Unilateral Neglect Research Articles

Aftereffects to Prism Exposure without Adaptation: A Single Case Study.

Visuo-motor adaptation to optical prisms (Prism Adaptation, PA), displacing the visual scene laterally, is a behavioral method used for the experimental investigation of visuomotor plasticity, and, in clinical settings, for temporarily ameliorating and rehabilitating unilateral spatial neglect. This study investigated the building up of PA, and the presence of the typically occurring subsequent Aftereffects (AEs) in a brain-damaged patient (TMA), suffering from apperceptive agnosia and a right visual half-field defect, with bilateral atrophy of the parieto-occipital cortices, regions involved in PA and AEs. Base-Right prisms and control neutral lenses were used. PA was achieved by repeated pointing movements toward three types of stimuli: visual, auditory, and bimodal audio-visual. The presence and the magnitude of AEs were assessed by proprioceptive, visual, visuo-proprioceptive, and auditory-proprioceptive straight-ahead pointing tasks. The patient’s brain connectivity was investigated by Diffusion Tensor Imaging (DTI). Unlike control participants, TMA did not show any adaptation to prism exposure, but her AEs were largely preserved. These findings indicate that AEs may occur even in the absence of PA, as indexed by the reduction of the pointing error, showing a dissociation between the classical measures of PA and AEs. In the PA process, error reduction, and its feedback, may be less central to the building up of AEs, than the sensorimotor pointing activity per se.

The orienting response drives pseudoneglect—Evidence from an objective pupillometric method

Spatial attention is generally slightly biased leftward (“pseudoneglect”), a phenomenon typically assessed with paper-and-pencil tasks, limited by the requirement of explicit responses and the inability to assess on a subsecond timescale. Pseudoneglect is often stable within experiments, but differs vastly between investigations and is sometimes directed to the left, sometimes to the right. To date, no exhaustive explanation to this phenomenon has been provided. Here, we objectively assessed lateralized attention over time, exploiting the phenomenon that changes in the pupil reflect the allocation of attention in space. Pupil sizes of 41 healthy participants fixating the center were influenced stronger by the differential background luminance of the left side compared to the right side of the visual display. These differences were mainly driven by visual information in the periphery. Differences in pupil sizes positively related with greyscales scores. Time-based analyses within trials show strongest effects early on. With increasing trial number (not time), the initial leftward bias shifted central in pupillometry-based and greyscales measures. This suggests that the orienting response determines the degree of attention bias. In our amplification hypothesis we pose that the quality of pseudoneglect (i.e., the direction) is determined by higher order factors such as hemispheric imbalances, whereas the quantity (i.e., the degree) is determined by the orienting network. This account might explain numerous—previously thought opposing—findings. We here show how pupil light responses reveal pseudoneglect, in a next step, this might allow clinical diagnosis of hemispatial neglect.

Diagnosing Gerstmann’s syndrome in a case of hypoxic brain injury

Objectives: Gerstmann’s syndrome (GS) is characterised by the cooccurrence of acalculia, finger agnosia, agraphia and left-right disorientation. Although there is a relatively large literature on the syndrome’s theoretical implications, less consideration has been given to the assessment of the syndrome in practice. We aimed to provide an illustrative case study of the differential diagnosis of GS.Methods: We describe a case of a 46-year-old woman who presented with the four classic symptoms of GS following a cardiac arrest. In addition to a standard neuropsychological assessment battery, an additional dedicated brief assessment was conducted to differentiate between GS and alternative possibilities.Results: The assessment revealed specific impairments in performing calculations, finger agnosia, agraphia and left-right disorientation, which could not be accounted for by alternative explanations, including a general cognitive impairment, dysphasia, apraxia, Balint’s syndrome, unilateral spatial neglect or object agnosia.Conclusions: The present article provides an illustrative case study of the differential diagnosis of Gerstmann’s syndrome, highlighting how the syndrome may be assessed in clinical practice.

Prism Adaptation Treatment of Spatial Neglect: Feasibility During Inpatient Rehabilitation and Identification of Patients Most Likely to Benefit.

