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Ikeda K, Kaneko T, Uchida J, Nakamura T, Takeda T, Nagayama H. Identifying profiles of stroke patients benefitting from additional training: a latent class analysis approach. J Rehabil Med 2024; 56:jrm22141. [PMID: 38380814 DOI: 10.2340/jrm.v56.22141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE To identify profiles of stroke patient benefitting from additional training, using latent class analysis. DESIGN Retrospective observational study. PATIENTS Patients with stroke (n = 6,875) admitted to 42 recovery rehabilitation units in Japan between January 2005 and March 2016 who were registered in the Japan Association of Rehabilitation Database. METHODS The main outcome measure was the difference in Functional Independence Measure (FIM) scores between admission and discharge (referred to as "gain"). The effect of additional training, categorized as usual care (no additional training), self-exercise, training with hospital staff, or both exercise (combining self-exercise and training with hospital staff), was assessed through multiple regression analyses of latent classes. RESULTS Applying inclusion and exclusion criteria, 1185 patients were classified into 7 latent classes based on their admission characteristics (class size n = 82 (7%) to n = 226 (19%)). Patients with class 2 characteristics (right hemiparesis and modified dependence in the motor-FIM and cognitive-FIM) had positive FIM gain with additional training (95% confidence interval (95% CI) 0.49-3.29; p < 0.01). One-way analysis of variance revealed that training with hospital staff (95% CI 0.07-16.94; p < 0.05) and both exercises (95% CI 5.38-15.13; p < 0.01) led to a significantly higher mean FIM gain than after usual care. CONCLUSION Additional training in patients with stroke with right hemiparesis and modified dependence in activities of daily living was shown to improve activities of daily living. Training with hospital staff combined with self-exercise is a promising rehabilitation strategy for these patients.
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Affiliation(s)
- Kohei Ikeda
- Kanagawa University of human Services, Faculty of Health and Social Service, School of Rehabilitation, Division of Occupational Therapy Program, Yokosuka, Kanagawa, Japan.
| | - Takao Kaneko
- Department of Rehabilitation, Yamagata prefectural central hospital, Yamagata, Japan
| | - Junya Uchida
- Department of Rehabilitation Therapy, Saiseikai Higashikanagawa Rehabilitation Hospital, Yokohama, Japan
| | - Takuto Nakamura
- Kanagawa University of human Services, Faculty of Health and Social Service, School of Rehabilitation, Division of Occupational Therapy Program, Yokosuka, Kanagawa, Japan
| | - Taisei Takeda
- Department of Rehabilitation Therapy, Saiseikai Higashikanagawa Rehabilitation Hospital, Yokohama, Japan
| | - Hirofumi Nagayama
- Kanagawa University of human Services, Faculty of Health and Social Service, School of Rehabilitation, Division of Occupational Therapy Program, Yokosuka, Kanagawa, Japan
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Meidian AC, Wahyuddin, Amimoto K. Rehabilitation interventions of unilateral spatial neglect based on the functional outcome measure: A systematic review and meta-analysis. Neuropsychol Rehabil 2022; 32:764-793. [PMID: 33106080 DOI: 10.1080/09602011.2020.1831554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
ABSTRACTThis review aimed to examine the bottom-up and top-down rehabilitation intervention effectiveness based on the functional outcome measure as immediate effect and long-term effect for unilateral spatial neglect conditions. The RCT studies were collected by searching in three databases J-Stage, PubMed, and PEDro from 2008 through 2018. The studies which used the following instruments: BI, CBS, FMA, and FIM, as the functional outcome with the PEDro score of six and above, were eligible for inclusion. A total of 492 participants in 13 studies included from 291 studies initially identified. The meta-analysis for overall ES revealed that BI and CBS had a significant mean of SMD = 0.65 (95% CI, 0.23-1.07; p = 0.003; I2 = 65%), and SMD = -0.23 (95% CI, -0.45 to -0.01; p = 0.04; I2 = 35%) respectively, while FMA and FIM had an insignificant mean of SMD = 0.14 (95% CI, -0.08-0.37; p = 0.22; I2 = 0%), and SMD = -0.22 (95% CI, -0.69-0.25; p = 0.37; I2 = 0%) respectively. Based on the results, although indicated the heterogeneity representation across studies, it showed that the top-down intervention approach of high-frequency rTMS was more effective in enhancing the functional abilities and ADL of unilateral spatial neglect patients on the immediate effects but not necessarily in the long-term effects.
