Severe Neglect Research Articles

Environmental sensitivity increases susceptibility to resilient contexts in adults with childhood experiences of neglect

Empirical evidence regarding the impact of childhood emotional neglect on later adjustment is mixed, with some studies reporting neglect to predict low psychological well-being, while others reporting a well-adjusted development despite childhood experiences of emotional neglect. This heterogeneity is understood within a resilient framework where individual and contextual factors act as moderators. This is the first study investigating the moderating role of environmental sensitivity and contextual resilience on the association between childhood emotional neglect and psychological well-being.737 students from the University of Florence with an age ranging from 18 to 30 years (M = 19.81; SD = 1.91; 87% female) took part in the research. To investigate the effects of childhood emotional neglect on relational well-being, and the moderating role of environmental sensitivity and contextual resilience on the impact of emotional neglect, a series of generalized linear models, including only main effects and then adding interaction terms, were run and compared. Results provided support for a three-way interaction model, with environmental sensitivity and contextual resilience moderating the impact of childhood emotional neglect on relational well-being in young adulthood (B = .37, SE = .11, p < .001). Among those who experienced severe levels of childhood emotional neglect, young adults high in environmental sensitivity were more susceptible to the positive impact of supportive contexts, presenting higher levels of well-being compared to those low in environmental sensitivity. This study suggests that promoting supportive contexts in adulthood might reduce the impact of severe childhood emotional neglect, particularly in individuals with an increased environmental sensitivity.

Reduced Segregation of Brain Networks in Spatial Neglect After Stroke.

Background/Purpose: To investigate the association between the degree of spatial neglect and the changes of brain system segregation (SyS; i.e., the ratio of the extent to which brain networks interact internally and with each other) after stroke. Methods: A cohort of 20 patients with right hemisphere lesion was submitted to neuropsychological assessment as well as to resting-state functional magnetic resonance imaging session at acute stage after stroke. The severity of spatial neglect was quantified using the Center of Cancellation (CoC) scores of the Bells cancellation test. For each patient, resting-state functional connectivity (FC) matrices were assessed by implementing a brain parcellation of nine networks that included the visual network, dorsal attention network (DAN), ventral attention network (VAN), sensorimotor network (SMN), auditory network, cingulo-opercular network, language network, frontoparietal network, and default mode network (DMN). For each patient and each network, we then computed the SyS derived by subtracting the between-network FC from the within-network FC (normalized by the within-network FC). Finally, for each network, the CoC scores were correlated with the SyS. Results: The correlational analyses indicated a negative association between CoC and SyS in the DAN, VAN, SMN, and DMN (q < 0.05 false discovery rate [FDR]-corrected). Patients with more severe spatial neglect exhibited lower SyS and vice versa. Conclusion: The loss of segregation in multiple and specific networks provides a functional framework for the deficits in spatial and nonspatial attention and motor/exploratory ability observed in neglect patients.

Psychoanalytic Interventions with Abusive Parents: An Opportunity for Children's Mental Health.

Research has extensively shown that most people who experience maltreatment in their childhood develop mental disorders, psychosocial adjustment problems, and, in many cases, become maltreating adults themselves. Preventing child maltreatment and treating abused children and abusive parents are, therefore, pressing public health issues. As established by the UK Children Act in 1989, child development is enhanced by remaining in the family whenever the child’s safety is assured. Thus, developing prevention and intervention programs for the purpose of repairing, whenever possible, the child–parent relationship should be a social priority. This narrative review focuses on the psychoanalytic studies related to intrapsychic dynamics and therapeutic intervention for physically abusive parents. The role of the transgenerational transmission of abuse and parents’ narcissistic fragility is crucial. Psychoanalytic interventions focus on helping the parent work through their past painful experiences and narcissistic vulnerability. Parent–child psychotherapy and mentalization-based treatment have been found to be prevalent, while there is scarce literature regarding intensive individual psychoanalytic treatment. Within the framework of attachment theory, brief interventions were developed; however, they did not prove effective for those parents who suffered experiences of maltreatment or severe neglect in childhood and for whom long-term parent–child psychotherapy resulted, which proved to be the most effective.

