Left Hemisphere Damage Research Articles

Remedial Training of the Less-Impaired Arm in Chronic Stroke Survivors With Moderate to Severe Upper-Extremity Paresis Improves Functional Independence: A Pilot Study.

The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.

Nonverbal Semantics Test (NVST)-A Novel Diagnostic Tool to Assess Semantic Processing Deficits: Application to Persons with Aphasia after Cerebrovascular Accident.

Assessment of semantic processing capacities often relies on verbal tasks which are, however, sensitive to impairments at several language processing levels. Especially for persons with aphasia there is a strong need for a tool that measures semantic processing skills independent of verbal abilities. Furthermore, in order to assess a patient’s potential for using alternative means of communication in cases of severe aphasia, semantic processing should be assessed in different nonverbal conditions. The Nonverbal Semantics Test (NVST) is a tool that captures semantic processing capacities through three tasks—Semantic Sorting, Drawing, and Pantomime. The main aim of the current study was to investigate the relationship between the NVST and measures of standard neurolinguistic assessment. Fifty-one persons with aphasia caused by left hemisphere brain damage were administered the NVST as well as the Aachen Aphasia Test (AAT). A principal component analysis (PCA) was conducted across all AAT and NVST subtests. The analysis resulted in a two-factor model that captured 69% of the variance of the original data, with all linguistic tasks loading high on one factor and the NVST subtests loading high on the other. These findings suggest that nonverbal tasks assessing semantic processing capacities should be administered alongside standard neurolinguistic aphasia tests.

Lesions that do or do not impair digit span: a study of 816 stroke survivors.

Prior studies have reported inconsistency in the lesion sites associated with verbal short-term memory impairments. Here we asked: How many different lesion sites can account for selective impairments in verbal short-term memory that persist over time, and how consistently do these lesion sites impair verbal short-term memory? We assessed verbal short-term memory impairments using a forward digit span task from the Comprehensive Aphasia Test. First, we identified the incidence of digit span impairments in a sample of 816 stroke survivors (541 males/275 females; age at stroke onset 56 ± 13 years; time post-stroke 4.4 ± 5.2 years). Second, we studied the lesion sites in a subgroup of these patients (n = 39) with left hemisphere damage and selective digit span impairment—defined as impaired digit span with unimpaired spoken picture naming and spoken word comprehension (tests of speech production and speech perception, respectively). Third, we examined how often these lesion sites were observed in patients who either had no digit span impairments or digit span impairments that co-occurred with difficulties in speech perception and/or production tasks. Digit span impairments were observed in 222/816 patients. Almost all (199/222 = 90%) had left hemisphere damage to five small regions in basal ganglia and/or temporo-parietal areas. Even complete damage to one or more of these five regions was not consistently associated with persistent digit span impairment. However, when the same regions were spared, only 5% (23/455) presented with digit span impairments. These data suggest that verbal short-term memory impairments are most consistently associated with damage to left temporo-parietal and basal ganglia structures. Sparing of these regions very rarely results in persistently poor verbal short-term memory. These findings have clinical implications for predicting recovery of verbal short-term memory after stroke.

Stroke Lesion Impact on Lower Limb Function.