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Affiliation(s)
- Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Faculty of Physiotherapy, Esa Unggul University, Jakarta, Indonesia
| | - Wahyuddin
- Faculty of Physiotherapy, Esa Unggul University, Jakarta, Indonesia
| | - Kazu Amimoto
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Meidian AC, Yige S, Irfan M, Rahayu UB, Amimoto K. Immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the unilateral spatial neglect model. J Phys Ther Sci 2021; 33:809-817. [PMID: 34776614 PMCID: PMC8575481 DOI: 10.1589/jpts.33.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study aimed to clarify the immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the left unilateral spatial neglect model. [Participants and Methods] We included 64 healthy participants to create left unilateral spatial neglect models and divided them into four subgroups. Each subgroup received opposite lateral weight-shifting training with or without mirror visual feedback. We then evaluated the static and dynamic standing balance by measuring the center of pressure point alterations in the medial-lateral and anterior-posterior planes. We further evaluated the center of pressure length and bilateral load ratio. [Results] The center of pressure was significantly stable upon performing the eyes-open static standing balance test in the left weight-shifting training subgroup with mirror visual feedback. When participants performed the left dynamic standing balance test, the center of pressure moved significantly rightward and became significantly stable in the right weight-shifting training subgroup with mirror visual feedback. The left load ratio significantly decreased in the right weight-shifting training of subgroups that either did or did not receive mirror visual feedback upon performing the left dynamic standing balance test. [Conclusion] We concluded that adding mirror visual feedback to lateral weight-shifting training affected some measurements of standing balance control of the left unilateral spatial neglect model.
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Affiliation(s)
- Abdul Chalik Meidian
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
- Faculty of Physiotherapy, Esa Unggul University,
Indonesia
| | - Song Yige
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
| | - Muhammad Irfan
- Department of Physiotherapy, Faculty of Health Sciences,
Universitas Aisyiyah Yogyakarta, Indonesia
| | - Umi Budi Rahayu
- Department of Physiotherapy, Faculty of Health Sciences,
Universitas Muhammadiyah Surakarta, Indonesia
| | - Kazu Amimoto
- Department of Physical Therapy, Graduate School of Human
Health Sciences, Tokyo Metropolitan University: 7-2-10 Higashi-Ogu, Arakawa-Ku, Tokyo
116-8551, Japan
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Di Gregorio F, La Porta F, Lullini G, Casanova E, Petrone V, Simoncini L, Ferrucci E, Piperno R. Efficacy of Repetitive Transcranial Magnetic Stimulation Combined With Visual Scanning Treatment on Cognitive-Behavioral Symptoms of Unilateral Spatial Neglect in Patients With Traumatic Brain Injury: Study Protocol for a Randomized Controlled Trial. Front Neurol 2021; 12:702649. [PMID: 34335455 PMCID: PMC8317998 DOI: 10.3389/fneur.2021.702649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
Left hemispatial neglect (LHSN) is a frequent and disabling condition affecting patients who suffered from traumatic brain injury (TBI). LHSN is a neuropsychological syndrome characterized clinically by difficulties in attending, responding, and consciously representing the right side of space. Despite its frequency, scientific evidence on effective treatments for this condition in TBI patients is still low. According to existing literature, we hypothesize that in TBI, LHSN is caused by an imbalance in inter-hemispheric activity due to hyperactivity of the left hemisphere, as observed in LHSN after right strokes. Thus, by inhibiting this left hyperactivity, repetitive Transcranial Magnetic Stimulation (rTMS) would have a rebalancing effect, reducing LHSN symptoms in TBI patients. We plan to test this hypothesis within a single-blind, randomized SHAM controlled trial in which TBI patients will receive inhibitory i-rTMS followed by cognitive treatment for 15 days. Neurophysiological and clinical measures will be collected before, afterward, and in the follow-up. This study will give the first empirical evidence about the efficacy of a novel approach to treating LHSN in TBI patients. Clinical Trial Registration:https://www.clinicaltrials.gov/ct2/show/NCT04573413?cond=Neglect%2C+Hemispatial&cntry=IT&city=Bologna&draw=2&rank=2, identifier: NCT04573413.