The impact of apraxia and neglect on early rehabilitation outcome after stroke

BackgroundThis study aims to characterize the impact of apraxia and visuospatial neglect on stroke patients’ cognitive and functional outcomes during early rehabilitation. Prior work implies an unfavorable effect of visuospatial neglect on rehabilitation; however, previous findings remain ambiguous and primarily considered long-term effects. Even less is known about the impact of apraxia on rehabilitation outcomes. Although clinicians agree on the significance of the first few weeks after stroke for the course of rehabilitation, studies exploring the impact of neglect and apraxia in this early rehabilitation period remain scarce.MethodsBased on a screening of 515 hospitalized stroke patients from an early rehabilitation ward, 150 stroke patients (75 left-hemispheric strokes, 75 right hemispheric strokes) fulfilled the inclusion criteria and were enrolled in this observational, longitudinal study. The patients’ cognitive and functional statuses were documented at admission to the early rehabilitation ward and discharge. Also, detailed apraxia and neglect assessments were performed at midterm. The predictive values of age and apraxia and neglect severity (as reflected in two components from a principal component analysis of the neglect and apraxia assessments) for cognitive and functional outcomes at discharge were evaluated by multiple regression analyses.ResultsBesides the expected influence of the respective variables at admission, we observed a significant effect of apraxia severity on the cognitive outcome at discharge. Moreover, neglect severity predicted the Early Rehabilitation Barthel Index (Frühreha-Barthel-Index) at discharge. Supplementary moderator analysis revealed a differential effect of neglect severity on the cognitive outcome depending on the affected hemisphere.ConclusionData indicate a strong association between apraxia and visuospatial neglect and early rehabilitation outcomes after stroke.

Classification of Latent Class and Prediction Factors of the Relationship between Attention, Agression, Social Withdrawal, Depression and School Adaptation of Middle School Students applying a Regression Mixture Model

본 연구는 잠재계층에 따라 주의집중, 공격성, 사회적 위축, 우울과 같은 정서문제가 학교적응에 어떻게 영향을 미치는지 살펴보고, 개인요인인 자아존중감, 자아탄력성, 학교요인인 또래애착, 가족요인인 방임과 학대가 잠재계층에 어떤 영향을 미치는지 살펴보는데 목적이 있다. 분석 결과에 따르면, 정서문제가 학교적응에 영향을 미치는 관계에서 총 3개의 계층이 도출되었고, 각 잠재계층의 특징은 다음과 같다. 먼저 계층1의 경우, 주의집중은 유의미하지 않았고, 공격성, 사회적 위축, 우울이 높음에도 불구하고 학교적응에 정적으로 유의미한 영향을 미쳤다. 계층2의 경우, 정서문제는 학교적응에 유의미한 영향을 미치지 못하는 것으로 나타났다. 계층3의 경우, 정서문제가 낮을수록 학교적응이 높게 나타났다. 또한 영향요인 분석 결과, 자아존중감이 높을수록 계층1 혹은 계층3에 속할 가능성이 높게 나타났고, 방임과 학대가 심할수록 계층2에 속할 가능성이 높았다. 자아탄려성과 또래애착이 높을수록 계층3에 속할 확률이 높았다.This study examines how emotional problems such as attention, aggression, social atrophy, and depression affect school adaptation, depending on the potential class as well as personal factors such as self-esteem, self-resilience, school factors, peer attachment, and family factors, including neglect. According to the data analysis results, a total of three potential classes were derived from the influence of emotional problems on school adaptation, and the characteristics of each potential class are as follows. First, in the case of the latent class 1, attention was not significant to school adaptation, and even although aggression, social withdrawal, and depression were elevated, this had a positive effect on school adaptation. In the case of latent class 2, we found that emotional problems such as attention, aggression, social withdrawal, and depression did not have a significant effect on school adaptation. In the case of latent class 3, the less seere the emotional problems such as attention, aggression, social withdrawal, and depression, the greater the school adaptation. In addition, as a result of analyzing influencing factors, the higher the self-esteem, the higher the probability of belonging to latent class 1 or latent class 3. The more severe neglect and abuse, the higher the likelihood of belonging to latent class 2. The higher the self-reliance and peer attachment, the higher the probability of belonging to class 3.

