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Fisher G, Quel de Oliveira C, Stubbs PW, Power E, Checketts M, Porter-Armstrong A, Kennedy DS. Spatial Neglect: An Exploration of Clinical Assessment Behaviour in Stroke Rehabilitation. Clin Rehabil 2024; 38:688-699. [PMID: 38347746 PMCID: PMC11005297 DOI: 10.1177/02692155241230270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE There is a large gap between evidence-based recommendations for spatial neglect assessment and clinical practice in stroke rehabilitation. We aimed to describe factors that may contribute to this gap, clinician perceptions of an ideal assessment tool, and potential implementation strategies to change clinical practice in this area. DESIGN Qualitative focus group investigation. Focus group questions were mapped to the Theoretical Domains Framework and asked participants to describe their experiences and perceptions of spatial neglect assessment. SETTING Online stroke rehabilitation educational bootcamp. PARTICIPANTS A sample of 23 occupational therapists, three physiotherapists, and one orthoptist that attended the bootcamp. INTERVENTION Prior to their focus group, participants watched an hour-long educational session about spatial neglect. MAIN MEASURES A deductive analysis with the Theoretical Domains Framework was used to describe perceived determinants of clinical spatial neglect assessment. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice-change strategies in this area. RESULTS Participants reported that their choice of spatial neglect assessment was influenced by a belief that it would positively impact the function of people with stroke. However, a lack of knowledge about spatial neglect assessment appeared to drive low clinical use of standardised functional assessments. Participants recommended open-source online education involving a multidisciplinary team, with live-skill practice for the implementation of spatial neglect assessment tools. CONCLUSIONS Our results suggest that clinicians prefer functional assessments of spatial neglect, but multiple factors such as knowledge, training, and policy change are required to enable their translation to clinical practice.
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Affiliation(s)
- Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Peter W Stubbs
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Emma Power
- Discipline of Speech Pathology, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Matthew Checketts
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alison Porter-Armstrong
- Healthcare Technology Innovation and Assessment in the School of Health and Social Care, Edinburgh Napier University, Scotland, UK
| | - David S Kennedy
- Motion and Mobility Rehabilitation Laboratory, School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
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Obrenovic M, Mouthon M, Chavan C, Saj A, Dieguez S, Aellen J, Chabwine JN. Acute right opercular stroke-associated polyopic heautoscopy and hallucinations caused by disconnection to the inferior parietal lobule through the superior longitudinal fasciculus III: A single case study. Cortex 2024; 174:125-136. [PMID: 38520766 DOI: 10.1016/j.cortex.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 03/25/2024]
Abstract
Illusory neuropsychiatric symptoms such as hallucinations or the feeling of a presence (FOP) can occur in diffuse brain lesion or dysfunction, in psychiatric diseases as well as in healthy individuals. Their occurrence due to focal brain lesions is rare, most probably due to underreporting, which limits progress in understanding their underlying mechanisms and anatomical determinants. In this single case study, an 86-year-old patient experienced, in the context of an acute right central opercular ischemic stroke, visual hallucinatory symptoms (including palinopsia), differently lateralized auditory hallucinations and FOP. This unusual clinical constellation could be precisely documented and illustrated while still present, allowing a realistic and immersive visual experience validated by the patient. The acute stroke appeared to be their most plausible cause (after exclusion of other etiologies). Furthermore, accurate analysis of tractographic data suggested that disruption in the posterior bundle of the superior longitudinal fasciculus connecting the stroke lesion to the inferior parietal lobule was the anatomical substrate explaining the FOP and, indirectly, also hallucinations through whiter matter involvement, in coherence with existing literature. We could finally elaborate on symptoms taxonomy and phenomenology (e.g., polyopic heautoscopy, hallucinatory FOP, etc), and on patient's remarkable distancing from them (with some therapeutic implications supported by plausibly engaged mechanisms). This case not only authentically enriched the description of such rare combination of heterogenous illusory symptoms through this novel visualization-based reporting approach, but disclosed an unrevealed anatomo-clinical link relating all of them to the acute stroke lesion through an association fiber, thereby contributing to the understanding of these intriguing symptoms and their determinants.
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Affiliation(s)
- Mihailo Obrenovic
- Department of Neurorehabilitation, Clinique Romande de Réadaptation SUVA Care, Sion, Switzerland
| | - Michael Mouthon
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg Switzerland
| | - Camille Chavan
- Neuropsychology-Logopedy Unit, Fribourg Hospital, Switzerland
| | - Arnaud Saj
- Neuropsychology-Logopedy Unit, Fribourg Hospital, Switzerland
| | - Sebastian Dieguez
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg Switzerland
| | - Jerôme Aellen
- Department of Radiology, Fribourg Hospital, Riaz, Switzerland
| | - Joelle N Chabwine
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg Switzerland; Division of Neurology, Department of Internal Medicine, Fribourg Hospital, Cantonal Hospital Fribourg, Switzerland.
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De Boi I, Embrechts E, Schatteman Q, Penne R, Truijen S, Saeys W. Assessment and treatment of visuospatial neglect using active learning with Gaussian processes regression. Artif Intell Med 2024; 149:102770. [PMID: 38462272 DOI: 10.1016/j.artmed.2024.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
Visuospatial neglect is a disorder characterised by impaired awareness for visual stimuli located in regions of space and frames of reference. It is often associated with stroke. Patients can struggle with all aspects of daily living and community participation. Assessment methods are limited and show several shortcomings, considering they are mainly performed on paper and do not implement the complexity of daily life. Similarly, treatment options are sparse and often show only small improvements. We present an artificial intelligence solution designed to accurately assess a patient's visuospatial neglect in a three-dimensional setting. We implement an active learning method based on Gaussian process regression to reduce the effort it takes a patient to undergo an assessment. Furthermore, we describe how this model can be utilised in patient oriented treatment and how this opens the way to gamification, tele-rehabilitation and personalised healthcare, providing a promising avenue for improving patient engagement and rehabilitation outcomes. To validate our assessment module, we conducted clinical trials involving patients in a real-world setting. We compared the results obtained using our AI-based assessment with the widely used conventional visuospatial neglect tests currently employed in clinical practice. The validation process serves to establish the accuracy and reliability of our model, confirming its potential as a valuable tool for diagnosing and monitoring visuospatial neglect. Our VR application proves to be more sensitive, while intra-rater reliability remains high.
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Affiliation(s)
- Ivan De Boi
- Faculty of Applied Engineering, Department Electromechanics, Research Group InViLab, University of Antwerp, Groenenborgerlaan 171, Antwerp, 2020, Belgium(1).
| | - Elissa Embrechts
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Quirine Schatteman
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Rudi Penne
- Faculty of Applied Engineering, Department Electromechanics, Research Group InViLab, University of Antwerp, Groenenborgerlaan 171, Antwerp, 2020, Belgium(1)
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, Research Group MOVANT, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium
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Robertson CE, Digre KB. Persistent aura, visual snow, and other visual symptoms. Handb Clin Neurol 2024; 199:441-464. [PMID: 38307662 DOI: 10.1016/b978-0-12-823357-3.00018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
In neurology practice, it is common to encounter a variety of visual complaints. Historically, in the absence of known ocular pathology, epilepsy, or insult to the central nervous system, positive symptoms were assumed to be migrainous in origin. This assumption was sometimes made even in the absence of a history of migraine. In the past decade, there has been considerable effort to better delineate and study nonmigrainous visual phenomena, with the most extensive focus on a newly defined syndrome, visual snow syndrome (VSS). The heightened awareness of visual snow as a symptom and syndrome has greatly enhanced the understanding of this visual phenomenon; however, in the last few years, there has been an almost pendulous swing in clinic, with patients now being given the diagnosis of VSS for any dots or flickering they may have in their vision. To avoid clinical misdiagnosis, it is critical that we expand our understanding not just of VSS but also of underlying pathologies that may present similarly. This chapter will review classical migraine aura, persistent migraine aura, visual snow and a number of positive and negative visual complaints that are on the differential when seeing patients with suspected aura or visual snow. This is followed by an in-depth discussion on the current understanding of the presenting symptoms, pathophysiology, evaluation and management of VSS. We also outline secondary causes of visual snow.
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Affiliation(s)
- Carrie E Robertson
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Kathleen B Digre
- Moran Eye Center, University of Utah, Salt Lake City, UT, United States.
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Norwood MF, Painter DR, Marsh CH, Reid C, Hine T, Harvie DS, Jones S, Dungey K, Chen B, Libera M, Gan L, Bernhardt J, Kendall E, Zeeman H. The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol. BRAIN IMPAIR 2023; 24:548-567. [PMID: 38167362 DOI: 10.1017/brimp.2022.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA). METHODS/DESIGN The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains. RESULTS Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual's orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search. CONCLUSIONS The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.