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Affiliation(s)
- Francesco Di Gregorio
- Azienda Unità Sanitaria Locale, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Fabio La Porta
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Giada Lullini
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Emanuela Casanova
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Valeria Petrone
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Loredana Simoncini
- Azienda Unità Sanitaria Locale, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Enrico Ferrucci
- Azienda Unità Sanitaria Locale, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Roberto Piperno
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
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Di Gregorio F, La Porta F, Casanova E, Magni E, Bonora R, Ercolino MG, Petrone V, Leo MR, Piperno R. Efficacy of repetitive transcranial magnetic stimulation combined with visual scanning treatment on cognitive and behavioral symptoms of left hemispatial neglect in right hemispheric stroke patients: study protocol for a randomized controlled trial. Trials 2021; 22:24. [PMID: 33407787 PMCID: PMC7789759 DOI: 10.1186/s13063-020-04943-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left hemispatial neglect (LHN) is a neuropsychological syndrome often associated with right hemispheric stroke. Patients with LHN have difficulties in attending, responding, and consciously representing the right side of space. Various rehabilitation protocols have been proposed to reduce clinical symptoms related to LHN, using cognitive treatments, or on non-invasive brain stimulation. However, evidence of their benefit is still lacking; in particular, only a few studies focused on the efficacy of combining different approaches in the same patient. METHODS In the present study, we present the SMART ATLAS trial (Stimolazione MAgnetica Ripetitiva Transcranica nell'ATtenzione LAteralizzata dopo Stroke), a multicenter, randomized, controlled trial with pre-test (baseline), post-test, and 12 weeks follow-up assessments based on a novel rehabilitation protocol based on the combination of brain stimulation and standard cognitive treatment. In particular, we will compare the efficacy of inhibitory repetitive-transcranial magnetic stimulation (r-TMS), applied over the left intact parietal cortex of LHN patients, followed by visual scanning treatment, in comparison with a placebo stimulation (SHAM control) followed by the same visual scanning treatment, on visuospatial symptoms and neurophysiological parameters of LHN in a population of stroke patients. DISCUSSION Our trial results may provide scientific evidence of a new, relatively low-cost rehabilitation protocol for the treatment of LHN. TRIAL REGISTRATION ClinicalTrials.gov NCT04080999 . Registered on September 2019.
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Affiliation(s)
- Francesco Di Gregorio
- Azienda Unità Sanitaria Locale, UOC di Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italy
| | - Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy.
| | - Emanuela Casanova
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Elisabetta Magni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Roberta Bonora
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Maria Grazia Ercolino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | - Valeria Petrone
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
| | | | - Roberto Piperno
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO di Medicina Riabilitativa e Neuroriabilitazione, Casa dei Risvegli Luca de Nigris, Via Giulio Gaist, 6, 40139, Bologna, Italy
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Pinto JO, Dores AR, Peixoto B, Geraldo A, Barbosa F. Systematic Review of Sensory Stimulation Programs in the Rehabilitation of Acquired Brain Injury. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Acquired Brain Injury (ABI) can lead to sensory deficits and compromise functionality. However, most studies have been focused on motor stimulation in stroke and traumatic brain injury (TBI). Sensory stimulation in stroke and mild/moderate TBI has received reduced interest. The main objective of this review is to know the methodological characteristics and effects of sensory programs in ABI. Studies with the purpose of testing the efficacy of those programs were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty-three studies were included in this review. The results show that in most studies sensory stimulation started within 12 months after injury and there is no consensus regarding frequency, duration and number of sessions, duration of intervention, and instruments used to assess outcomes. Most programs involved unisensory stimulation, and vision was the predominant target. The most used methods were compensation and somatosensory discrimination training. Most studies used a pre- and post-intervention assessment, with few studies comprising follow-up assessment. Regarding the studies revised, the interventions with positive outcomes in ABI are: compensation, cognitive training, vestibular intervention, somatosensory discrimination training, proprioceptive stimulation with muscle vibration, and sustained attention training with olfactory stimulation. Available findings suggest that sensory stimulation has positive results with immediate and long-term improvements in sensory functioning. This review provides useful information to improve rehabilitation and to design future investigation.