The impact of stroke on motor functioning is analyzed at different levels. ‘Impairment’ denotes the loss of basic characteristics of voluntary movement. ‘Activity limitation’ denotes the loss of normal capacity for independent execution of daily activities. Recovery from impairment is accomplished by ‘restitution’ and recovery from activity limitation is accomplished by the combined effect of ‘restitution’ and ‘compensation.’ We aimed to unravel the long-term effects of variation in lesion topography on motor impairment of the hemiparetic lower limb (HLL), and gait capacity as a measure of related activity limitation. Gait was assessed by the 3 m walk test (3MWT) in 67 first-event chronic stroke patients, at their homes. Enduring impairment of the HLL was assessed by the Fugl–Meyer Lower Extremity (FMA-LE) test. The impact of variation in lesion topography on HLL impairment and on walking was analyzed separately for left and right hemispheric damage (LHD, RHD) by voxel-based lesion-symptom mapping (VLSM). In the LHD group, HLL impairment tended to be affected by damage to the posterior limb of the internal capsule (PLIC). Walking capacity tended to be affected by a larger array of structures: PLIC and corona radiata, external capsule and caudate nucleus. In the RHD group, both HLL impairment and walking capacity were sensitive to damage in a much larger number of brain voxels. HLL impairment was affected by damage to the corona radiata, superior longitudinal fasciculus and insula. Walking was affected by damage to the same areas, plus the internal and external capsules, putamen, thalamus and parts of the perisylvian cortex. In both groups, voxel clusters have been found where damage affected FMA-LE and also 3MWT, along with voxels where damage affected only one of the measures (mainly 3MWT). In stroke, enduring ‘activity limitation’ is affected by damage to a much larger array of brain structures and voxels within specific structures, compared to enduring ‘impairment.’ Differences between the effects of left and right hemisphere damage are likely to reflect variation in motor-network organization and post-stroke re-organization related to hemispheric dominance. Further studies with larger sample size are required for the validation of these results.

In Search for the Meaning of Illness: Content of Narrative Discourse Is Related to Cognitive Deficits in Stroke Patients.

Stroke survivors undergo a thorough cognitive diagnosis that often involves administration of multiple standardized tests. However, patient’s narrative discourse can provide clinicians with additional knowledge on patient’s subjective experience of illness, attitude toward current situation, and motivation for treatment. We evaluated the methods of analyzing thematic content and story types in relationship to cognitive impairment in stroke survivors with no aphasia (including 9 left hemisphere damage – LHD patients, and 16 right hemisphere damage – RHD patients). Cognitive impairment was evaluated in comparison to a group of 25 patients with orthopaedic injury not involving the brain. Our findings primarily show that higher elaboration on own cognitive problems, physical ailments or coping strategies in LHD patients and cognitive problems, emotional issues and circumstances of illness onset in RHD patients is related to deficits in executive functions and retrieval of information from memory. Furthermore, RHD patients who use more chaos story type show lower executive functioning. However, these results did not survive the significance threshold of p < 0.05 after Bonferroni adjustment for multiple comparisons. In conclusion, this study provides preliminary evidence that stroke survivor’s narrative can constitute an additional source of clinically-relevant information regarding patient’s experience of illness and attitude toward recovery. This knowledge can aid clinicians and nurses in everyday interactions with the patients and support individualized strategy to treatment. Still, the current results need be confirmed with future studies in a larger cohort of stroke patients.

Linguistic and nonlinguistic processing speed across age-matched normal healthy controls and individuals with left-hemisphere damage, with and without aphasia

ABSTRACT Background Slowed language production and comprehension in people with aphasia (PWA) is frequently cited as a characteristic of the disorder, even after full recovery. However, results supporting the existence of slowness are inconsistent and the mechanisms are unclear. Previous research has failed to determine the neurocognitive locus of the slowing and whether it is due to left hemisphere damage, general aging, or language-specific mechanisms. The goals of this study are: (1) to explore whether reduced processing speed is present and specific to the presence of aphasia or due to left-hemisphere damage more generally and (2) whether it is specific to the linguistic domain of cognition. Results The results of the mixed effects model revealed significant main effects for groups and domains, and no significant interactions among groups or between domains. The two brain-damaged groups exhibited significantly longer processing times across tasks compared to the NHC group. The processing speed of the PWA group was significantly longer than that of the LHD group across simple perceptual and more cognitively complex tasks. Groups were not significantly different on three nonlinguistic sensory-motor tasks. Conclusions Left-hemisphere damage-related slowing, as well as aphasia-additive slowing, was demonstrated as evidenced by significant differences between the two brain-damaged groups and between these two groups and the NHC group. Therefore, the observed slowing in the PWA group appears to be due to both brain-damage-related and aphasia-additive slowing. Domain-specificity was not observed as evidenced by significant slowing on both linguistic and nonlinguistic tasks in both brain-damaged groups compared to the performance of the NHCs.