ObjectiveSpatial Neglect is prevalent among stroke survivors, yet few treatments have evidence supporting efficacy. This study examines the feasibility of Prism Adaptation Treatment (PAT) within an inpatient rehabilitation facility and the degree by which PAT improves symptoms of spatial neglect and functional independence among sub-acute survivors of right hemispheric stroke.DesignIn this retrospective cohort study, 37 right hemispheric stroke patients were identified as having received at least 4 PAT sessions during their inpatient stay. Spatial neglect and functional independence levels of patients in the PAT cohort were compared to a matched active control group comprised of rehabilitation patients receiving alternative therapies to address neglect admitted during the same time period.ResultsMost patients received the full recommended 10 sessions of PAT (average sessions completed = 8.6). A higher percentage of severe neglect patients receiving PAT (69%) displayed clinically significant gains on FIM (≥22 points) compared to those receiving alternative treatments (6%). Patients with mild or moderate neglect in the PAT cohort did not exhibit greater benefit than controls.ConclusionProvision of PAT for treatment of spatial neglect in right hemispheric stroke patients was feasible during the inpatient rehabilitation admission. Patients with severe neglect showed the most benefit from PAT.Clinical Trial RegistrationThis study was registered as a retrospective observational study on Itab Clinical Trials.gov. NCT04977219.

Current knowledge and practice of post-stroke unilateral spatial neglect rehabilitation: A cross-sectional survey of South African neurorehabilitation physiotherapists.

BackgroundUnilateral spatial neglect (USN) affects the rehabilitation process leading to poor functional outcomes after stroke. South African physiotherapists’ level of uptake of available evidence in USN rehabilitation and the barriers they encounter are not known.ObjectivesTo evaluate knowledge, current practice enablers and barriers to USN management in stroke survivors amongst physiotherapists in South Africa.MethodsOur cross-sectional survey used a total sampling technique. Questionnaires were sent to neurorehabilitation physiotherapists in South Africa. Descriptive and inferential statistics analysed the data.ResultsThe overall knowledge score of USN was 14.11 ± 5.23 of a total of 25. The knowledge was good for definitions of USN; moderate for incidences, causes, screening, diagnosis and prognosis of USN and poor for pharmacological approaches to the management of USN. A significant low positive correlation between respondents’ age (r = 0.46; p = 0.016) and years of practice as a physiotherapist (r = 0.43; p = 0.026) and knowledge of USN was found. The most frequently utilised intervention was constraint-induced movement therapy; the commonly utilised assessment tool was the comb and razor test. ‘Inadequate therapy time’ (55.56%) and ‘lack of relevant equipment for rehabilitation of USN’ (38.89%) were identified as major barriers to USN rehabilitation. Major enablers to USN rehabilitation were the ‘presence of multidisciplinary stroke team in clinical practice’ (83.35%) and ‘availability of adequate staff’ (76.47%).ConclusionPhysiotherapists demonstrated a fair knowledge of USN although knowledge about pharmacological management of USN was modest. Current practice in post-stroke USN by South African neuro-physiotherapists follows current evidence and practice guidelines.Clinical implicationOur study shows the level of knowledge and current practice of post-stroke USN rehabilitation. The demonstrated fair knowledge of USN may be improved through training, curriculum modifications or continuing professional development. Identified barriers to the rehabilitation of post-stroke USN can assist health policy, managers and clinicians to improve stroke-specific care.

Glioblastoma with concomitant moyamoya vasculopathy in neurofibromatosis type 1: illustrative case.

BACKGROUNDIn a case of concurrent glioblastoma and moyamoya vasculopathy, it is arduous to safely perform surgery because the brain is highly vulnerable and collaterals are sometimes well developed. In addition, radiotherapy carries a risk of aggravating moyamoya vasculopathy, and chemotherapeutic agents also have a risk of interfering with collateral development.OBSERVATIONSA 48-year-old woman with neurofibromatosis type 1 was admitted because of left hemiparesis and hemispatial neglect. Brain imaging studies revealed a large mass with peripheral enhancement in the right frontal lobe and occlusion of the bilateral middle cerebral arteries with an abnormal vascular network at the base of the brain. Total tumor resection was performed, and the pathological diagnosis was isocitrate dehydrogenase–mutant glioblastoma. Radiotherapy with a total dose of 60 Gy was delivered with concurrent temozolomide, and thereafter six cycles of adjuvant temozolomide were given. Progression of moyamoya vasculopathy without symptoms was observed after the completion of each of radiotherapy and adjuvant temozolomide.LESSONSThe authors present the first adult case of glioblastoma with moyamoya vasculopathy. Careful consideration and attention should be given throughout treatment to avoiding moyamoya vasculopathy–related ischemic and hemorrhagic events. Although the patient did not exhibit neurological deterioration, progression of moyamoya vasculopathy occurred early after radiotherapy and continued thereafter.