What Is a Trauma Informed Classroom? What Are the Benefits and Challenges Involved?

This paper investigates the elements of a “trauma informed classroom.” The origins of this approach lie in the developing understanding of Adverse Childhood Experiences (ACEs) and their significant life-long negative effects on development in all areas of life. The study takes a narrative topical approach drawing on established research on trauma impact, and the emerging studies on trauma informed approaches in education. Children and young people affected by traumas such as living with addiction, domestic violence or severe neglect are currently attending educational institutions. There are also young refugees, who are victims of state sponsored violence and brutality. These young people frequently struggle with concentration and may also have relational and behavioural difficulties. Logistical difficulties around attendance, resources, and PTSD type symptoms add to their burden and lead to dropping out or gaining a reputation as a troublemaker or incapable student. The foundation of the “trauma informed classroom” is an understanding by teachers of the daily circumstances of their pupils’ lives, and awareness of what trauma-based reactions and behaviours look like. The rituals and teaching methods of the classroom may be modified in response to the pupils’ needs, in consultation with them, and in a system of ongoing feedback. This work necessitates a collaborative team to support the teacher, and access relevant services. The aim of this paper is to explore the elements of a trauma informed classroom. The benefits and challenges for pupils and teachers will also be discussed.

A Proposal for a New Index to Quantify the Ratio of Near and Far Spatial Neglect Using Immersive Virtual Reality Technology: A Technical Report.

Unilateral spatial neglect (USN) is defined as impaired attention to sensory stimuli on one side, which can exist for near and far spaces combined or independently. Thus, quantifying both near- and far-space neglect is crucial. This study aims to propose an index to quantify the near/far spatial neglect ratio to describe the USN symptoms' characteristics in each patient using immersive virtual reality (VR) technology. An object-detecting task was performed for five USN patients in a three-dimensional VR space. The examiner recorded the positional data of the objects that were recognized by the USN patient using coordinate data. The near/far ratio (NFRatio) was calculated using the proposed equation to quantify the difference in neglect severity in near and far spaces of each patient. Among the patients, four tended to have greater far-space neglect, and one tended to have greater near-space neglect. Moreover, the near/far spatial neglect ratio was shown to vary according to height. This is the first study to propose immersive VR to quantify the near and far spatial neglect. However, further study is needed to assess its reliability and validity and describe its clinical usability. Clinical Relevance- In clinical practice USN symptoms cause neglected symptoms in 3D space so the proposed system will be of high clinical significance if 3D assessment is realized.

Investigating the Influence of Childhood Emotional Maltreatment and Emotional Neglect on Sense of Coherence in Young Adulthood

Child maltreatment contributes to numerous negative health and mental health outcomes. Previous research has emphasized that sense of coherence (SOC), which includes personal resources that promote stress management, is a potent construct shown to positively affect quality of life, psychological health, and symptoms of traumatic stress among trauma survivors. However, less is known about the effect of specific forms of child maltreatment and their relationship to SOC. The purpose of this study was to understand the relationship among specific types of child maltreatment and SOC and to determine the unique contribution of specific forms of child maltreatment on SOC in young adulthood. Results indicated that the most robust predictors of poorer SOC scores among young adults in this sample were severity of childhood emotional maltreatment and of emotional neglect, suggesting that participants who reported more severe childhood emotional maltreatment and emotional neglect reported fewer resources to manage stress. Implications for counseling practice and research are discussed.