Unexpected absence of aphasia following left temporal hemorrhage: a case study with functional neuroimaging to characterize the nature of atypical language localization

ABSTRACT Unexpected absence of aphasia after left-hemisphere perisylvian damage is often assumed to reflect right-hemisphere language lateralization, but other potential explanations include bilateral language representation, or sparing of critical left-hemisphere regions due to individual variability. We describe the case of a left-handed gentleman who presented with no aphasia after a left temporal hemorrhage. We used functional neuroimaging to determine how his language network had been spared. In this case, we observed unequivocal right-hemisphere lateralization of language function, explaining his lack of aphasia. We discuss the variability of language organization and highlight outstanding questions about the implications of damage in different scenarios.

Comparative Analysis of Facial Expressions of Right and Left Hemisphere Damaged Patients Using Facial Action Coding System

Comparative Analysis of Facial Expressions of Right and Left Hemisphere Damaged Patients Using Facial Action Coding System

Working memory training in post-stroke aphasia: Near and far transfer effects

PurposeIndividuals with aphasia (IWA) show various impairments in speech, language, and cognitive functions. Working memory (WM), a cognitive system that functions to hold and manipulate information in support of complex, goal-directed behaviors, is one of the impaired cognitive domains in aphasia. The present study intended to examine the effects of a WM training program on both memory and language performance in IWA. MethodThis quasi-experimental study with an active control group was performed on 25 people with mild or moderate Broca’s aphasia aged 29–61 years resulting from left hemisphere damage following ischemic stroke. Participants were assigned into two groups, including a training group (n = 13) and a control group (n = 12). The treatment and control groups received WM training and routine speech therapy, respectively. Two separate lists of WM tests, including one list for both pre-training assessment and training program and a second list for the post-training assessment, were used in this study. ResultsThe treatment group showed significant improvements in both trained and non-trained WM tasks (near transfer effect) and language performance (far transfer effect) compared to the control group. ConclusionGiven the good generalizability of the WM training program on both WM and language performance, WM training is suggested as part of the rehabilitation program in aphasia.

Motor Deficits in the Ipsilesional Arm of Severely Paretic Stroke Survivors Correlate With Functional Independence in Left, but Not Right Hemisphere Damage.

Chronic stroke survivors with severe contralesional arm paresis face numerous challenges to performing activities of daily living, which largely rely on the use of the less-affected ipsilesional arm. While use of the ipsilesional arm is often encouraged as a compensatory strategy in rehabilitation, substantial evidence indicates that motor control deficits in this arm can be functionally limiting, suggesting a role for remediation of this arm. Previous research has indicated that the nature of ipsilesional motor control deficits vary with hemisphere of damage and with the severity of contralesional paresis. Thus, in order to design rehabilitation that accounts for these deficits in promoting function, it is critical to understand the relative contributions of both ipsilesional and contralesional arm motor deficits to functional independence in stroke survivors with severe contralesional paresis. We now examine motor deficits in each arm of severely paretic chronic stroke survivors with unilateral damage (10 left-, 10 right-hemisphere damaged individuals) to determine whether hemisphere-dependent deficits are correlated with functional independence. Clinical evaluation of contralesional, paretic arm impairment was conducted with the upper extremity portion of the Fugl-Meyer assessment (UEFM). Ipsilesional arm motor performance was evaluated using the Jebsen-Taylor Hand Function Test (JTHFT), grip strength, and ipsilesional high-resolution kinematic analysis during a visually targeted reaching task. Functional independence was measured with the Barthel Index. Functional independence was better correlated with ipsilesional than contralesional arm motor performance in the left hemisphere damage group [JTHFT: [r(10) = −0.73, p = 0.017]; grip strength: [r(10) = 0.64, p = 0.047]], and by contralesional arm impairment in the right hemisphere damage group [UEFM: [r(10) = 0.66, p = 0.040]]. Ipsilesional arm kinematics were correlated with functional independence in the left hemisphere damage group only. Examination of hemisphere-dependent motor correlates of functional independence showed that ipsilesional arm deficits were important in determining functional outcomes in individuals with left hemisphere damage only, suggesting that functional independence in right hemisphere damaged participants was affected by other factors.