CLINICAL AND DEMOGRAPHIC PREDICTORS OF UNILATERAL SPATIAL NEGLECT RECOVERY AFTER PRISM THERAPY AMONG STROKE SURVIVORS IN THE SUB-ACUTE PHASE OF RECOVERY

Background and Aims Unilateral Spatial Neglect (USN) affects rehabilitation process and leads to poor outcomes after stroke. Intervention for USN treatment has been suggested such as prism therapy (PA). However, factors that influence USN recovery has not been investigated. This study investigated the predictors of USN recovery after prism therapy. Methods This study was a single-blinded randomised controlled trial. USN was assessed with the conventional subset of the behavioural inattention test (BIT-C). A total of 74 USN patients who presented with USN following right-brain damage were divided into prism (n = 37) and control (n = 37) groups. Prism group used 20 dioptre prism lenses for repeated aiming, for 12 sessions, the control group used neutral lenses for similar aiming training. Clinical recovery was defined as BIT-C score>129: recovery, BIT-C score< 129: No recovery. Logistic regression was done to establish significant variable in the prediction recovery after PA. Results There were significantly greater improvement of BIT-C in the intervention group post treatment (P≤0.001). Predictor variables considered in this study was cognitive ability (assessed using the mini-mental scale), gender, age, years of education, race, employment status, handedness, type of stroke, site of stroke and site of stroke. Cognitive ability (OR =1.52, CI=1.08-2.14, p= 0.016) was found to significantly influence recovery following PA treatment. Conclusions This study highlights the characteristics of stroke patient that will most likely benefit from a PA treatment regimen. Higher cognitive ability was implicated to be a factor for USN recovery after PA treatment post-stroke.

Indexes for the E-Baking Tray Task: A Look on Laterality, Verticality and Quality of Exploration

The Baking Tray Task is an ecological task developed for the assessment of unilateral neglect that can also be used for research on neurotypical participants. In this task, participants are asked to place 16 objects inside a board as evenly as possible. In the case of impaired spatial exploration, consequent to right attentional networks damage, asymmetrical object disposition is observed as more objects are placed on the ipsilesional side (typically the right side). The E-BTT is a technology-enhanced version of the Baking Tray Task, implemented with a software platform, E-TAN, which detects the objects and automatically computes their spatial coordinates. This allows a complement to the traditional scoring methods with new measures to extract richer information from the data. In this study, we focus on neurotypical participants to explore if some new indexes, derived from the literature review on similar tasks, can be applied to BTT and E-BTT for research aims. A principal component analysis (PCA) was then performed to verify if these new indexes reflect some common dimensions. Results indicate the emergence of two principal dimensions: spatiality, which summarizes both laterality and verticality, and quality, which regards the explored space and (dis)organization in placing the items.

Effect of Missed Items on the Reliability of the Kessler Foundation Neglect Assessment Process

ObjectiveTo determine the maximum permissible number of missed items on the 10-item Catherine Bergego Scale administered after the Kessler Foundation Neglect Assessment Process (KF-NAP). Secondary objectives were to determine the frequency, characteristics, and most commonly cited reasons reported for missed items. DesignRetrospective diagnostic accuracy study. SettingSixteen inpatient rehabilitation facilities in the United States. ParticipantsA consecutive clinical sample of 4256 patients (N=4256) with stroke or other neurologic deficits who were assessed for spatial neglect with the KF-NAP. InterventionsNot applicable. Main Outcome MeasuresCatherine Bergego Scale via KF-NAP. ResultsThe majority (69.7%) of patients had at least 1 missed item on their KF-NAP. Among those with missed items, it was most common to have 2 missed items (51.4%), and few had more than 3 missed items (11.3%). The most commonly missed items were Collisions (37.2%), Cleaning After Meals (36.1%), Meals (34.0%), and Navigation (19.7%). The most commonly reported reasons for missed items included time constraints, cognitive or communication deficits, and behavior or refusal of the therapy session. These reasons were reported for nearly all item types. Item-specific reasons were also commonly reported, such as a lack of a needed resource for task completion or low functional status of the patient. Prorated scoring of measures with up to 3 missed items maintained an acceptable level of concordance with complete measures (Lin's Concordance Correlation Coefficient=0.96, 95% CI, 0.9478-0.9626) for the combination of 3 missed items with lowest concordance. ConclusionsClinicians should make every effort to capture all items on the KF-NAP. However, missed items occur in the majority of cases because of patient factors and barriers inherent to the inpatient hospital setting. When missed items are necessary, clinicians can confidently interpret a prorated score when 7 or more items are scored.