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Affiliation(s)
- Michael Francis Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - David Ross Painter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - Chelsea Hannah Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Connor Reid
- Technical Partners Health (TPH), Griffith University, Nathan, QLD, Australia
| | - Trevor Hine
- School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Daniel S Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Susan Jones
- Neurosciences Rehabilitation Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Kelly Dungey
- Neurosciences Rehabilitation Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Ben Chen
- Allied Health and Rehabilitation, Emergency and Specialty Services, Gold Coast Health, Gold Coast, QLD, Australia
| | - Marilia Libera
- Psychology Department, Logan Hospital, Logan, QLD, Australia
| | - Leslie Gan
- Rehabilitation Unit, Logan Hospital, Meadowbrook, QLD, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Elizabeth Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
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Painter DR, Norwood MF, Marsh CH, Hine T, Harvie D, Libera M, Bernhardt J, Gan L, Zeeman H. Immersive virtual reality gameplay detects visuospatial atypicality, including unilateral spatial neglect, following brain injury: a pilot study. J Neuroeng Rehabil 2023; 20:161. [PMID: 37996834 PMCID: PMC10668447 DOI: 10.1186/s12984-023-01283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries. METHODS In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds. RESULTS The study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients-those with and without neglect. CONCLUSION Our research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect.
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Affiliation(s)
- David R Painter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
| | - Michael F Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia.
| | - Chelsea H Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Trevor Hine
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Daniel Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University South Australia, Adelaide, SA, Australia
| | - Marilia Libera
- Psychology Department, Logan Hospital, Logan, QLD, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Leslie Gan
- Rehabilitation Unit, Logan Hospital, Meadowbrook, QLD, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
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Azouvi P, Rousseaux M, Bartolomeo P, Pérennou D, Pradat-Diehl P, Wiart L, Rode G, Godefroy O. Discriminative value of different combinations of tests to detect unilateral neglect in patients with right hemisphere damage. Eur J Neurol 2023; 30:3332-3340. [PMID: 37405828 DOI: 10.1111/ene.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/27/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND PURPOSE This study was undertaken to assess the most sensitive combination of tests to detect peripersonal unilateral neglect (UN) after stroke. METHODS The present study is a secondary analysis of a previously reported multicentric study of 203 individuals with right hemisphere damage (RHD), mainly subacute stroke, 11 weeks postonset on average, and 307 healthy controls. A battery of seven tests, providing 19 age- and education-adjusted z-scores, were given: the bells test, line bisection, figure copying, clock drawing, overlapping figures test, and reading and writing. Statistical analyses used a logistic regression and a receiver operating characteristic (ROC) curve after adjustment on demographic variables. RESULTS A combination of four z-scores based on the following three tests provided good discrimination of patients with RHD from matched healthy controls: the starting point and the difference between the number of omissions on left and right sides from the bells test, rightward deviation in bisection of long lines (20 cm), and left-sided omissions in a reading task. The area under the ROC curve was 0.865 (95% confidence interval = 0.83-0.901), with sensitivity = 0.68, specificity = 0.95, accuracy = 0.85, positive predictive value = 0.90, and negative predictive value = 0.82. CONCLUSIONS The most sensitive and parsimonious combination of tests to detect UN after stroke relies on four scores from three simple tests (bells test, line bisection, and reading). Future study is warranted to assess its ability to account for the functional difficulties of UN in daily life in the patient's actual environment.
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Affiliation(s)
- Philippe Azouvi
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Paris-Saclay, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- Université Paris-Saclay, Université de Versailles Saint Quentin, Institut national de la santé et de la recherche médicale, Centre de recherche en Epidémiologie et Santé des Populations, Villejuif, France
| | - Marc Rousseaux
- Department of Physical Medicine and Rehabilitation, Hôpital Swynghedauw, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-Institut du Cerveau et de la Moelle, Institut national de la santé et de la recherche médicale, Centre National de la Recherche Scientifique, Assistance Publique Hopitaux de Paris, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Dominic Pérennou
- Grenoble Alpes University, Unité mixte de recherche Centre National de la Recherche Scientifique 5105, Neuropsychology and Neurocognition, Centre Hospitalier Universitaire Grenoble Alpes, Department of Neurorehabilitation, South Hospital, Grenoble, France
| | - Pascale Pradat-Diehl
- Department of Physical Medicine and Rehabilitation, Salpêtrière Hospital, Paris, France
| | - Laurent Wiart
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gilles Rode
- Lyon Neuroscience Research Center, Trajectoires Team, Institut national de la santé et de la recherche médicale U1028 and Centre National de la Recherche Scientifique Unité mixte de recherche 5292, Université Claude Bernard-Lyon 1, Bron, France
- Service de Médecine Physique et Réadaptation, Plateforme Mouvement et Handicap, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (Unité de recherche Université de Picardie Jules Verne 4559), Jules Verne University of Picardie, Amiens, France
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Ott J, Oh-Park M, Boukrina O. Association of delirium and spatial neglect in patients with right-hemisphere stroke. PM R 2023; 15:1075-1082. [PMID: 36377594 DOI: 10.1002/pmrj.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/14/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Delirium, an acute and fluctuating decline in cognitive functioning, increases mortality and length of hospital stays (LOS) and adversely affects functional outcomes. Previous studies suggested that the incidence of delirium may be increased in right-hemisphere strokes. Similarly, spatial neglect, a disabling deficit in unilateral spatial processing, is more common and more severe following a right-sided stroke. Spatial neglect has been established as a risk factor for delirium. OBJECTIVE It was hypothesized that functionally relevant spatial neglect and delirium are associated in patients with right-hemisphere stroke during acute inpatient rehabilitation. Data were examined from consecutive unilateral stroke patients evaluated with the 3-minute diagnostic interview for confusion assessment method (3D-CAM) and the Catherine Bergego Scale (CBS) via the Kessler Foundation Neglect Assessment Process (KF-NAP). DESIGN A retrospective, cohort study. SETTING Data collected in an acute inpatient rehabilitation facility. PARTICIPANTS Six hundred twenty six patients with stroke were included. MAIN OUTCOME MEASURES The measures were the relative risk of patients with right-hemisphere stroke having delirium when also positive for spatial neglect compared to patients with right-hemisphere stroke without spatial neglect, the incidence of 3D-CAM positive results by stroke hemisphere, and the effect of spatial neglect and delirium on functional outcomes for patients with right-brain stroke patients. RESULTS There was a significantly higher risk of delirium in patients with right-hemisphere stroke with spatial neglect compared to patients with right-hemisphere stroke without spatial neglect. The rates of 3D-CAM positive results were not statistically different for left- compared to right-hemisphere strokes. Both delirium and spatial neglect had significant adverse effects on right-hemisphere stroke patients' functional independence. CONCLUSIONS The results demonstrate an association between spatial neglect and delirium in patients with right hemisphere stroke in the acute inpatient rehabilitation setting. Because of the negative effect of these impairments on functional outcomes after stroke, prevention, early detection, and targeted treatments should be prioritized for these patients.
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Affiliation(s)
- Jamie Ott
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Mooyeon Oh-Park
- Burke Rehabilitation Hospital, Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, White Plains, New York, USA
| | - Olga Boukrina
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, New Jersey, USA
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Rosenzopf H, Sperber C, Wortha F, Wiesen D, Muth A, Klein E, Möller K, Karnath HO. Spatial neglect in the digital age: Influence of presentation format on patients' test behavior. J Int Neuropsychol Soc 2023; 29:686-695. [PMID: 36303420 DOI: 10.1017/s1355617722000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Computerized neglect tests could significantly deepen our disorder-specific knowledge by effortlessly providing additional behavioral markers that are hardly or not extractable from existing paper-and-pencil versions. This study investigated how testing format (paper versus digital), and screen size (small, medium, large) affect the Center of cancelation (CoC) in right-hemispheric stroke patients in the Letters and the Bells cancelation task. Our second objective was to determine whether a machine learning approach could reliably classify patients with and without neglect based on their search speed, search distance, and search strategy. METHOD We compared the CoC measure of right hemisphere stroke patients with neglect in two cancelation tasks across different formats and display sizes. In addition, we evaluated whether three additional parameters of search behavior that became available through digitization are neglect-specific behavioral markers. RESULTS Patients' CoC was not affected by test format or screen size. Additional search parameters demonstrated lower search speed, increased search distance, and a more strategic search for neglect patients than for control patients without neglect. CONCLUSION The CoC seems robust to both test digitization and display size adaptations. Machine learning classification based on the additional variables derived from computerized tests succeeded in distinguishing stroke patients with spatial neglect from those without. The investigated additional variables have the potential to aid in neglect diagnosis, in particular when the CoC cannot be validly assessed (e.g., when the test is not performed to completion).