Semantic and logopenic primary progressive aphasia differ in pitch variation during a motor speech task

AbstractBackgroundSemantic variant primary progressive aphasia (svPPA) is an uncommon neurodegenerative disease associated with selective atrophy of the dominant temporal lobe. Previous observations of left hemisphere damage suggest that prosodic expression (mediated predominantly by the right hemisphere and dorsal processing streams) is often preserved and may even be enhanced as a release phenomenon in some aphasic syndromes. We predicted left temporal injury would be associated with increased pitch variation, thereby distinguishing it from other PPA syndromes such as the logopenic variant of primary progressive aphasia (lvPPA).Method8 patients with svPPA and 10 patients with lvPPA repeated the syllable "Pa" as part of a motor speech evaluation. We compared the coefficient of variation of fundamental frequency, perceived as vocal pitch, using a separate variances two‐way t‐test. To better understand what may drive differences in pitch variation, we also correlated pitch variation with disinhibition measures on the Neuropsychiatric Symptoms Inventory Questionnaire (NPI‐Q) and the Frontal Assessment Battery (FAB).ResultCompared to 10 patients with lvPPA (M 4.5, SD 1.6), patients with svPPA (M 14.0, SD 10.3) displayed more variation of fundamental frequency (T = 2.6, p = 0.02). There was no correlation with either the NPIQ or FAB disinhibition measures.ConclusionPitch variation during simple motor speech tasks may serve as an additional diagnostic feature to distinguish between subtypes of PPA. The temporal atrophy associated with svPPA may release hyperprosodic performances on a simple motor speech task, through a mechanism beyond behavioral disinhibition as assessed in either the NPI‐Q or the FAB. Further research is needed to better understand the neural underpinnings of prosodic differences between PPA subtypes.

Left hemisphere damage produces deficits in predictive control of bilateral coordination.

Previous research has demonstrated hemisphere-specific motor deficits in ipsilesional and contralesional unimanual movements in patients with hemiparetic stroke due to MCA infarct. Due to the importance of bilateral motor actions on activities of daily living, we now examine how bilateral coordination may be differentially affected by right or left hemisphere stroke. To avoid the caveat of simply adding unimanual deficits in assessing bimanual coordination, we designed a unique task that requires spatiotemporal coordination features that do not exist in unimanual movements. Participants with unilateral left (LHD) or right hemisphere damage (RHD) and age-matched controls moved a virtual rectangle (bar) from a midline start position to a midline target. Movement along the long axis of the bar was redundant to the task, such that the bar remained in the center of and parallel to an imaginary line connecting each hand. Thus, to maintain midline position of the bar, movements of one hand closer to or further away from the bar midline required simultaneous, but oppositely directed displacements with the other hand. Our findings indicate that left (LHD), but not right (RHD) hemisphere-damaged patients showed poor interlimb coordination, reflected by significantly lower correlations between displacements of each hand along the bar axis. These left hemisphere-specific deficits were only apparent prior to peak velocity, likely reflecting predictive control of interlimb coordination. In contrast, the RHD group bilateral coordination was not significantly different than that of the control group. We conclude that predictive mechanisms that govern bilateral coordination are dependent on left hemisphere mechanisms. These findings indicate that assessment and training in cooperative bimanual tasks should be considered as part of an intervention framework for post-stroke physical rehabilitation.