Pennhurst and the Struggle for Disability Rights

Pennhurst and the Struggle for Disability Rights

Oxytocin receptor gene methylation as a molecular marker for severity of depressive symptoms in affective disorder patients

BackgroundOxytocin (OXT) is a neuropeptide and hormone involved in emotional functioning and also seems to play a role in moderating the stress response. Both preclinical and clinical studies point to an increased methylation status of the Oxytocin receptor (OXTR) promoter region with concomitant deficits in social, cognitive and emotional functioning. We hypothesize that methylation levels (%) of the oxytocin receptor promoter region correlate with the severity of depression symptoms and/or with the severity of childhood trauma within this present sample of affective disorder patients.MethodologyEight hundred forty six (846) affective disorder patients of Central European origin were recruited at the Department of Psychiatry and Psychotherapy of the Medical University Vienna, the Karl Landsteiner University for Health and Science and Zentren für seelische Gesundheit, BBRZ-Med Leopoldau. Psychiatric assessment included a semi-structured diagnostic interview (Schedules for Clinical Assessment in Neuropsychiatry), the Hamilton Depression Scale and the Childhood Trauma Questionnaire. Concomitantly DNA samples of peripheral blood cells were collected for Multiplexed and Sensitive DNA Methylation Testing.ResultsOur data suggests a positive but not significant association between OXTR promoter Exons 1–3 methylation levels and severity of depression symptoms as well as severity of emotional neglect in affective disorder patients and no association with childhood trauma.ConclusionsOur findings contribute to elucidate the role of OXTR in affective disorders, but further longitudinal studies in particular are necessary to broaden the current state of knowledge.

Changes in Electroencephalography Alpha Associated With Childhood Neglect and Adolescent Alcohol Use.

The present pilot study is interested in the relationship between childhood neglect, brain function, and alcohol use in adolescence. The goal is to guide future prevention and intervention efforts related to alcohol use following childhood neglect. This pilot study comprised 53 adolescents (12-14 years at baseline) recruited from the Department of Social Services (DSS). Self- and DSS-reported neglect, electroencephalography (EEG) alpha power, and alcohol use behaviors were measured over 1year. Higher DSS neglect severity in year 1 was related to lower self-efficacy to alcohol use temptation in year 2. Lower EEG alpha power in the parietal region in year 1 was linked to lower self-efficacy to the temptation of alcohol use in year 2. This pilot project has value for using tools, such as EEG, in child maltreatment and alcohol use studies, including with underrepresented adolescents, to better understand brain-related mechanisms in home-based research.

Cognitive assessment scale for stroke patients (CASP): A multicentric validation study.

The Mini Mental State Examination and Montreal Cognitive Assessment are commonly used as short screening batteries for assessing cognitive impairment after stroke. However, aphasia or hemispatial neglect may interfere with the results. For this reason, we developed the Cognitive Assessment scale for Stroke Patients (CASP), which takes these conditions into consideration and previously demonstrated its superiority over these scales in terms of feasibility. Our goal was to verify the psychometric properties of the (original) French version of the CASP. We included 201 patients with a recent first hemispheric stroke and 50 controls. Stroke patients were examined 4 times (visit 1 [V1] to visit 4 [V4]) in the subacute post-stroke phase. The structural validity of the CASP was studied by principal factorial analysis, convergent validity by comparison with several variables including a comprehensive neuropsychological assessment, divergent validity by comparison with the total score between stroke patients and controls, and sub-scores between right and left stroke. Internal consistency, reproducibility and sensitivity to change were assessed. We propose the Minimal Clinically Important Difference (MCID) value and a pathological threshold as well as a threshold to predict cognitive change between V1 and V4. Of the 201 participants included (63% male; mean [SD] age 63 [13] years), CASP data were available for 199/150/133/93 at V1/V2/V3/V4, respectively. CASP has a one-dimensional structure. The hypotheses of convergent/divergent validities were confirmed. Internal consistency was good and reliability excellent. Responsiveness was small to moderate, but the MCID could still be estimated. We discuss the choice of a pathological threshold and a predictive threshold of V1 over V4. CASP has good psychometric properties for screening cognitive impairment in the subacute post-stroke phase, which is consistent with its Italian and Korean versions. It can be used for patients with severe motor aphasia or left hemispatial neglect but not in case of severe oral comprehension or visual impairment.