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Affiliation(s)
- Hannah Rosenzopf
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Christoph Sperber
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Franz Wortha
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Annika Muth
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Elise Klein
- University of Paris, LaPsyDÉ, CNRS, Sorbonne Paris Cité, Paris, France
- Leibniz Institut für Wissensmedien, Tuebingen, Germany
| | - Korbinian Möller
- Leibniz Institut für Wissensmedien, Tuebingen, Germany
- Centre for Mathematical Cognition, School of Science, Loughborough University, Loughborough, United Kingdom
- Centre for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany
| | - Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Stammler B, Rosenzopf H, Röhrig L, Smaczny S, Matuz T, Schenk T, Karnath HO. [Clinical examination of spatial neglect and other disorders of spatial cognition]. Nervenarzt 2023; 94:744-756. [PMID: 37535111 DOI: 10.1007/s00115-023-01525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/04/2023]
Abstract
Neglect occurring after stroke, neoplasms or degenerative processes can lead to considerable disability in everyday life as can other disorders of spatial orientation. Therefore, a dedicated examination and early diagnostic classification are obligatory. Behavioral tests are helpful in this respect, enabling the clinician to obtain an initial overview of the existing deficits even at the patient's bedside. The clinical (bedside) examination of spatial neglect as well as the corresponding differential diagnostic procedure for the clarification of (possibly additionally or exclusively existing) hemianopia and extinction, as well as the examination of disorders of visuospatial perception, visuoconstructive disorders, topographic disorders, Bálint's syndrome, simultanagnosia, and optic ataxia are presented. The presentation is based on the newly revised (year 2023) guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) on this subject area.
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Affiliation(s)
- Britta Stammler
- Zentrum für Neurologie, Sektion für Neuropsychologie, Hertie-Institut für klinische Hirnforschung, Universität Tübingen, 72076, Tübingen, Deutschland
| | - Hannah Rosenzopf
- Zentrum für Neurologie, Sektion für Neuropsychologie, Hertie-Institut für klinische Hirnforschung, Universität Tübingen, 72076, Tübingen, Deutschland
| | - Lisa Röhrig
- Zentrum für Neurologie, Sektion für Neuropsychologie, Hertie-Institut für klinische Hirnforschung, Universität Tübingen, 72076, Tübingen, Deutschland
| | - Stefan Smaczny
- Zentrum für Neurologie, Sektion für Neuropsychologie, Hertie-Institut für klinische Hirnforschung, Universität Tübingen, 72076, Tübingen, Deutschland
| | - Tamara Matuz
- Zentrum für Neurologie, Sektion für Neuropsychologie, Hertie-Institut für klinische Hirnforschung, Universität Tübingen, 72076, Tübingen, Deutschland
| | - Thomas Schenk
- Ludwig-Maximilians-Universität München, Department Psychologie - Neuropsychologie, Leopoldstraße 13, 80802, München, Deutschland
| | - Hans-Otto Karnath
- Zentrum für Neurologie, Sektion für Neuropsychologie, Hertie-Institut für klinische Hirnforschung, Universität Tübingen, 72076, Tübingen, Deutschland.
- Zentrum für Neurologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
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Carter AR, Barrett A. Recent advances in treatment of spatial neglect: networks and neuropsychology. Expert Rev Neurother 2023; 23:587-601. [PMID: 37273197 PMCID: PMC10740348 DOI: 10.1080/14737175.2023.2221788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Spatial neglect remains an underdiagnosed and undertreated consequence of stroke that imposes significant disability. A growing appreciation of brain networks involved in spatial cognition is helping us to develop a mechanistic understanding of different therapies under development. AREAS COVERED This review focuses on neuromodulation of brain networks for the treatment of spatial neglect after stroke, using evidence-based approaches including 1) Cognitive strategies that are more likely to impact frontal lobe executive function networks; 2) Visuomotor adaptation, which may depend on the integrity of parietal and parieto- and subcortical-frontal connections and the presence of a particular subtype of neglect labeled Aiming neglect; 3) Non-invasive brain stimulation that may modulate relative levels of activity of the two hemispheres and depend on corpus callosum connectivity; and 4) Pharmacological modulation that may exert its effect primarily via right-lateralized networks more closely involved in arousal. EXPERT OPINION Despite promising results from individual studies, significant methodological heterogeneity between trials weakened conclusions drawn from meta-analyses. Improved classification of spatial neglect subtypes will benefit research and clinical care. Understanding the brain network mechanisms of different treatments and different types of spatial neglect will make possible a precision medicine treatment approach.
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Affiliation(s)
- Alex R. Carter
- Department of Neurology, Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - A.M. Barrett
- UMass Chan Medical School and UMass Memorial Healthcare, Worcester, MA, USA
- Central Western MA VA Healthcare System, Worcester, MA, USA
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Yasuda K, Takazawa S, Muroi D, Fujimoto Y, Hirano M, Koshino A, Iwata H. Unilateral spatial neglect affected by right-sided stimuli in a three-dimensional virtual environment: A preliminary proof-of-concept study. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083245 DOI: 10.1109/embc40787.2023.10340296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Unilateral spatial neglect (USN) is defined as the inability to attend and see on one side, which seriously interferes with daily life. Clinically, patients with left USN commonly demonstrate a striking immediate capture of attention from ipsilesional, right-sided items as soon as a visual scene unfolds (i.e., magnetic attraction [MA]). Therefore, this preliminary study utilized a three-dimensional (3D) virtual environment to evaluate the effects of eliminating stimuli in the rightward space and directing attention to the left on neglect symptoms. METHODS Seven patients with USN participated in this study, and two types of visual stimuli were created: the numbers and objects in the 3D virtual environment. To eliminate the visual stimuli on the right side, a moving slit was introduced in the virtual environment. During the experiment, patients were required to orally identify each object and number both in moving and nonmoving slit conditions. RESULTS A statistical comparison of scores with and without the moving slit in the 3D virtual space indicated significant changes in the object stimuli condition; however, no statistically significant difference was observed in the number stimuli condition. CONCLUSIONS Masking the right side within the 3D virtual space increased the number of objects that can be recognized on the left side by patients with USN. The results may allow interventions in a virtual reality environment that closely resembles the patient's real-life space.Clinical Relevance-Magnetic attraction is a symptom seen in patients in clinical practice, but there is no method of rehabilitation. The proposed moving slit method is expected to be effective because it enables attention guidance in a three-dimensional space.
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13
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Guilbert A. Clinical assessment of unilateral spatial neglect dissociations and heterogeneities: A narrative synthesis. Neuropsychology 2023; 37:450-462. [PMID: 35797173 DOI: 10.1037/neu0000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Unilateral spatial neglect (USN) is a neuropsychological syndrome whose symptoms differ considerably between patients. Several heterogeneities and dissociations have been described between processing stages, spatial regions, reference frames, or sensory modalities. However, in clinical practice, current routine tests rarely assess the different USN subtypes. There is a real lack of practice guidance for clinicians to help them choosing the right USN assessment tools for specific USN aspects. METHOD The present article is a narrative synthesis based on a systematic literature search of (a) the dissociations and heterogeneities that can appear in USN and of (b) the different clinical tools available for their assessment. RESULTS Several tools have been developed to better assess USN heterogeneities. This review highlights their potential relevance and advocates for their widespread use in a clinical practice context. However, it also raised the issue of the lack of standardized clinical tools for the evaluation of some USN aspects. CONCLUSION While USN heterogeneities and dissociations are difficult to assess in current clinical practice, there is a real need to improve their assessment. This will allow clinicians to establish the individual USN profile of each patient not only in terms of severity but also of impaired aspects in order to provide them the rehabilitation program that suits the best their needs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Alma Guilbert
- Laboratoire Vision Action Cognition (VAC), Universite Paris Cite
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14
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Perez-Marcos D, Ronchi R, Giroux A, Brenet F, Serino A, Tadi T, Blanke O. An immersive virtual reality system for ecological assessment of peripersonal and extrapersonal unilateral spatial neglect. J Neuroeng Rehabil 2023; 20:33. [PMID: 36934277 PMCID: PMC10024837 DOI: 10.1186/s12984-023-01156-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Unilateral spatial neglect (USN) is a debilitating neuropsychological syndrome that often follows brain injury, in particular a stroke affecting the right hemisphere. In current clinical practice, the assessment of neglect is based on old-fashioned paper-and-pencil and behavioral tasks, and sometimes relies on the examiner's subjective judgment. Therefore, there is a need for more exhaustive, objective and ecological assessments of USN. METHODS In this paper, we present two tasks in immersive virtual reality to assess peripersonal and extrapersonal USN. The tasks are designed with several levels of difficulty to increase sensitivity of the assessment. We then validate the feasibility of both assessments in a group of healthy adult participants. RESULTS We report data from a study with a group of neurologically unimpaired participants (N = 39). The results yield positive feedback on comfort, usability and design of the tasks. We propose new objective scores based on participant's performance captured by head gaze and hand position information, including, for instance, time of exploration, moving time towards left/right and time-to-reach, which could be used for the evaluation of the attentional spatial bias with neurological patients. Together with the number of omissions, the new proposed parameters can result in lateralized index ratios as a measure of asymmetry in space exploration. CONCLUSIONS We presented two innovative assessments for USN based on immersive virtual reality, evaluating the far and the near space, using ecological tasks in multimodal, realistic environments. The proposed protocols and objective scores can help distinguish neurological patients with and without USN.