Neural correlates of spontaneous language production in two patients with right hemispheric language dominance

ABSTRACT Background It is not conclusively explored what kind of reorganisation processes are set off after a stroke with resulting aphasia. Since the development of functional Magnetic Resonance Imaging (fMRI), linguistic processes and their neural representation have been researched, especially in aphasic patients after left hemispheric insult. The situation differs in aphasic patients with crossed aphasia or aphasia after a right hemispheric lesion, for which only few studies have been carried out. In order to close this gap, the present study deals with the localisation of language functions in the brain of patients with crossed aphasia and right hemispheric language dominance. Aim The objective of the current study was to provide insights into the neural correlates of continuous aphasic language production of patients with right hemispheric language dominance. Based on the current state of research, a mirror image representation was expected. Methods & Procedures Two patients with fluent aphasia due to right hemisphere lesions, one presenting with crossed aphasia, described complex pictures. The continuous language output was transcribed and categorised into events. Lexical search (i.e. the difference between unimpaired speaking and word-finding difficulties) was analysed using fMRI. The neural activation clusters were compared with the corresponding areas of a control group consisting of 12 patients with left hemispheric aphasia. Outcomes & Results The analysis of the behavioural data revealed word-finding difficulties as one of the most limiting factors in the spontaneous language output of the patients. The neural correlates of lexical search (unimpaired minus impaired) were observed in four activation clusters both patients had in common. Each cluster was predominantly localised in the contra-lesional hemisphere. Compared to the corresponding areas of the control group, in general, a mirrored image representation could be confirmed. Conclusions The combination of detailed linguistic analysis and fMRI confirmed the assumption of mirrored language organisation for anomia in continuous language production. Moreover, the study might add to a more general understanding of the contribution of the contra-lesional hemisphere to language recovery in aphasia after left or right hemisphere damage.

Performance of discrete, reciprocal, and cyclic movements of the ipsilesional upper limb in individuals after stroke.

Aiming movements of the upper limbs can be classified either as discrete, or reciprocal, or cyclic. The control of these movements after a stroke can be affected. The aim of this experimental, cross-sectional study was to characterize the performance of these movements after the right and left hemisphere chronic stroke. Thirty-six individuals aged between 40 and 70years, right-handed, were allocated into three groups (control, right stroke, and left stroke). Participants were asked to perform aiming movements on a tablet. Individuals after stroke performed the tasks only with their ipsilesional limb, while the control group performed movements with both limbs. The reaction and movement times, peak velocity, and the variability and error of the endpoint were analyzed. Individuals after stroke presented a worse performance in all movement classes as expected, but differently depending on the damaged hemisphere. Participants with right hemisphere damage showed larger endpoint errors, while those with left hemisphere damage had longer reaction and movement times. Both differences were seen consistently in discrete and reciprocal, but not in cyclic movements. Cyclic movements presented shorter latencies, were faster, and showed greater endpoint errors when compared to discrete and reciprocal movements. These results suggest that stroke affects differently the performance of discrete and reciprocal movements according to the hemisphere lesion side, but not in cyclic movements. Different levels of motor control among the three classes of movements by the nervous system may justify these results.

Influence of right versus left unilateral spatial neglect on the functional recovery after rehabilitation in sub-acute stroke patients