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Affiliation(s)
- Joana O. Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | | | - Bruno Peixoto
- CESPU, University Institute of Health Sciences, Gandra, Portugal
- NeuroGen – Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Andreia Geraldo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
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Van Vleet T, Bonato P, Fabara E, Dabit S, Kim S, Chiu C, Bisogno AL, Merzenich M, Corbetta M, DeGutis J. Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect. Ann Neurol 2020; 88:747-758. [DOI: 10.1002/ana.25862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas Van Vleet
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Boston MA USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Eric Fabara
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Sawsan Dabit
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Sarah‐Jane Kim
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Christopher Chiu
- Department of Psychology University of Massachusetts Boston MA USA
| | - Antonio Luigi Bisogno
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
| | - Michael Merzenich
- Department of Research and Development Posit Science Inc San Francisco CA USA
- School of Medicine University of California San Francisco CA USA
| | - Maurizio Corbetta
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
- Department of Neurology, Radiology Neuroscience Washington University School of Medicine St. Louis MO USA
- Venetian Institute of Molecular Medicine, VIMM Padova Italy
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
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Stone A, Cooke D, Morton D, Steele M. Reliability of revised scoring methods for the Schenkenberg Line Bisection Test with adults following stroke: Preliminary findings. Br J Occup Ther 2019. [DOI: 10.1177/0308022619866377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Stone
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Deirdre Cooke
- School of Allied Health, Australian Catholic University, Brisbane, Australia
- Mater Private Hospital Rehabilitation Unit, Brisbane, Australia
| | - Deborah Morton
- Mater Private Hospital Rehabilitation Unit, Brisbane, Australia
| | - Michael Steele
- School of Allied Health, Australian Catholic University, Brisbane, Australia
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[Top-down and bottom-up approaches for the treatment of unilateral spatial neglect in stroke patients: A systematic review]. Rehabilitacion (Madr) 2019; 53:93-103. [PMID: 31186102 DOI: 10.1016/j.rh.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of top-down and bottom-up approaches in the rehabilitation of unilateral spatial neglect in stroke patients. METHODOLOGY We carried out a systematic review of randomized controlled trials from January of 2013 to March of 2017. The following databases were searched: Scopus, Science Direct, Web of Science, Pubmed and CINHAL. The methodological quality, level of scientific evidence and the strength of recommendation were evaluated. RESULTS We included 13 studies (294 subjects): nine studies (188 patients) carried out therapies with a bottom-up approach such us eye patching, virtual reality, optokinetic stimulation, transcranial magnetic stimulation and prism adaption; three studies (94 patients) evaluated therapies with a top-down approach such us visual scanning, sensory feedback and mental practice; one study incorporated both approaches. Nine of these studies showed improvements in spatial neglect scales; five of these used bottom-up approaches, another three used top-down approaches and the remaining study combined both approaches. Disability was evaluated by nine studies, and only three reported improvements. Three studies reported significant improvements in motor function in the intervention groups. CONCLUSIONS Top-down and bottom-up approaches could improve unilateral spatial neglect, disability and motor function in patients with stroke.