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Affiliation(s)
| | - Roberta Ronchi
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
- Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland.
| | | | | | - Andrea Serino
- MindMaze SA, Lausanne, Switzerland
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- MySpace Lab, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | - Tej Tadi
- MindMaze SA, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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15
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Chen P, Hreha K, Gonzalez-Snyder C, Rich TJ, Gillen RW, Parrott D, Barrett AM. Impacts of Prism Adaptation Treatment on Spatial Neglect and Rehabilitation Outcome: Dosage Matters. Neurorehabil Neural Repair 2022; 36:500-513. [PMID: 35673990 DOI: 10.1177/15459683221107891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined whether number of prism adaptation treatment (PAT) sessions in regular clinical practice would predict spatial neglect (SN) improvement and rehabilitation outcomes. We reviewed clinical records from 16 U.S. rehabilitation hospitals where neurological patients were assessed for SN using the Catherine Bergego Scale (CBS) and if SN was detected, and may have received PAT. Multiple linear regression was used to predict CBS Change (indicating SN improvement) in 520 patients who received PAT while considering age, sex, diagnosis, time post diagnosis, CBS at baseline, neglected side of space, and length of stay. Another set of regression models including the same variables and adding Function Independent Measure (FIM®) at admission was used to predict FIM Gains (indicating rehabilitation outcomes) in 1720 patients receiving PAT or not. We found that greater number of PAT sessions predicted greater CBS Change, especially in patients with moderate-to-severe neglect. Number of PAT sessions also positively correlated with Total FIM, Motor FIM, and Cognitive FIM Gains regardless of SN severity classification at baseline. Furthermore, number of PAT sessions predicted CBS Change and FIM Gains among patients completing ≤8 PAT sessions but not among patients with ≥8 sessions, who however, showed greater CBS Change with increased PAT frequency (i.e., fewer days between two consecutive sessions). Receiving more once-daily PAT sessions predicted greater improvement in SN and rehabilitation outcomes. Receiving PAT at a higher frequency for 8 or more sessions predicted better SN improvement. Thus, dosage matters. The study provides practice-based evidence that PAT is appropriate for inpatient rehabilitation.
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Affiliation(s)
- Peii Chen
- Center for Stroke Rehabilitation Research, 158368Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Division of Occupational Therapy Doctorate, Department of Orthopaedic Surgery, School of Medicine, 12277Duke University, Durham, NC, USA
| | | | - Timothy J Rich
- Center for Stroke Rehabilitation Research, 158368Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Robert W Gillen
- Neuropsychology Department, 21489Sunnyview Rehabilitation Hospital, Schenectady, NY, USA
| | - Devan Parrott
- Research, Training, and Outcome Center for Brain Injury, 24119Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - A M Barrett
- Department of Neurology, 1371Emory University School of Medicine, Atlanta, GA, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Decatur, GA, USA
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Mak J, Kocanaogullari D, Huang X, Kersey J, Shih M, Grattan ES, Skidmore ER, Wittenberg GF, Ostadabbas S, Akcakaya M. Detection of Stroke-Induced Visual Neglect and Target Response Prediction Using Augmented Reality and Electroencephalography. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1840-1850. [PMID: 35786558 DOI: 10.1109/tnsre.2022.3188184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We aim to build a system incorporating electroencephalography (EEG) and augmented reality (AR) that is capable of identifying the presence of visual spatial neglect (SN) and mapping the estimated neglected visual field. An EEG-based brain-computer interface (BCI) was used to identify those spatiospectral features that best detect participants with SN among stroke survivors using their EEG responses to ipsilesional and contralesional visual stimuli. Frontal-central delta and alpha, frontal-parietal theta, Fp1 beta, and left frontal gamma were found to be important features for neglect detection. Additionally, temporal analysis of the responses shows that the proposed model is accurate in detecting potentially neglected targets. These targets were predicted using common spatial patterns as the feature extraction algorithm and regularized discriminant analysis combined with kernel density estimation for classification. With our preliminary results, our system shows promise for reliably detecting the presence of SN and predicting visual target responses in stroke patients with SN.
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Akatsuka T, Yasuda K, Sabu R, Kawaguchi S, Iwata H. A Proposal for a New Index to Quantify the Ratio of Near and Far Spatial Neglect Using Immersive Virtual Reality Technology: A Technical Report. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:4151-4154. [PMID: 36086512 DOI: 10.1109/embc48229.2022.9871683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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18
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Takazawa S, Yasuda K, Sabu R, Kawaguchi S, Iwata H. Quantification of Unilateral Spatial Neglect Symptoms Based on Identification of Exploratory Ability. IEEE Int Conf Rehabil Robot 2022; 2022:1-5. [PMID: 36176126 DOI: 10.1109/icorr55369.2022.9896489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Unilateral spatial neglect (USN) is the failure to report, respond, or orient to novel or meaningful stimuli presented on the side opposite a brain lesion. In our previous study, we reported that the ability of patients with USN to perform when the neck was fixed (called cognitive ability) was different from that when the neck was not fixed (called exploratory ability). However, the exploratory ability index has not been clarified, and cognitive and exploratory abilities have not been quantified. Thus, in this study, we identified neck movement as an exploratory ability index for patients with USN. Furthermore, we proposed equations to quantify cognitive and exploratory abilities and suggested that these equations can be used to understand patients' neglect symptoms in more detail. These findings revealed that the two evaluations of cognitive and exploratory abilities are crucial in USN evaluation and are key to individualizing intervention for each patient.
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Franceschiello B, Noto TD, Bourgeois A, Murray MM, Minier A, Pouget P, Richiardi J, Bartolomeo P, Anselmi F. Machine learning algorithms on eye tracking trajectories to classify patients with spatial neglect. Comput Methods Programs Biomed 2022; 221:106929. [PMID: 35675721 DOI: 10.1016/j.cmpb.2022.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Eye-movement trajectories are rich behavioral data, providing a window on how the brain processes information. We address the challenge of characterizing signs of visuo-spatial neglect from saccadic eye trajectories recorded in brain-damaged patients with spatial neglect as well as in healthy controls during a visual search task. METHODS We establish a standardized pre-processing pipeline adaptable to other task-based eye-tracker measurements. We use traditional machine learning algorithms together with deep convolutional networks (both 1D and 2D) to automatically analyze eye trajectories. RESULTS Our top-performing machine learning models classified neglect patients vs. healthy individuals with an Area Under the ROC curve (AUC) ranging from 0.83 to 0.86. Moreover, the 1D convolutional neural network scores correlated with the degree of severity of neglect behavior as estimated with standardized paper-and-pencil tests and with the integrity of white matter tracts measured from Diffusion Tensor Imaging (DTI). Interestingly, the latter showed a clear correlation with the third branch of the superior longitudinal fasciculus (SLF), especially damaged in neglect. CONCLUSIONS The study introduces new methods for both the pre-processing and the classification of eye-movement trajectories in patients with neglect syndrome. The proposed methods can likely be applied to other types of neurological diseases opening the possibility of new computer-aided, precise, sensitive and non-invasive diagnostic tools.
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Affiliation(s)
- Benedetta Franceschiello
- The LINE (Laboratory for Investigative Neurophysiology), Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.; CIBM Center for Biomedical Imaging, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; The Sense Innovation and Research Center, Lausanne and Sion, Switzerland; School of Engineering, Institute of Systems Engineering, HES-SO Valais-Wallis, Route de L'industrie 23, Sion, Switzerland
| | - Tommaso Di Noto
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexia Bourgeois
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Micah M Murray
- The LINE (Laboratory for Investigative Neurophysiology), Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.; Department of Ophthalmology, Fondation Asile des Aveugles and University of Lausanne, Lausanne, Switzerland; CIBM Center for Biomedical Imaging, Lausanne, Switzerland; Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA; The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Astrid Minier
- The LINE (Laboratory for Investigative Neurophysiology), Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.; Department of Ophthalmology, Fondation Asile des Aveugles and University of Lausanne, Lausanne, Switzerland
| | - Pierre Pouget
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Universite, Inserm, CNRS, Institut du Cerveau - Paris Brain Institute, ICM, Hopital de la Pitie-Salpetriere, Paris, France
| | - Fabio Anselmi
- Center for Neuroscience and Artificial Intelligence, Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA; Center for Brains, Minds, and Machines, McGovern Institute for Brain Research at MIT, Cambridge, MA, USA.