Walking through a narrow opening improves collision avoidance behavior in a patient with stroke and unilateral spatial neglect: an ABA single-case design

ABSTRACT We investigated the effect of a 3-week intervention—wherein a patient with unilateral spatial neglect walks through a narrow opening while entering from the contralesional side—to improve walking ability or ADL. A 66-year-old man was diagnosed with right parietal subcortical hemorrhage. We used an ABA single-case design; period B was set as the intervention. The intervention improved the continuous walking distance and balance ability and decreased the number of collisions when walking through the narrow opening; however, it exerted minimal effect on ADL. Thus, the intervention may effectively improve continuous physical or spatial attention behavior, regardless of ADL improvement.

Should Primary Stroke Centers Perform Advanced Imaging?

Should Primary Stroke Centers Perform Advanced Imaging?

Various tests of left neglect are associated with distinct territories of hypoperfusion in acute stroke.

Hemispatial neglect is among the most disabling consequences of right hemisphere stroke. However, there is no consensus on the optimal assessments to identify neglect. We hypothesized that different tests for neglect given the same day (i) detect distinct aspects and types of neglect, (ii) are sensitive to different cognitive functions (beyond spatially specific processing) and (iii) are associated with distinct regions of hypoperfusion. We examined data from 135 participants with acute, right-hemispheric ischaemic stroke who received an MRI and neglect testing within 48 h of acute infarct in a cross-sectional study. The volume of infarct was calculated on diffusion-weighted imaging. We also scored severity and location of fluid-attenuated inversion recovery hyperintense vessels in six areas (anterior cerebral artery territory, posterior cerebral artery territory and four within the middle cerebral artery territory) to estimate the volume and location of hypoperfusion in acute stroke. Neglect tests included gap detection, scene copy, line bisection, line cancellation, oral reading and picture description. We found strong correlations between tests that evaluated viewer-centred processing, as well as strong correlations between tests that evaluated stimulus-centred processing. The error rate on different tests was associated with hypoperfusion in different vascular territories, even after controlling for the volume of an infarct. Our results confirm that it is essential to administer a battery of different tests of hemispatial neglect to capture various deficits in attention and spatially specific processing that underlies neglect. Our results also show the potential usefulness of hyperintense vessel ratings as an indication of dysfunction beyond the infarct, as the ratings (and not infarct volume) were highly associated with many clinical deficits. Finally, results underscore that diverse types of neglect are clinically important in acute stroke, as they reflect different areas of hypoperfused tissue, which may be salvageable in the absence of infarct in those areas. As such, neglect batteries may be useful for detecting patients with cortical hypoperfusion who are candidates for reperfusion therapies.

Electroencephalogram (EEG) With or Without Transcranial Magnetic Stimulation (TMS) as Biomarkers for Post-stroke Recovery: A Narrative Review.

Stroke is one of the leading causes of death and disability. Despite the high prevalence of stroke, characterizing the acute neural recovery patterns that follow stroke and predicting long-term recovery remains challenging. Objective methods to quantify and characterize neural injury are still lacking. Since neuroimaging methods have a poor temporal resolution, EEG has been used as a method for characterizing post-stroke recovery mechanisms for various deficits including motor, language, and cognition as well as predicting treatment response to experimental therapies. In addition, transcranial magnetic stimulation (TMS), a form of non-invasive brain stimulation, has been used in conjunction with EEG (TMS-EEG) to evaluate neurophysiology for a variety of indications. TMS-EEG has significant potential for exploring brain connectivity using focal TMS-evoked potentials and oscillations, which may allow for the system-specific delineation of recovery patterns after stroke. In this review, we summarize the use of EEG alone or in combination with TMS in post-stroke motor, language, cognition, and functional/global recovery. Overall, stroke leads to a reduction in higher frequency activity (≥8 Hz) and intra-hemispheric connectivity in the lesioned hemisphere, which creates an activity imbalance between non-lesioned and lesioned hemispheres. Compensatory activity in the non-lesioned hemisphere leads mostly to unfavorable outcomes and further aggravated interhemispheric imbalance. Balanced interhemispheric activity with increased intrahemispheric coherence in the lesioned networks correlates with improved post-stroke recovery. TMS-EEG studies reveal the clinical importance of cortical reactivity and functional connectivity within the sensorimotor cortex for motor recovery after stroke. Although post-stroke motor studies support the prognostic value of TMS-EEG, more studies are needed to determine its utility as a biomarker for recovery across domains including language, cognition, and hemispatial neglect. As a complement to MRI-based technologies, EEG-based technologies are accessible and valuable non-invasive clinical tools in stroke neurology.

