foundation and the NIH/NINDS (K02 NS 047099-05, R01 NS 055808-02, PI: Barrett). Disclosure: Dr. Chen has nothing to disclose. Dr. Hreha has nothing to disclose. Dr. Fortis has nothing to disclose. Dr. Goedert has nothing to disclose. Dr. Barrett has received personal compensation for activities with WebMD. Dr. Barrett has received research support from the Kessler Foundation, NIH, O9Brien Technologies, Pfizer/Eisai, and the Wallerstein Foundation for Geriatric Improvement.