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Wang D, Casares S, Eilers K, Hitchcock S, Iverson R, Lahn E, Loux M, Schnetzer C, Frey-Law LA. Assessing Multisensory Sensitivity Across Scales: Using the Resulting Core Factors to Create the Multisensory Amplification Scale. J Pain 2022; 23:276-288. [PMID: 34461307 PMCID: PMC11065416 DOI: 10.1016/j.jpain.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
Multisensory sensitivity (MSS), observed in some chronic pain patients, may reflect a generalized central nervous system sensitivity. While several surveys measure aspects of MSS, there remains no gold standard. We explored the underlying constructs of 4 MSS-related surveys (80 items in total) using factor analyses using REDCap surveys (N = 614, 58.7% with pain). Four core- and 6 associated-MSS factors were identified from the items assessed. None of these surveys addressed all major sensory systems and most included additional related constructs. A revised version of the Somatosensory Amplification Scale was developed, encompassing 5 core MSS systems: vision, hearing, smell, tactile, and internal bodily sensations: the 12-item Multisensory Amplification Scale (MSAS). The MSAS demonstrated good internal consistency (alpha = 0.82), test-retest reliability (ICC3,1 = 0.90), and construct validity in the original and in a new, separate cohort (R = 0.54-0.79, P < .0001). Further, the odds of having pain were 2-3.5 times higher in the highest sex-specific MSAS quartile relative to the lowest MSAS quartile, after adjusting for age, sex, BMI, and pain schema (P < .03). The MSAS provides a psychometrically comprehensive, brief, and promising tool for measuring the core-dimensions of MSS. PERSPECTIVE: Multiple multisensory sensitivity (MSS) tools are used, but without exploration of their underlying domains. We found several measures lacking core MSS domains, thus we modified an existing scale to encompass 5 core MSS domains: light, smell, sound, tactile, and internal bodily sensations using only 12 items, with good psychometric properties.
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Affiliation(s)
- Dan Wang
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Sabrina Casares
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Karen Eilers
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Shannon Hitchcock
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ryan Iverson
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ethan Lahn
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Megan Loux
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Colton Schnetzer
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
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Barrett AM. Spatial Neglect and Anosognosia After Right Brain Stroke. Continuum (Minneap Minn) 2021; 27:1624-1645. [PMID: 34881729 DOI: 10.1212/con.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke. RECENT FINDINGS Stroke and occupational therapy practice guidelines stress a quality standard for spatial neglect assessment and treatment to reduce adverse outcomes for patients, their families, and society. Neurologists may attribute poor outcomes associated with spatial neglect to stroke severity. However, people with spatial neglect are half as likely to return to home and community, have one-third the community mobility, and require 3 times as much caregiver supervision compared with similar stroke survivors. Multiple randomized trials support a feasible first-line rehabilitation approach for spatial neglect: prism adaptation therapy; more than 20 studies reported that this treatment improves daily life independence. Evidence-based treatment of anosognosia is not as developed; however, treatment for this problem is also available. SUMMARY This article guides neurologists' assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.
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Kocanaogullari D, Huang X, Mak J, Shih M, Skidmore E, Wittenberg GF, Ostadabbas S, Akcakaya M. Fine-tuning and Personalization of EEG-based Neglect Detection in Stroke Patients. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:1096-1099. [PMID: 34891478 DOI: 10.1109/embc46164.2021.9630794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Spatial neglect (SN) is a neurological disorder that causes inattention to visual stimuli in the contralesional visual field, stemming from unilateral brain injury such as stroke. The current gold standard method of SN assessment, the conventional Behavioral Inattention Test (BIT-C), is highly variable and inconsistent in its results. In our previous work, we built an augmented reality (AR)-based BCI to overcome the limitations of the BIT-C and classified between neglected and non-neglected targets with high accuracy. Our previous approach included personalization of the neglect detection classifier but the process required rigorous retraining from scratch and time-consuming feature selection for each participant. Future steps of our work will require rapid personalization of the neglect classifier; therefore, in this paper, we investigate fine-tuning of a neural network model to hasten the personalization process.
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Abstract
BACKGROUND Sensorimotor abnormalities precede and predict the onset of psychosis. Despite the practical utility of sensorimotor abnormalities for early identification, prediction, and individualized medicine applications, there is currently no dedicated self-report instrument designed to capture these important behaviors. The current study assessed and validated a questionnaire designed for use in individuals at clinical high-risk for psychosis (CHR). METHODS The current study included both exploratory (n = 3009) and validation (n = 439) analytic datasets-that included individuals identified as meeting criteria for a CHR syndrome (n = 84)-who completed the novel Sensorimotor Abnormalities and Psychosis-Risk (SMAP-R) Scale, clinical interviews and a finger-tapping task. The structure of the scale and reliability of items were consistent across 2 analytic datasets. The resulting scales were assessed for discriminant validity across CHR, community sample non-psychiatric volunteer, and clinical groups. RESULTS The scale showed a consistent structure across 2 analytic datasets subscale structure. The resultant subscale structure was consistent with conceptual models of sensorimotor pathology in psychosis (coordination and dyskinesia) in both the exploratory and the validation analytic dataset. Further, these subscales showed discriminant, predictive, and convergent validity. The sensorimotor abnormality scales discriminated CHR from community sample non-psychiatric controls and clinical samples. Finally, these subscales predicted to risk calculator scores and showed convergent validity with sensorimotor performance on a finger-tapping task. CONCLUSION The SMAP-R scale demonstrated good internal, discriminant, predictive, and convergent validity, and subscales mapped on to conceptually relevant sensorimotor circuits. Features of the scale may facilitate widespread incorporation of sensorimotor screening into psychosis-risk research and practice.
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Affiliation(s)
- Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL
| | | | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL
- Department of Psychiatry, Northwestern University, Chicago, IL
- Medical Social Sciences, Northwestern University, Chicago, IL
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL
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Kim TL, Kim K, Choi C, Lee JY, Shin JH. FOPR test: a virtual reality-based technique to assess field of perception and field of regard in hemispatial neglect. J Neuroeng Rehabil 2021; 18:39. [PMID: 33602254 PMCID: PMC7890954 DOI: 10.1186/s12984-021-00835-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We previously proposed a novel virtual reality-based method to assess human field of perception (FOP) and field of regard (FOR), termed the FOPR test. This study assessed the diagnostic validity of the FOPR test for hemispatial neglect (HSN). METHODS We included 19 stroke patients with a lesion in the right hemisphere and with HSN (HSN+SS), 22 stroke patients with a lesion in the right hemisphere and without HSN (HSN-SS), and 22 healthy controls aged 19-65 years. The success rate (SR) and response time (RT) in the FOPR test for both FOP and FOR were assessed (FOP-SR, FOR-SR, FOP-RT, and FOR-RT, respectively). Using a Bland-Altman plot, agreements between the FOPR test and conventional tests were confirmed, and the FOPR test accuracy was verified using the support vector machine (SVM). Measured values were analysed using ANOVA and Kruskall-Wallis tests for group comparison. RESULTS The Bland-Altman plot showed good agreement between FOPR test and conventional tests; individuals within 95% agreement limits were within the range of 94.8-100.0%. The SVM classification accuracy, using FOP and FOR variables from the left hemispace, ranged from 83.3 to 100.0% in a binary classification (HSN vs non-HSN). The FOPR test demonstrated differences in SR and RT for both FOP and FOR across the groups. CONCLUSION The FOPR test was valid for the HSN diagnosis and provided quantitative and intuitive information regarding visuospatial function. Furthermore, it might enhance our understanding of visuospatial function including HSN by applying the time relative component and concepts of perception and exploration, FOP and FOR. TRIAL REGISTRATION NCT03463122. Registered 13 March 2018, retrospectively registered.
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Affiliation(s)
- Tae-Lim Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Kwanguk Kim
- Department of Computer Science, Hanyang University, Seoul, Republic of Korea
| | - Changyeol Choi
- Department of Computer Science, Hanyang University, Seoul, Republic of Korea
| | - Ji-Yeong Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea.
- Department of Neurorehabilitation, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea.
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kocanaogullari D, Mak J, Kersey J, Khalaf A, Ostadabbas S, Wittenberg G, Skidmore E, Akcakaya M. EEG-based Neglect Detection for Stroke Patients. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:264-267. [PMID: 33017979 DOI: 10.1109/embc44109.2020.9176378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spatial neglect (SN) is a neurological syndrome in stroke patients, commonly due to unilateral brain injury. It results in inattention to stimuli in the contralesional visual field. The current gold standard for SN assessment is the behavioral inattention test (BIT). BIT includes a series of penand-paper tests. These tests can be unreliable due to high variablility in subtest performances; they are limited in their ability to measure the extent of neglect, and they do not assess the patients in a realistic and dynamic environment. In this paper, we present an electroencephalography (EEG)-based brain-computer interface (BCI) that utilizes the Starry Night Test to overcome the limitations of the traditional SN assessment tests. Our overall goal with the implementation of this EEG-based Starry Night neglect detection system is to provide a more detailed assessment of SN. Specifically, to detect the presence of SN and its severity. To achieve this goal, as an initial step, we utilize a convolutional neural network (CNN) based model to analyze EEG data and accordingly propose a neglect detection method to distinguish between stroke patients without neglect and stroke patients with neglect.Clinical relevance-The proposed EEG-based BCI can be used to detect neglect in stroke patients with high accuracy, specificity and sensitivity. Further research will additionally allow for an estimation of a patient's field of view (FOV) for more detailed assessment of neglect.