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Küçükdeveci AA, Stibrant Sunnerhagen K, Golyk V, Delarque A, Ivanova G, Zampolini M, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2019; 54:957-970. [DOI: 10.23736/s1973-9087.18.05501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Kang SH, Kim DK, Seo KM, Choi KN. Modifying and evaluating efficacy of interactive computerized program using motion tracking technology to improve unilateral neglect in patients with chronic stroke. Medicine (Baltimore) 2018; 97:e11932. [PMID: 30235656 PMCID: PMC6160019 DOI: 10.1097/md.0000000000011932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To modify and evaluate the efficacy of a computerized visual perception rehabilitation program using interactive motion tracking technology with unilateral neglect after chronic stroke. METHODS Study design is single-blinded (analyst-blinded) controlled prospective clinical trial. Subjects are 16 patients with chronic stroke and unilateral neglect for over 6 months and 19 healthy volunteers. We modified our previous program to 9 tasks with built-in scoring system, and the subjects performed 3 sessions per week, 30 minutes per session for 4 weeks. RESULTS Scores for the Modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), Motor-free Visual Perception Test (MVPT), Line bisection test, Star cancellation test, Forward Digit Test, and Backward Digit Test showed significant improvement at the end of the sessions in the patient group. By comparing the parameters of built-in scoring system of each task among the control group, the first session of training in the patient group, and the last session of training in the patient group, we categorized the parameters for optional measurement to determine the effect of training or to be a candidate for evaluative use. CONCLUSIONS Our modified computerized visual perception rehabilitation program using improved unilateral neglect in patients post-stroke. Built-in scoring system in this program was helpful to assess availability of it more objectively.
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Affiliation(s)
- Si Hyun Kang
- Department of Physical Medicine & Rehabilitation
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation
| | | | - Kwang Nam Choi
- School of Computer Science & Engineering, Chung-Ang University, Seoul, Republic of Korea
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Simon JJ, Welfringer A, Leifert-Fiebach G, Brandt T. Motor imagery in chronic neglect: An fMRI pilot study. J Clin Exp Neuropsychol 2018; 41:58-68. [PMID: 30080434 DOI: 10.1080/13803395.2018.1500527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Previous studies indicate the effectiveness of motor imagery training in stroke patients. To determine whether patients showing chronic visuospatial neglect symptoms may profit from motor imagery training, it is important to assess how the brain implements motor imagery when cortical systems involved in attentional control are impaired. METHOD Therefore, in this pilot study, nine chronic neglect patients with right-hemispheric stroke performed motor imagery of a finger opposition task during functional magnetic resonance imaging (fMRI). RESULTS Imagery of unaffected hand movements was related to activations in the left primary somatosensory and premotor cortices as well as in the left supplementary motor area. During the imagery of the affected hand, patients displayed activations in the left premotor cortex and supplementary motor area as well as left dorsolateral prefrontal cortex. Furthermore, time since onset and visual imagery capacity were negatively related to activation in the supplementary motor area during the imagery of the affected hand. CONCLUSIONS These initial results demonstrate motor imagery capacity in patients with chronic neglect via compensatory neural processing during motor imagery of the affected hand in ipsilateral brain regions, since we found that the supplementary motor area appears to be specifically related to neglect severity. Although our results must be treated with caution due to the small sample size and missing control group, they indicate that neglect is not necessarily an exclusion criterion for motor imagery training per se.
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Affiliation(s)
- Joe J Simon
- a Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine , University Hospital Heidelberg , Heidelberg , Germany.,b Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty , Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany
| | | | | | - Tobias Brandt
- d Department of Neurology , University of Heidelberg , Heidelberg , Germany.,e Suva, Insurance Medicine , Luzern , Switzerland
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Tobler-Ammann BC, Surer E, de Bruin ED, Rabuffetti M, Borghese NA, Mainetti R, Pirovano M, Wittwer L, Knols RH. Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study. JMIR Serious Games 2017; 5:e17. [PMID: 28842388 PMCID: PMC5591404 DOI: 10.2196/games.7923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 01/08/2023] Open
Abstract
Background Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames—games based on therapeutic principles—aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. Objectives The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. Methods A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. Results The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%). Conclusions The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations—for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.