Abstract WMP35: Assessment Of Spatial Neglect In Acute Stroke Patients: Results Of A Cross-country Pilot Study To Validate A Simplified Version Of The Catherine Bergego Scale

Background: Spatial neglect (SN) is present in about 20% patients in acute stroke units. If left unidentified SN may obstruct rehabilitation. The 10-item Catherine Bergego Scale (CBS) is increasingly recommended for SN assessment and has excellent psychometric properties. However, a standardized assessment with the CBS takes around 30-40 minutes to complete, making it rather unrealistic for nurses and physicians to use in the fast pace of the stroke unit. Objectives: To test a revised protocol for the CBS to make its routine use feasible in acute stroke units. We will: a). Compare the time used to administer the original version of the CBS with the simplified version of the CBS (sCBS), b). evaluate the agreement between the results of the CBS and sCBS, c). establish the interrater agreement between two rates, R1+R2, when scoring the sCBS, and d). correlate the sCBS with stroke severity and disability. Methods: Out of 98 consecutive stroke patients from the stroke units in Kaunas and Reykjavik, 15 with right-sided SN were included within five days following stroke. A structured assessment with the CBS established the presence and severity of SN. Patients identified with SN using the original structured assessment underwent a replicated evaluation with a simplified version of the sCBS. Two raters assessed the participants with the sCBS while they were blinded to the other rater’s scores. Stroke severity was assessed with NIHSS and disability with smRS. Results: There was a positive correlation between the NIHSS and the severity of SN r(13) = .78, p = .001. and the smRS and SN r(13) = .72, p =.002. On average it took 42 minutes to assess patients with mild/moderate SN with the CBS versus 14 minutes with the sCBS. Patients with very severe SN took &lt;10 minutes to assess, both with the CBS and sCBS, because many scale items were impossible to score. A total of 54 items were impossible to score across patients with the CBS. Significantly more items could be scored using the sCBS (p&lt; .05; 39 items, r1 and 40 items, r2). Conclusions: In contrast to the original CBS, the sCBS is more assessment-friendly for application in bedridden acute SN patients. We expect that the shortening of the assessment time may enhance SN screening in stroke units.

Effect of Mirror Image Therapy Combined with Whole Body Vibration Training on Unilateral Spatial Neglect after Stroke

<sec><title>Objective</title> To explore the effect of mirror image therapy combined with whole body vibration training on the rehabilitation of patients with unilateral spatial neglect after stroke. </sec><sec><title>Methods</title> According to the inclusion criteria, patients with unilateral spatial neglect after stroke who attended the rehabilitation center of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from October 2019 to December 2020 were selected. After the hospital ethics committee approvaled, 90 eligible patients were included. According to the random grouping method, participants were divided into mirror image therapy group, whole body vibration training group and combination group, with 30 cases in each group. There was no statistically significant difference in the general data of the three groups. The mirror image therapy group used a mirror box dedicated to mirror therapy for upper limb and hand mirror training. According to the differences in the patients functional status, different movement tasks were selected, such as grooming, eating, buttoning, turning books, and holding objects. The whole body vibration training group adopted whole body vibration training, using the Wellengang vibration therapy instrument developed by SVG company in Germany, the vibration frequency with 30 Hz, the vibration amplitude with 3 mm, the total treatment time was 30 minutes, 1 time/d, 6 days a week for 8 weeks. The combined group used both mirror image therapy (20 min) + whole body vibration training (10 min) for 6 days once a week for 8 weeks. All three groups were treated with the Catherine Bogor scale (CBS) before treatment and at the time of treatment for 8 weeks, respectively, to assess the severity of the spatial neglect of the patients. The mini-mental status examination (MMSE) was used to evaluate the cognitive dysfunction of patients. The simplified Fugl-Meyer Assessment scale (FMA) was used to evaluate the patients upper limb motor function. The Barthel index (BI) was used to measure the self-care ability of patients. </sec><sec><title>Results</title> Before treatment, there was no significant difference in CBS, MMSE, FMA and BI scores among the three groups (<italic>P</italic>>0.05). After 8 weeks of treatment, the CBS scores of the three groups were significantly lower than those before treatment, however MMSE, FMA and BI scores were significantly higher than those before the treatment, but the combined group was better than the mirror image group and the whole body vibration training group, and the difference was statistically significant respectively (<italic>P</italic><0.05). </sec><sec><title>Conclusion</title> Mirror image therapy combined with whole body vibration training can effectively improve the degree of spatial neglect and cognitive dysfunction in patients with unilateral spatial neglect after stroke, and enhance upper limb motor function and self-care ability. </sec>