ABSTRACT Unilateral spatial neglect (USN) may lead to poor functional rehabilitation outcomes. However, studies investigating the rehabilitation outcomes of right-sided USN are lacking. We aimed to investigate (1) the clinical impacts of USN, including right-sided USN, for stroke patients in sub-acute rehabilitation, and (2) evaluate the differences in clinical characteristics and rehabilitation outcomes between right- and left-sided USN patients. We retrospectively screened the medical records of 297 inpatients at the Tokyo-Bay Rehabilitation Hospital who experienced a cerebrovascular accident with supratentorial lesions between January 1st, 2014 and December 31st, 2016. We performed independent multiple regression analysis in patients with left and right hemisphere damage. The Behavioral Inattention Test was a significant independent variable for predicting the motor, cognitive, and total functional independence measure (FIM), compared to the Stroke Impairment Assessment Set and Mini-Mental State Examination. USN affects motor FIM recovery more than cognitive FIM recovery regardless of the damaged hemisphere. Our study results confirm that both right- and left-sided USN influence the functional recovery of stroke patients. USN occurs, slightly less frequently, following a left hemisphere stroke. However, USN negatively affected rehabilitation outcomes, regardless of the neglected side. Therefore, USN treatment is necessary for patients with left and right hemisphere damage.

Lesion Topography Impact on Shoulder Abduction and Finger Extension Following Left and Right Hemispheric Stroke.

The existence of shoulder abduction and finger extension movement capacity shortly after stroke onset is an important prognostic factor, indicating favorable functional outcomes for the hemiparetic upper limb (HUL). Here, we asked whether variation in lesion topography affects these two movements similarly or distinctly and whether lesion impact is similar or distinct for left and right hemisphere damage. Shoulder abduction and finger extension movements were examined in 77 chronic post-stroke patients using relevant items of the Fugl-Meyer test. Lesion effects were analyzed separately for left and right hemispheric damage patient groups, using voxel-based lesion-symptom mapping. In the left hemispheric damage group, shoulder abduction and finger extension were affected only by damage to the corticospinal tract in its passage through the corona radiata. In contrast, following the right hemispheric damage, these two movements were affected not only by corticospinal tract damage but also by damage to white matter association tracts, the putamen, and the insular cortex. In both groups, voxel clusters have been found where damage affected shoulder abduction and also finger extension, along with voxels where damage affected only one of the two movements. The capacity to execute shoulder abduction and finger extension movements following stroke is affected significantly by damage to shared and distinct voxels in the corticospinal tract in left-hemispheric damage patients and by damage to shared and distinct voxels in a larger array of cortical and subcortical regions in right hemispheric damage patients.

Acoustic Measures of Prosody in Right-Hemisphere Damage: A Systematic Review and Meta-Analysis.

Purpose The aim of the study was to use systematic review and meta-analysis to quantitatively assess the currently available acoustic evidence for prosodic production impairments as a result of right-hemisphere damage (RHD), as well as to develop methodological recommendations for future studies. Method We systematically reviewed papers reporting acoustic features of prosodic production in RHD in order to identify shortcomings in the literature and make recommendations for future studies. We estimated the meta-analytic effect size of the acoustic features. We extracted standardized mean differences from 16 papers and estimated aggregated effect sizes using hierarchical Bayesian regression models. Results RHD did present reduced fundamental frequency variation, but the trait was shared with left-hemisphere damage. RHD also presented evidence for increased pause duration. No meta-analytic evidence for an effect of prosody type (emotional vs. linguistic) was found. Conclusions Taken together, the currently available acoustic data show only a weak specific effect of RHD on prosody production. However, the results are not definitive, as more reliable analyses are hindered by small sample sizes, lack of detail on lesion location, and divergent measuring techniques. We propose recommendations to overcome these issues: Cumulative science practices (e.g., open data and code sharing), more nuanced speech signal processing techniques, and the integration of acoustic measures and perceptual judgments are recommended to more effectively investigate prosody in RHD.