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Wajuihian SO. Correlations between clinical measures and symptoms: Report 1: Stereoacuity with accommodative, vergence measures, and symptoms. J Optom 2020; 13:171-184. [PMID: 32475793 PMCID: PMC7301208 DOI: 10.1016/j.optom.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
AIM The aim of this study was to explore associations between reduced stereoacuity and clinical measures of accommodation, vergences, and symptoms which could facilitate the development of quick and reliable screening tools. METHODS Using a multi-stage random cluster sampling, 1211 high school students (481 males and 730 females) between 13 and 18 years of age, were selected and examined. Visual acuity, stereoacuity and suppression, refractive errors, near point of convergence, heterophoria and fusional vergences, as well as, amplitude of accommodation, accommodative response, facility and relative accommodation were evaluated. Correlations among variables and the validity of Randot stereoacuity to distinguish between children with and without defective clinical measures as well as symptomatic versus asymptomatic children were characterized by the sensitivity and specificity of the tests. RESULTS The overall mean stereoacuity was 43.9 ± 25.23 s arc, and 18.9% [95% Confidence Interval, 16.6-21.4%)] of the participants had reduced stereoacuity (defined as ≥60). Stereoacuity values and symptoms scores were worse in children with defective clinical measures. The Receiver Operation Curve showed that maximum sensitivity and specificity was obtained with near point of convergence break (≥10 cm) of (0.70 95% confidence interval: 0.63-0.77) with Randot stereoacuity test (defined as ≥60 s arc). The correlations between reduced stereoacuity and symptoms scores was moderately strong and statistically significant (Pearson's, r = 0.507, p = 0.01). The Receiver Operation Curve showed that maximum sensitivity and specificity obtained with the Convergence Insufficiency Symptoms Survey was 0.57 (95% Confidence interval = 0.53-0.62, p = 0.001), sensitivity of 90.26%, and specificity 15.26% with the Randot stereoacuity test. CONCLUSION Reduced stereoacuity, defective clinical measures and symptoms of asthenopia were prevalent among sample of school children studied. Randot stereoacuity test could fairly distinguish between defective and normal clinical measures; though the accuracy to differentiate between symptomatic and asymptomatic school children is poor. These findings highlight the need for validation of a simple and fast screening tool in school settings. Further studies to confirm above findings will be needed.
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Affiliation(s)
- Samuel Otabor Wajuihian
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa.
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28
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Shepherd AJ, Patterson AJK. Exploration of anomalous perceptual experiences in migraine between attacks using the Cardiff Anomalous Perceptions Scale. Conscious Cogn 2020; 82:102945. [PMID: 32422548 DOI: 10.1016/j.concog.2020.102945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/04/2023]
Abstract
Distortions in sensory experiences that precede a migraine attack have been extensively documented, the most well-known being the visual aura. Distortions in the experience of other senses are also reported as part of an aura, albeit less frequently, together with changes in the perception or ownership of the body or body parts. There are many examples of differences in aspects of visual perception between migraine and control groups, between attacks, but not as much on unusual experiences involving other senses, the sense of the body or the experience of the environment. Seventy-seven migraine (33 with aura) and 74 control participants took part. Anomalous perceptions were experienced by both migraine and control groups, but more with migraine experienced them and rated them as more distressing, intrusive and frequent. Associations with reports of visual triggers of migraine and visual discomfort are presented. This study is the first to show relationships between these factors.
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Affiliation(s)
- Alex J Shepherd
- Department of Psychological Sciences, Birkbeck College, University of London, UK.
| | - Adam J K Patterson
- Department of Psychological Sciences, Birkbeck College, University of London, UK
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29
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Loas G. Visual-spatial processing and dimensions of schizophrenia: a preliminary study on 62 schizophrenic subjects. Eur Psychiatry 2020; 19:370-3. [PMID: 15363477 DOI: 10.1016/j.eurpsy.2004.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Revised: 03/16/2004] [Accepted: 03/16/2004] [Indexed: 11/22/2022] Open
Abstract
AbstractThe aim of the study was to explore the relationships between the performance in figure-ground segregation and the clinical dimensions in schizophrenia. Sixty-two schizophrenic subjects filled out the embedded figures test (EFT) and the schizophrenic symptomatology was rated using the brief psychiatric rating scale (BPRS). The BPRS items were grouped into four categories: positive, negative, general and disorganization. The results showed in male schizophrenics negative and significant correlations between EFT scores and negative or disorganization subscales. Taken into account that in schizotypic subjects EFT scores was negatively correlated with negative dimension of schizotypy we suggested that those relationship could constitute a trait of the disease.
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Affiliation(s)
- Gwenolé Loas
- University Department of Psychiatry, Hopital Pinel, 80044 Amiens, cedex 1, France.
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30
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Mahlberg R, Kienast T, Bschor T, Adli M. Evaluation of time memory in acutely depressed patients, manic patients, and healthy controls using a time reproduction task. Eur Psychiatry 2020; 23:430-3. [PMID: 18515048 DOI: 10.1016/j.eurpsy.2007.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 06/25/2007] [Accepted: 07/01/2007] [Indexed: 11/30/2022] Open
Abstract
AbstractPatients with affective disorders have often been reported to experience subjective changes in how they perceive the flow of time. Time reproduction tasks provide information about the memory component of time perception and are thought to remain unaffected by pulse rate disturbances in the pacemaker of the internal clock.In our study, 30 patients with acute depression, 30 patients with acute mania, and 30 healthy subjects of all age groups were presented with a time reproduction task. Participants were asked to observe a stimulus presented on a computer screen for a certain length of time and, subsequently, to reproduce the stimulus for a similar length of time by pressing the space bar on the computer keyboard. Stimuli were presented to each subject for 1, 6, and 37 s.On average, the time intervals reproduced by manic patients were shorter than those reproduced by depressed patients. Manic patients reproduced the short time interval (6 s) correctly, but under-reproduced the long time interval (37 s, P < 0.001). Depressed patients correctly reproduced the long time interval, but over-reproduced the short time interval (P < 0.001).Remembering time intervals as having been longer than they actually were may lead to a slowed experience of time, as has been described in depressed patients; precisely the converse seems to apply to manic patients.
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Affiliation(s)
- Richard Mahlberg
- Institute of Psychogerontology, Naegelsbachstr. 25, D-91052 Erlangen, Germany.
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31
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Espiard ML, Lecardeur L, Abadie P, Halbecq I, Dollfus S. Hallucinogen persisting perception disorder after psilocybin consumption: a case study. Eur Psychiatry 2020; 20:458-60. [PMID: 15963699 DOI: 10.1016/j.eurpsy.2005.04.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 04/20/2005] [Indexed: 11/25/2022] Open
Abstract
AbstractThe recurrence of flashbacks without acute or chronic hallucinogen consumption has been recognized in the DSM IV criteria as the hallucinogen persisting perception disorder (HPPD). Perceptual disturbances may last for 5 years or more and represent a real psychosocial distress. We reported here a case of a 18-year-old young man presenting HPPD after a mixed intoxication with psylocibin and cannabis. This report shows symptomatic recurrences persisting more than 8 months. Various differential diagnoses were evoked and our therapeutic strategies were described.
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Affiliation(s)
- Marie-Laure Espiard
- Centre Esquirol, Centre Hospitalier Universitaire de Caen, 14033 Caen cedex, France
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32
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Pirondini E, Goldshuv-Ezra N, Zinger N, Britz J, Soroker N, Deouell LY, Ville DVD. Resting-state EEG topographies: Reliable and sensitive signatures of unilateral spatial neglect. Neuroimage Clin 2020; 26:102237. [PMID: 32199285 PMCID: PMC7083886 DOI: 10.1016/j.nicl.2020.102237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
Theoretical advances in the neurosciences are leading to the development of an increasing number of proposed interventions for the enhancement of functional recovery after brain damage. Integration of these novel approaches in clinical practice depends on the availability of reliable, simple, and sensitive biomarkers of impairment level and extent of recovery, to enable an informed clinical-decision process. However, the neuropsychological tests currently in use do not tap into the complex neural re-organization process that occurs after brain insult and its modulation by treatment. Here we show that topographical analysis of resting-state electroencephalography (rsEEG) patterns using singular value decomposition (SVD) could be used to capture these processes. In two groups of subacute stroke patients, we show reliable detection of deviant neurophysiological patterns over repeated measurement sessions on separate days. These patterns generalized across patients groups. Additionally, they maintained a significant association with ipsilesional attention bias, discriminating patients with spatial neglect of different severity levels. The sensitivity and reliability of these rsEEG topographical analyses support their use as a tool for monitoring natural and treatment-induced recovery in the rehabilitation process.