Abstract WP66: Acute Stroke Screening For Cognitive Disorders And Depression

Introduction: As stroke survivors transition from acute to post-acute care, and finally to community settings, the Centers for Disease Control reports ~65% receive NO rehabilitation. Even more receive rehabilitation too late, after critical brain changes for recovery are complete. Stroke survivors with invisible disabilities of cognition and depression are especially vulnerable to experience poor recovery. We launched a dedicated process to identify invisible disabilities. Our long-term objective is to make acute and post-acute, evidence-based intervention accessible. Hypothesis: &gt;50% of acute stroke patients have cognitive deficits, or depression. Methods: Our comprehensive stroke center completes bedside psychometric assessment with standardized instruments for aphasia (Language Screening Test, LAST), spatial neglect (Catherine Bergego Scale, CBS), memory/global cognition (Montreal Cognitive Assessment, MoCA), delirium (3-Minute Diagnostic Interview for the Confusion Assessment Method, 3D-CAM) and depression (Patient health questionnaire, PHQ-8). Patients unable to respond to questions are assessed for spatial neglect and delirium (standardized observations). Results: 105 ischemic stroke survivors were assessed in the first quarter of program launch (April-July, 2021). Of that group, patients met screening criteria for spatial neglect (47%), aphasia (40%), delirium (19%) and depression (31%). Over 90% had memory / global cognitive impairment (MoCA&lt;26/30). Conclusions: Our initiative, which includes systematic acute stroke unit spatial neglect screening, confirmed the previously reported high rate of cognitive disorders and depression (Champod, Eskes, Barrett, 2020). Our current step implements uniform recommendations for patients with deficits, and will examine post-acute outcomes, number receiving rehabilitation and medical follow-up, and treatment disparities (right/left stroke, under-represented groups).

Disruption of large-scale electrophysiological networks in stroke patients with visuospatial neglect.

Stroke frequently produces attentional dysfunctions including symptoms of hemispatial neglect, which is characterized by a breakdown of awareness for the contralesional hemispace. Recent studies with functional MRI (fMRI) suggest that hemineglect patients display abnormal intra- and interhemispheric functional connectivity. However, since stroke is a vascular disorder and fMRI signals remain sensitive to nonneuronal (i.e., vascular) coupling, more direct demonstrations of neural network dysfunction in hemispatial neglect are warranted. Here, we utilize electroencephalogram (EEG) source imaging to uncover differences in resting-state network organization between patients with right hemispheric stroke (N = 15) and age-matched, healthy controls (N = 27), and determine the relationship between hemineglect symptoms and brain network organization. We estimated intra- and interregional differences in cortical communication by calculating the spectral power and amplitude envelope correlations of narrow-band EEG oscillations. We first observed focal frequency-slowing within the right posterior cortical regions, reflected in relative delta/theta power increases and alpha/beta/gamma decreases. Secondly, nodes within the right temporal and parietal cortex consistently displayed anomalous intra- and interhemispheric coupling, stronger in delta and gamma bands, and weaker in theta, alpha, and beta bands. Finally, a significant association was observed between the severity of left-hemispace search deficits (e.g., cancellation test omissions) and reduced functional connectivity within the alpha and beta bands. In sum, our novel results validate the hypothesis of large-scale cortical network disruption following stroke and reinforce the proposal that abnormal brain oscillations may be intimately involved in the pathophysiology of visuospatial neglect.