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Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute (CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Marco Rabuffetti
- Polo Tecnologico, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Renato Mainetti
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Michele Pirovano
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Lia Wittwer
- Parkinson Center, Epileptology, Neurorehabilitation, Clinic Bethesda, Tschugg, Switzerland
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
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Sedda G, Ottonello M, Fiabane E, Pistarini C, Sedda A, Sanguineti V. Computational rehabilitation of neglect: Using state-space models to understand the recovery mechanisms. IEEE Int Conf Rehabil Robot 2017; 2017:187-192. [PMID: 28813816 DOI: 10.1109/icorr.2017.8009244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Unilateral spatial neglect is a neuropsychological syndrome often observed in right hemisphere stroke patients. The symptoms differ from subject to subject. A few rehabilitation approaches, e.g. prism adaptation, have demonstrated some effect in reducing the symptoms, but the underlying mechanisms are still largely unclear. Recently, neural models have been proposed to qualitatively describe cortical lesions, the resulting neglect symptoms and the effects of treatment. However, these predictions are qualitative and cannot be used to compare different hypotheses or to interpret symptoms at individual subjects level. Here we propose a computational model of the trial-by-trial dynamics of training-induced recovery from neglect. Neglect is modelled in terms of an impaired internal representation of visual stimuli in the left hemispace. The model assumes that recovery is driven by the mismatch between defective representations of visual stimuli and the corresponding hand positions. The model reproduces the main observations of prism adaptation experiments. Using standard system identification techniques, we fitted the model to data from a rehabilitation trial based on a novel rehabilitation approach based on virtual reality, involving reaching movements within an adaptive environment. Our results suggest that the model can be used to interpret data from individual subjects and to formulate testable hypotheses on the mechanisms of recovery and directions for treatment.
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15
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Chen P, Pitteri M, Gillen G, Ayyala H. Ask the experts how to treat individuals with spatial neglect: a survey study. Disabil Rehabil 2017; 40:2677-2691. [DOI: 10.1080/09638288.2017.1347720] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peii Chen
- Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, USA
| | - Marco Pitteri
- Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Glen Gillen
- Department of Regenerative and Rehabilitation Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY, USA
| | - Harsha Ayyala
- New Jersey Medical School, Rutgers University, Newark, NJ, USA
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16
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Azouvi P, Jacquin-Courtois S, Luauté J. Rehabilitation of unilateral neglect: Evidence-based medicine. Ann Phys Rehabil Med 2016; 60:191-197. [PMID: 27986428 DOI: 10.1016/j.rehab.2016.10.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 10/28/2016] [Accepted: 10/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the last decades, several rehabilitation methods have been developed to improve spatial neglect. These can be classified according to their theoretical basis: (i) enhance awareness of neglect behaviour through a top-down mechanism; (ii) low-level bottom-up sensory stimulation; (iii) modulation of inhibitory processes; (iv) increase arousal. OBJECTIVE The purpose of this study was to provide an overview of the evidence on the effectiveness of rehabilitation procedures for unilateral neglect. METHOD A systematic search was performed to look for all randomised controlled trials aimed at reducing left spatial neglect that included a functional assessment. In addition, recent review papers and meta-analyses were analysed. RESULTS Thirty-seven randomized controlled trials were found (12 bottom-up; 12 top-down; 1 interhemispheric competition; 12 combination of approaches) that included 1027 patients with neglect. Although there are some encouraging results, overall, the level of evidence remains low. Poor methodological quality and small sample sizes are major limitations in many published trials. CONCLUSION There is a need for well-conducted, large-scale randomised controlled trials that incorporate blinded assessments, evaluation of the generalization to activities of daily living and long-term follow-up.