The mobility assessment course: A ready-to-use dynamic measure of visuospatial neglect.

The Mobility Assessment Course (MAC) is a tool to measure visuospatial neglect in a dynamic fashion. Although the MAC has been shown to dissociate between patients with and without neglect, it remains unclear whether it is applicable in clinical settings. We evaluated the MAC regarding its (1) feasibility as a diagnostic tool as part of standard care, (2) construct validity, and (3) underlying constructs and potential confounders. A consecutive sample of stroke patients admitted to inpatient rehabilitation completed the MAC, shape cancellation, line bisection, and/or Catherine Bergego Scale (CBS) as part of the standard assessment. To assess feasibility, we computed the percentage of patients who completed the MAC. Construct validity was tested by evaluating MAC performance between patients with and without neglect and controls. Finally, a regression analysis was conducted to assess underlying constructs and potential confounders of MAC performance (i.e., level of mobility and lesion side). The MAC was completed by 82% of patients (N = 182/223; of whom 145 completed all tasks). Patients with neglect performed worse on the MAC (indicating more severe neglect) compared to patients without neglect and controls. The MAC had a lower sensitivity and higher specificity than paper-and-pencil tasks and the CBS. Performance on shape cancellation, line bisection, and CBS were predictors of MAC performance. Level of mobility and lesion side did not predict MAC scores, indicating that these factors do not confound its reliability. To conclude, the MAC is an easy-to-implement tool to evaluate neglect in a dynamic manner, which can be administered in addition to conventional paper-and-pencil tasks.

Multidomain cognitive dysfunction after minor stroke suggests generalized disruption of cognitive networks.

ObjectiveAlthough small strokes typically result in “good” functional outcomes, significant cognitive impairment can occur. This longitudinal study examined a cohort of patients with minor stroke to determine the pattern of deficits, evolution over time, and factors associated with outcome.MethodsPatients admitted to the hospital with their first clinical minor stroke (NIH Stroke Scale [NIHSS] ≤ 10, absence of severe hemiparesis, aphasia, or neglect) were assessed at 1 month post‐infarct, and a subset were followed over time (with 6‐ and 12‐month evaluations). Composite scores at each time point were generated for global cognition, verbal memory, spatial memory, motor speed, processing speed, and executive function. Paired t‐tests evaluated change in scores over time. Regression models identified factors associated with initial performance and better recovery.ResultsEighty patients were enrolled, evaluated at 1 month, and prospectively followed. The average age of the participants was 62.3 years, and mean education was 13.5 years. The average stroke volume was 6.6 cc; mean NIHSS score was 2.8. At 1 month, cognitive scores were below the normative range and > 1 standard deviation below the patient's peak (“recovery”) score for every cognitive domain, strongly suggesting that they were well below patients’ prestroke baselines. Forty‐eight patients followed up at 6 months, and 39 at 12 months. Nearly all (98%) patients significantly improved in global cognition (averaged across domains) between 1 and 6 months. Between 6 and 12 months, recovery was variable. Higher education, occupational class, and Caucasian race were associated with higher recovery scores for most domains.ConclusionsCognitive impairment across multiple domains is common following minor stroke regardless of infarct location, suggesting a global process such as network dysfunction that improves over 6 months. Degree of recovery can be predicted using baseline factors.

Thresholds for Intervention in Child Neglect by Ordinary Citizens: Implications for Measuring Informal Social Control of Child Neglect

Abstract There is growing attention towards neighbourhood and contextual approaches to address and prevent child maltreatment. However, research into neighbour’s protective intervention (protective informal social control) in child neglect has seen little attention. Even amongst the limited research, the findings have not been consistent. The limited research on the subject is partly explained by the contested issue, which centres on the question; how do neighbours witness and intervene in non-aggressive forms of maltreatment, such as neglect? This article aimed to contribute to address this question by exploring thresholds in child neglect amongst ordinary residents. It draws on narrative interviews with seventeen female parents from seven settlements in Ghana. Severity of neglect, consistent exposure and poor parental capacity were key threshold measures reported. It emerged that threshold criteria (high or low) vary based on the subtypes of neglect. Whilst medical and supervisory neglect attracts low threshold criteria, more than one-time exposure is required to meet threshold in food neglect. The findings contrast the uncritical approach of lumping up subtypes of neglect. Instead, it advocates for the development of a context-based measure for protective informal social control of neglect that accounts for subtype effects. Such development should follow an item response theory approach.