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Affiliation(s)
- Elvira Pirondini
- Institute of Bioengineering/Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
| | - Nurit Goldshuv-Ezra
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel; Evoked Potentials Laboratory, Technion - Israel Institute of Technology, Haifa, Israel
| | - Nofya Zinger
- Department of Psychology and Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, Israel
| | - Juliane Britz
- Department of Psychology and Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg 1700, Switzerland
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leon Y Deouell
- Department of Psychology and Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, Israel.
| | - Dimitri Van De Ville
- Institute of Bioengineering/Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
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Morishima R, Bandoh M, Sunami Y, Isozaki E. [Progressive supranuclear palsy-Richardson syndrome with visual attention disturbance (Holmes and Horrax) and ataxie optique (Garcin): a case report]. Rinsho Shinkeigaku 2019; 59:730-735. [PMID: 31656263 DOI: 10.5692/clinicalneurol.cn-001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
[Background] Supranuclear extraorbital muscle palsy is the core feature of progressive supranuclear palsy (PSP), and ordinarily presents as spontaneous vertical gaze constriction. However, higher visual function associated with visuospatial cognition in PSP patients was not previously considered. [Case presentation] We present a 72-year old right-handed man with PSP- Richardson syndrome (PSP-RS) and abnormal higher visual function. His symptoms began 2 years previously and included the use of small steps while walking, forgetfulness, and postural instability. Neurological examination revealed supranuclear vertical gaze limitation, akinesia, and lead-pipe rigidity without laterality. Neuro-ophthalmological examination showed abnormal ocular movement consistent with PSP, and no visual abnormality was observed. General cognitive functions, including attention and prominent visuospatial orientation and visual attention disturbances, were assessed using neuropsychological tests and concomitant spatial agraphia and impaired configuration using figure copying. Although he presented with mildly decreased and monotonous speech with palilalia, he showed no apparent aphasia, apraxia, visual object agnosia, or Bálint's 'optische Ataxie' i.e. visual ataxia under fixation. Brain MRI revealed atrophy of the mesencephalic tegmentum, bilateral frontal lobe, and bilateral hippocampus. N-isopropyl-p-(iodine-123)-iodoamphetamine single photon emission computed tomography revealed decreased cerebral blood flow in the bilateral frontal lobe, lateral temporal lobe, and basal ganglia. Dopamine transporter single photon emission CT revealed uptake attenuation in the bilateral striatum. 123I-metaiodobenzyl-guanidine myocardium scintigraphy results were normal. [Discussion] The patient's symptoms indicated classical PSP-RS accompanied with a combination of disturbances in spatial orientation and visual attention as noted by Holmes and Horrax and 'ataxie optique' by Garcin. Thus, as observed in this patient, many clinically diagnosed PSP patients with undiagnosed higher visual dysfunction, masked by limited eye movement may exist. These symptoms may further our understanding about posterior cortical atrophy and tauopathy including not only PSP but also corticobasal syndrome and Alzheimer disease.
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Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Mitsuaki Bandoh
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Yoko Sunami
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
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Prasad S, Dinkin M. Higher Cortical Visual Disorders. Continuum (Minneap Minn) 2019; 25:1329-1361. [PMID: 31584540 DOI: 10.1212/con.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the disorders that result from disruption of extrastriate regions of the cerebral cortex responsible for higher visual processing. For each disorder, a historical perspective is offered and relevant neuroscientific studies are reviewed. RECENT FINDINGS Careful analysis of the consequences of lesions that disrupt visual functions such as facial recognition and written language processing has improved understanding of the role of key regions in these networks. In addition, modern imaging techniques have built upon prior lesion studies to further elucidate the functions of these cortical areas. For example, functional MRI (fMRI) has identified and characterized the response properties of ventral regions that contribute to object recognition and dorsal regions that subserve motion perception and visuospatial attention. Newer network-based functional imaging studies have shed light on the mechanisms behind various causes of spontaneous visual hallucinations. SUMMARY Understanding the regions and neural networks responsible for higher-order visual function helps the practicing neurologist to diagnose and manage associated disorders of visual processing and to identify and treat responsible underlying disease.
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Abstract
Amblyopia is a neurodevelopmental disorder of the visual system, as a result of discordant visual experience during infancy or early childhood. Because amblyopia is typically defined as monocularly reduced visual acuity accompanied by one or more known amblyogenic factors, it is often assumed that the fellow eye is normal and sufficient for tasks like reading and eye-hand coordination. Recent scientific evidence of ocular motor, visual, and visuomotor deficits that are present with fellow eye monocular viewing and with binocular viewing calls this assumption into question. This clinical update reviews the research that has revealed fellow ocular motor and visual deficits and the effect that these deficits have on an amblyopic child's visuomotor and visuocognitive skills. We need to understand how to prevent and rehabilitate the effects of amblyopia not only on the nonpreferred eye but also on the fellow eye.
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Affiliation(s)
- Eileen E Birch
- Crystal Charity Ball Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, TX, USA
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 11 USA
| | - Krista R Kelly
- Crystal Charity Ball Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, TX, USA
| | - Deborah E Giaschi
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
PURPOSE OF REVIEW Spatial neglect is asymmetric orienting and action after a brain lesion, causing functional disability. It is common after a stroke; however, it is vastly underdocumented and undertreated. This article addresses the implementation gap in identifying and treating spatial neglect, to reduce disability and improve healthcare costs and burden. RECENT FINDINGS Professional organizations published recommendations to implement spatial neglect care. Physicians can lead an interdisciplinary team: functionally relevant spatial neglect assessment, evidence-based spatial retraining, and integrated spatial and vision interventions can optimize outcomes. Research also strongly suggests spatial neglect adversely affects motor systems. Spatial neglect therapy might thus "kick-start" rehabilitation and improve paralysis recovery. Clinicians can implement new techniques to detect spatial neglect and lead interdisciplinary teams to promote better, integrated spatial neglect care. Future studies of brain imaging biomarkers to detect spatial neglect, and real-world applicability of prism adaptation treatment, are needed.
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Affiliation(s)
- A M Barrett
- Stroke Rehabilitation Research, Kessler Foundation, East Hanover, NJ, USA.
| | - K E Houston
- Harvard Medical School, Department of Ophthalmology, Spaulding Rehabilitation Hospital, Boston, MA, USA
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Hill NJ, Mooney SWJ, Ryklin EB, Prusky GT. Shady: A software engine for real-time visual stimulus manipulation. J Neurosci Methods 2019; 320:79-86. [PMID: 30946876 DOI: 10.1016/j.jneumeth.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Precise definition, rendering and manipulation of visual stimuli are essential in neuroscience. Rather than implementing these tasks from scratch, scientists benefit greatly from using reusable software routines from freely available toolboxes. Existing toolboxes work well when the operating system and hardware are painstakingly optimized, but may be less suited to applications that require multi-tasking (for example, closed-loop systems that involve real-time acquisition and processing of signals). NEW METHOD We introduce a new cross-platform visual stimulus toolbox called Shady (https://pypi.org/project/Shady)-so called because of its heavy reliance on a shader program to perform parallel pixel processing on a computer's graphics processor. It was designed with an emphasis on performance robustness in multi-tasking applications under unforgiving conditions. For optimal timing performance, the CPU drawing management commands are carried out by a compiled binary engine. For configuring stimuli and controlling their changes over time, Shady provides a programmer's interface in Python, a powerful, accessible and widely-used high-level programming language. RESULTS Our timing benchmark results illustrate that Shady's hybrid compiled/interpreted architecture requires less time to complete drawing operations, exhibits smaller variability in frame-to-frame timing, and hence drops fewer frames, than pure-Python solutions under matched conditions of resource contention. This performance gain comes despite an expansion of functionality (e.g. "noisy-bit" dithering as standard on all pixels and all frames, to enhance effective dynamic range) relative to previous offerings. CONCLUSIONS Shady simultaneously advances the functionality and performance available to scientists for rendering visual stimuli and manipulating them in real time.