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Affiliation(s)
- Philippe Azouvi
- AP-HP, hôpital Raymond-Poincaré, service de médecine physique et de réadaptation, 92380 Garches, France; EA 4047 HANDIReSP, université de Versailles-Saint-Quentin, 78180 Montigny-Le-Bretonneux, France.
| | - Sophie Jacquin-Courtois
- Service de médecine physique et de réadaptation, rééducation neurologique, hôpital Henry-Gabrielle, CHU de Lyon, 69230 Saint-Genis-Laval, France; Université de Lyon, université Lyon 1, 69100 Villeurbanne, France; Centre de recherche en neuroscience de Lyon (CRNL), équipe IMPACT, Inserm, U1028, CNRS, UMR5292, 69675 Bron, France
| | - Jacques Luauté
- Service de médecine physique et de réadaptation, rééducation neurologique, hôpital Henry-Gabrielle, CHU de Lyon, 69230 Saint-Genis-Laval, France; Université de Lyon, université Lyon 1, 69100 Villeurbanne, France; Centre de recherche en neuroscience de Lyon (CRNL), équipe IMPACT, Inserm, U1028, CNRS, UMR5292, 69675 Bron, France
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17
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Volkening K, Kerkhoff G, Keller I. Effects of repetitive galvanic vestibular stimulation on spatial neglect and verticality perception-a randomised sham-controlled trial. Neuropsychol Rehabil 2016; 28:1179-1196. [PMID: 27820972 DOI: 10.1080/09602011.2016.1248446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recent evidence shows that bipolar galvanic vestibular stimulation (GVS) with the cathode on the left (CL) or right (CR) mastoid ameliorates spatial neglect, extinction and verticality perception transiently and partly permanently. However, no randomised controlled trial evaluated the long-term effects of repetitive GVS in comparison to sham-GVS on exploration and verticality perception. To compare the effects of CL-GVS, CR-GVS and Sham-GVS on spatial exploration and verticality perception in right-hemispheric stroke patients with left neglect we conducted a randomised controlled trial with minimisation. Twenty-four patients completed 10-12 training sessions on a daily basis, 5 days/week. The CL-and CR-GVS group received 20 min of stimulation at 1.5 mA, the Sham-GVS group only 30 s of CL-GVS. Simultaneously, all patients performed a standard therapy of smooth pursuit eye movement training (SPT) followed by visual scanning training (VST). Outcome measures (Neglect test, visuo-tactile search task, subjective visual and tactile vertical) were assessed before and immediately after the intervention and at 2- and 4-week follow-ups. Our results show that neither our standard therapy nor the combination of standard therapy and GVS improved neglect symptoms significantly. The reasons for our non-significant results are discussed.
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Affiliation(s)
- Katharina Volkening
- a Department of Neuropsychology , Schoen Klinik Bad Aibling , Bad Aibling , Germany.,b German Center for Vertigo and Balance Disorders (IFB) , Ludwig-Maximilians-University , Munich , Germany
| | - Georg Kerkhoff
- c Clinical Neuropsychology & Neuropsychological University Clinic , Saar University , Saarbruecken , Germany
| | - Ingo Keller
- a Department of Neuropsychology , Schoen Klinik Bad Aibling , Bad Aibling , Germany
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Chen P, Ward I, Khan U, Liu Y, Hreha K. Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury: A Retrospective Study. Neurorehabil Neural Repair 2015; 30:451-60. [PMID: 26338431 DOI: 10.1177/1545968315604397] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury-induced mass effect predicted left-sided neglect. Conclusions Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment.
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Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, NJ, USA Rutgers University, Newark, NJ, USA
| | - Irene Ward
- Rutgers University, Newark, NJ, USA Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | | | - Yan Liu
- Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Kessler Institute for Rehabilitation, West Orange, NJ, USA Columbia University, New York, NY, USA
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A Systematic Research Review Assessing the Effectiveness of Pursuit Interventions in Spatial Neglect Following Stroke. Transl Stroke Res 2015; 6:410-20. [DOI: 10.1007/s12975-015-0420-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
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20
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Klinke ME, Hafsteinsdóttir TB, Hjaltason H, Jónsdóttir H. Ward-based interventions for patients with hemispatial neglect in stroke rehabilitation: A systematic literature review. Int J Nurs Stud 2015; 52:1375-403. [DOI: 10.1016/j.ijnurstu.2015.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/28/2015] [Accepted: 04/03/2015] [Indexed: 11/26/2022]
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