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.

Strengths and problems of families in contact with child protective services during the COVID-19 pandemic

Objective: The study investigates the dynamics within families in contact with child protective services in reaction to the Covid-19 pandemic as perceived by social workers. Based on the Family Adjustment and Adaptation Response (FAAR) model, strengths and problems are outlined.&#x0D; Background: Following the first lockdown of public life in March 2020, concerns about children’s well-being have been raised. Practitioners and scientists alike worried that particularly children in families with multiple problems would suffer severe abuse and neglect. However, it remains unclear how these families have actually been affected by the Covid-19 pandemic and the measures to reduce transmission of SARS-CoV-2.&#x0D; Method: Child protection caseworkers from 40 child and youth welfare authorities across Germany were interviewed twice via telephone. The first interview was conducted during summer 2020, and the second interview two months later. Caseworkers were questioned about their professional experience in their daily work since March 2020. Moreover, they provided information on the perceived effects of the Covid-19 pandemic on families in contact with child protective services.&#x0D; Results: The interviews were analyzed using content analyses. Six overall challenges for families were identified. Families reacted differently to these. The caseworkers reported problems in families like increased parental conflict, media use, and alcohol consumption during the first lockdown. Nevertheless in some families, the caseworkers also perceived there to be less stress and tension during the lockdown in March 2020 due to fewer school requirements. Furthermore, some families were able to establish routines, activate resources, and find solutions for problems on their own. At the time of the second interview, some families’ problems had increased, particularly regarding children’s difficulties at school due to insufficient homeschooling.&#x0D; Conclusion: The results show that the effects of the Covid-19 pandemic on child protection families are positive and negative. Some are resourceful in the face of adversities, and others show an aggravation of problems. The results are discussed in light of findings on family dynamics during the Covid-19 pandemic in other countries.

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.

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>

Auditory spatial cueing reduces neglect after right-hemispheric stroke: A proof of concept study

Spatial neglect after right-hemispheric stroke, characterized by the failure to attend or respond to the contralesional space, is a strong negative outcome predictor. Neglect is a supramodal syndrome affecting not only the visual but also the auditory modality. Preliminary studies used this audio-visual cross-modal effect to show short-lasting effects on attention towards the neglected space. The aim of the present study was to introduce a new technique of auditory stimulation combining the unspecific effect of music (i.e., patients choose their preferred music) with the effects of auditory spatial cueing (i.e., the music is presented dynamically as moving from right to left). The effect of this new auditory stimulation technique was investigated in two proof-of-concept experiments using repeated-measures, cross-over designs including 21 patients with visual neglect after a first right-hemispheric stroke. In Experiment I (n = 9), neglect patients showed a significantly larger improvement in Letter Cancellation after listening to preferred music with than without auditory spatial cueing. After granting the feasibility of this new auditory stimulation technique, we investigated the long-term aftereffects in Experiment II (n = 12). Herefore, we used video-oculography during Free Visual Exploration, a sensitive and reliable tool to assess spatial attention over time. Listening to music with auditory spatialcueing – as compared to music without auditory spatialcueing – significantly improved neglect severity in terms of visual exploration behaviour for up to 3h. A voxel-based-lesion-symptom mapping analysis over all patients revealed that the response variability in listening to music with auditory spatial cueing is determined by the integrity of the right inferior parietal lobule, the second branch of the superior longitudinal fascicle, and parieto-parietal callosal fibres. Our study shows that listening to music with auditory spatial cueing significantly reduces neglect severity and has the potential to be used as an add-on in the neurorehabilitation of neglect.