Investigation of Speech and Language in a Persian Patient with Crossed Aphasia in Dextrals: A Case Report

Introduction: In the current study, we report a patient of crossed aphasia in dextrals (CAD) that presented with aphasia and typical neuropsychological deficits following right hemisphere brain damage. To the best of the authors’ knowledge, it is the first Persian language patient of CAD reported internationally. Case Presentation: The patient was a 59-year-old right-handed female with no history of left-handedness or ambidexterity in her family. Right handedness was measured in the current patient by the Edinburgh right-handedness inventory. Speech and language functions were measured by the Persian Western-Aphasia Battery (P-WAB) and the Bilingual Aphasia test (BAT). Also, the bedside version of Persian WAB (P-WAB-1) was used. Hemianopia/neglect was investigated by line bisection, painting, and cancellation tasks that confirmed left visuospatial neglect. Telegraphic speech was her dominant output feature. She had a problem with sentence construction; also, her morphological derivation skills were impaired. The syntactic structures of utterances were very simple. In writing tasks, her sample was unintelligible semantically. The auditory comprehension of the patient was impaired at the level of semi-complex and complex commands. It should be mentioned that difficulty in topic maintenance was observed in storytelling. Left visuospatial neglect was confirmed in the patient by assessments. The results confirmed the presence of neglect and language disorder, typologically consistent with Broca’s aphasia. Conclusions: The current study patient represented the typical symptoms of language dominant left hemisphere damage and a range of deficits indicating right hemisphere pathology. Analysis of patient symptoms confirmed the right hemisphere language dominance.

The right hemisphere is important for driving-related cognitive function after stroke.

Considering quality of life (QOL) after stroke, car driving is one of the most important abilities for returning to the community. In this study, directed attention and sustained attention, which are thought to be crucial for driving, were examined. Identification of specific brain structure abnormalities associated with post-stroke cognitive dysfunction related to driving ability would help in determining fitness for car driving after stroke. Magnetic resonance imaging was performed in 57 post-stroke patients (51 men; mean age, 63 ± 11years) who were assessed for attention deficit using a standardized test (the Clinical Assessment for Attention, CAT), which includes a Continuous Performance Test (CPT)-simple version (CPT-SRT), the Behavioral Inattention Test (BIT), and a driving simulator (handle task for dividing attention, and simple and selective reaction times for sustained attention). A statistical non-parametric map (SnPM) that displayed the association between lesion location and cognitive function for car driving was created. From the SnPM analysis, the overlay plots were localized to the right hemisphere during handling the hit task for bilateral sides (left hemisphere damage related to right-side neglect and right hemisphere damage related to left-side neglect) and during simple and selective reaction times (false recognition was related to damage of both hemispheres). A stepwise multiple linear regression analysis confirmed the importance of both hemispheres, especially the right hemisphere, for cognitive function and car driving ability. The present study demonstrated that the right hemisphere has a crucial role for maintaining directed attention and sustained attention, which maintain car driving ability, improving QOL for stroke survivors.

Evaluation of Recovery of Cognitive Disorders of Patients with Stroke in Occupational Therapy

The aim of the research was evaluate cognitive disorders and their dynamics in patients with stroke and to asses the effectiveness of occupational therapy. The sample consisted of 30 patients with stroke, rehabilitated in the Department of Neurorehabilitation of Kaunas University of Medicine Hospital. The average age of the subjects was 65.33 SD ± 13.2 years. During the research we evaluated patients’ cognitive functions, hand grip strength, reaction time and frequency of movements. Conclusions: After the application of individual occupational therapy, the cognitive functions of the patients significantly improved. The average change of cognitive functions estimated with MMSE was 6.4 (± 2.3) scores, and 13.3 (± 10) estimated by NCSE. In the early stage of rehabilitation most affected cognitive areas were as follows: memory (83% of patients suffered from this disorder), constructional abilities (70% of patients) and orientation (57% of patients). At the end of the rehabilitation we estimated significant improvement in all areas of cognitive functioning. The examination showed that before rehabilitation there was a significant difference between the right and the left hemisphere damage, as well as in patients’ movement frequency. After the rehabilitation we estimated a significant change in patients’ reaction time and movement frequency. The results of the research showed that there was significant, moderately strong correlation in patients’ mental state and reaction time after the applied rehabilitation.Keywords: stroke, rehabilitation, occupational therapy, cognitive disorders, reaction time.