Abstract 50: Testing Procedures Influence Allocentric And Egocentric Neglect Associations

Testing Procedures Influence Allocentric and Egocentric Neglect Associations Hemispatial visual neglect is common after right hemisphere (RH) stroke and can impact attention to the left side of view (egocentric) or the left side of objects irrespective of location (allocentric). Allocentric and egocentric neglect correlations have been reported as high as 0.80; however, others report low correlations and dissociations between them using the same task but with different administration procedures. To determine if divergent results are due to distinct procedures, we compared allocentric and egocentric neglect presence and severity between the two. Thirty-eight adults (21 female, age 65±15 years, 14±2 years education, 21 black/16 white) completed neglect testing within 10 days of RH stroke. Neglect testing comprised circling 10 complete circles (egocentric task) and crossing out 20 circles with gaps (10 left gaps, 10 right gaps; allocentric task). All participants completed testing once with allocentric and egocentric tasks on separate pages and once with both tasks on the same page. We used paired t -tests, Pearson correlations, and Fisher’s Exact test for analyses. Neglect severity did not differ across single- and separate-page conditions ( allocentric : t (32)=0.68, p =0.50; egocentric : t (36)=-1.27, p =0.21). Single- and separate-page severity scores were strongly associated ( allocentric : r =0.65, p &lt;0.001; egocentric : r =0.52, p =0.004). Allocentric and egocentric neglect severity were moderately associated for single-page ( r =0.45, p =0.008) but not separate-page ( r =0.10, p =0.60) conditions. Diagnosis of allocentric ( single-page : 6%, separate-page : 3%), egocentric ( single-page : 12%, separate-page : 9%), or allocentric and egocentric ( single-page : 27%, separate-page : 39%) neglect was not dependent on page condition ( p =0.75). To conclude, assessment procedures influenced association of allocentric and egocentric neglect severity but not categorical diagnosis, and presence of both appeared more common than either alone. Studies that reported high correlations between the allocentric and egocentric neglect on the same task may have included participants with lesions causing both types of neglect due to their size and/or location.

Comparing the effectiveness of bimanual and unimanual mirror therapy in unilateral neglect after stroke: A pilot study.

Unilateral neglect in stroke patients is a major obstacle to rehabilitation, which is a great challenge for therapists. This study aimed to compare the effectiveness of bimanual mirror therapy (BMT) and unimanual mirror therapy (UMT), the two protocols of mirror therapy, for the reduction of the symptoms of unilateral neglect in stroke patients. Twenty-eight individuals were randomly assigned to the BMT or UMT groups. Both groups received mirror therapy for 30 minutes per day, 5 days a week, for a period of 4 weeks. The Star Cancelation Test (SCT), Line Bisection Test (LBT), Picture Scanning Test (PST), and Korean Catherine Bergego Scale (K-CBS) were used to measure the change in unilateral neglect, and the Korean version of the Modified Barthel Index (K-MBI) was used to evaluate activities of daily living (ADL). The results of SCT, LBT, PST, and K-CBS showed significant decreases in unilateral neglect in both groups (p < 0.05). K-MBI improved significantly in both groups (p < 0.05). There were significant differences between the two groups in the unilateral neglect tests (p < 0.05), but no significant difference in ADL evaluation (p > 0.05). Mirror therapy protocols can be applied to treat unilateral neglect in stroke patients. However, BMT may be more beneficial for reducing the symptoms of unilateral neglect.

Effects of visual-motor illusion in stroke hemiplegic patients with left-side personal neglect: A report of two cases

ABSTRACT Personal neglect is the neglect of self-body space, which often occurs in patients with unilateral spatial neglect (USN), but lacks a dedicated rehabilitation. The purpose of this study was to investigate the effects of visual-motor illusion (VMI) on two-stroke hemiplegic patients with left-side personal neglect. Case 1 was a 53-year-old man diagnosed with a right lenticulostriate artery infarction. Case 2 was a 76-year-old woman diagnosed with a right middle cerebral artery infarction. USN symptoms were not observed in either patient in the desk USN assessment, but personal neglect and USN symptoms in daily life were observed in both patients. Intervention effects were verified using an ABA design, comprising a 5-day three-phase (A1, B, A2). In phase B, VMI was performed on the paralyzed upper limb for 10 min in addition to conventional physical therapy. Outcomes measures were the Fluff test, Catherine Bergego Scale (CBS), Fugl-Meyer Assessment (FMA), and Functional Independence Measure (FIM). In both patients, no improvements were noted in FMA, but improvements were observed in the Fluff test, CBS, and FIM in phase B; these effects were retained in phase A2. Therefore, VMI may have contributed to improvements in Personal neglect and USN symptoms in daily life.