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Affiliation(s)
- N Jeremy Hill
- Burke Neurological Institute, White Plains, NY, USA; Blythedale Children's Hospital, Valhalla, NY, USA.
| | - Scott W J Mooney
- Burke Neurological Institute, White Plains, NY, USA; Blythedale Children's Hospital, Valhalla, NY, USA
| | | | - Glen T Prusky
- Burke Neurological Institute, White Plains, NY, USA; Blythedale Children's Hospital, Valhalla, NY, USA; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
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Wadhwa A, Bajaj BK, Pandey S. Assessment of visual misperceptions in patients with Parkinson's disease using single and bistable percepts as testing tools. Neurol India 2019; 67:123-128. [PMID: 30860109 DOI: 10.4103/0028-3886.253587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Visual misperceptions (VMs) and hallucinations (VHs) often go unreported in patients with Parkinson's disease (PD). We assessed the utility of single and bistable visual percepts as testing tools for visual perceptual abnormalities in PD. AIM To assess VM in patients with PD using single and bistable percepts as testing tools. SETTINGS AND DESIGN This was a case-control study conducted at a movement disorders clinic. MATERIALS AND METHODS Thirty patients with PD and 30 age and sex-matched controls were assessed for motor severity and stage using Unified Parkinson's Disease Rating Scale-III (UPDRS-III) and modified Hoehn and Yahr scale. Higher mental functions were assessed by Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Trail making tests (TMT-A and B) scores. The participants were presented with monochromatic images representing either "single" or "bistable percepts" and the misperceptions were recorded. VM scores of patients and controls were compared. The correlation between disease duration, treatment period, motor severity, frontal executive functions, and VMs were determined. RESULTS Twenty-six patients had mild-to-moderate PD. Patients with PD had higher mean VM scores (P < 0.0005). None of the patients reported VHs. TMT-A, TMT-B, TMT-B - A scores were significantly lower in the control group (P < 0.0005). Cases showed significant positive correlation of VM with disease duration, treatment duration, UPDRS-III score, H and Y stage, and TMT A and B and an inverse correlation with MMSE and FAB scores. The patients with VM score greater than the upper limit of normal (Mean + 1.5 standard deviation [SD]), calculated from the control group, showed similar correlation of VM with motor and cognitive parameters. CONCLUSIONS VMs are frequent in patients with PD when assessed using single and bistable visual percepts. VM correlates with frontal executive dysfunction, disease duration, and severity.
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Affiliation(s)
- Ankur Wadhwa
- Department of Neurology, PGIMER and Dr. RML Hospital, New Delhi, India
| | - Bhupender K Bajaj
- Department of Neurology, PGIMER and Dr. RML Hospital, New Delhi, India
| | - Shweta Pandey
- Department of Neurology, PGIMER and Dr. RML Hospital, New Delhi, India
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Kawamura M, Miller MW. History of Amusia. Front Neurol Neurosci 2019; 44:83-88. [PMID: 31220839 DOI: 10.1159/000494955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 03/25/2023]
Abstract
We live in a world surrounded by sound. Throughout life, we are exposed to music: from lullabies and songs taught at school to instrumental music both heard and played for pleasure. Every nation, along with its own language, has unique forms of music and dance. "Music knows no boundaries," as the saying goes. Just as language impairment is known as "aphasia," impairment of the perception of music is called "amusia." In this article, we will first classify the types of amusia. This will be followed by an introduction to the classical research of Salomon Eberhard Henschen (1847-1930), and to a discussion of higher auditory functions in which we highlight cases of amusia encountered in a person and through the literature.
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Affiliation(s)
| | - Michael W Miller
- Medical Research Communications Program, The University of Tokyo Postgraduate School of Medicine, Tokyo, Japan
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Quaia C, FitzGibbon EJ, Optican LM, Cumming BG. Binocular Summation for Reflexive Eye Movements: A Potential Diagnostic Tool for Stereodeficiencies. Invest Ophthalmol Vis Sci 2018; 59:5816-5822. [PMID: 30521669 PMCID: PMC6284466 DOI: 10.1167/iovs.18-24520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Stereoscopic vision, by detecting interocular correlations, enhances depth perception. Stereodeficiencies often emerge during the first months of life, and left untreated can lead to severe loss of visual acuity in one eye and/or strabismus. Early treatment results in much better outcomes, yet diagnostic tests for infants are cumbersome and not widely available. We asked whether reflexive eye movements, which in principle can be recorded even in infants, can be used to identify stereodeficiencies. Methods Reflexive ocular following eye movements induced by fast drifting noise stimuli were recorded in 10 adult human participants (5 with normal stereoacuity, 5 stereodeficient). To manipulate interocular correlation, the stimuli shown to the two eyes were either identical, different, or had opposite contrast. Monocular presentations were also interleaved. The participants were asked to passively fixate the screen. Results In the participants with normal stereoacuity, the responses to binocular identical stimuli were significantly larger than those induced by binocular opposite stimuli. In the stereodeficient participants the responses were indistinguishable. Despite the small size of ocular following responses, 40 trials, corresponding to less than 2 minutes of testing, were sufficient to reliably differentiate normal from stereodeficient participants. Conclusions Ocular-following eye movements, because of their reliance on cortical neurons sensitive to interocular correlations, are affected by stereodeficiencies. Because these eye movements can be recorded noninvasively and with minimal participant cooperation, they can potentially be measured even in infants and might thus provide an useful screening tool for this currently underserved population.
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Affiliation(s)
- Christian Quaia
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States
| | - Edmond J FitzGibbon
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States
| | - Lance M Optican
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States
| | - Bruce G Cumming
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States
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Puig-Pijoan A, Giralt-Steinhauer E, Zabalza de Torres A, Manero Borràs RM, Sánchez-Benavides G, García Escobar G, Pérez Enríquez C, Gómez-González A, Ois Á, Rodríguez-Campello A, Cuadrado-Godía E, Jiménez-Conde J, Peña-Casanova J, Roquer J. Underdiagnosis of Unilateral Spatial Neglect in stroke unit. Acta Neurol Scand 2018; 138:441-446. [PMID: 30058181 DOI: 10.1111/ane.12998] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/16/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Unilateral spatial neglect (USN) is the incapacity to respond to stimuli presented opposite to a dysfunctional cerebral hemisphere. It is usually caused by non-dominant hemisphere lesions, leads to poorer prognosis and might be underdiagnosed. The objectives of the study were to ascertain the presence of USN in acute stroke patients and analyze the possible degree of underdiagnosis in a Stroke Unit. MATERIALS AND METHODS Prospective study of consecutive non-dominant hemisphere stroke patients within a period of 21 months. "Line Bisection" and "Triangles Cancellation" tests were used for USN screening and "Circle Gap Detection Task" to confirm the USN. The results were compared with routine Stroke Unit assessment using the NIHSS to determine the possible degree of underdiagnosis. RESULTS A total of 62 subjects, 38 women (61.29%), mean age of 74.05 (SD 10.5) years, were included. USN was diagnosed in 25 cases (40.3%) but 56% of them were not detected in routine evaluation using the NIHSS. CONCLUSIONS Unilateral spatial neglect, a common cognitive deficit after acute stroke, is greatly underdiagnosed in routine Stroke Unit assessment. The use of simple USN-specific screening tools would improve diagnosis and therefore the possibility of implementing appropriate rehabilitation strategies.
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Affiliation(s)
- Albert Puig-Pijoan
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Eva Giralt-Steinhauer
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rosa Maria Manero Borràs
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Greta García Escobar
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Carmen Pérez Enríquez
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Alejandra Gómez-González
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
| | - Ángel Ois
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Rodríguez-Campello
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godía
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Jiménez-Conde
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Peña-Casanova
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurofunctionality and Language Group, Neurosciences Program, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Neurovascular Research Unit, Department of Neurology, IMIM-Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Pitteri M, Chen P, Passarini L, Albanese S, Meneghello F, Barrett AM. Conventional and functional assessment of spatial neglect: Clinical practice suggestions. Neuropsychology 2018; 32:835-842. [PMID: 29975073 PMCID: PMC6188804 DOI: 10.1037/neu0000469] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Spatial neglect (SN) constitutes a substantial barrier to functional recovery after acquired brain injury. However, because of its multimodal nature, no single test can capture all the signs of SN. To provide a clinically feasible solution, we used conventional neuropsychological tests as well as the Catherine Bergego Scale (CBS) via the Kessler Foundation Neglect Assessment Process (KF-NAP). The goal was to add evidence that a global approach should detect better even subtle signs of SN. METHOD Fourteen individuals with lesions located in the right cerebral hemisphere participated in the study. Participants were assessed with a comprehensive battery of neuropsychological tests, comprising a set of visuospatial tests to evaluate several spatial domains. In addition, patients underwent functional assessment with the Barthel Index, the Functional Independence Measure (FIM), and the CBS via KF-NAP. RESULTS The CBS via KF-NAP was associated with the visuospatial paper-based tests (p = .004) as well as the Motor FIM (p = .003), and was more sensitive than the Behavioral Inattention Test-Conventional in detecting SN (p = .014). CONCLUSIONS We showed that the CBS via KF-NAP was able: (a) to detect functional impairment, especially motor, related to SN; (b) to selectively measures spatial rather than nonspatial dysfunctions; and (c) to be highly sensitive in detecting SN signs especially in those patients with mild severity, covering several aspects of SN manifestations. The patient's SN diagnosis based on the CBS via KF-NAP is clinically important and directly relevant to care planning and goal setting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona
| | | | - Laura Passarini
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital Foundation
| | - Silvia Albanese
- Laboratory of Neuropsychology, IRCCS San Camillo Hospital Foundation
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Kashiwagi FT, El Dib R, Gomaa H, Gawish N, Suzumura EA, da Silva TR, Winckler FC, de Souza JT, Conforto AB, Luvizutto GJ, Bazan R. Noninvasive Brain Stimulations for Unilateral Spatial Neglect after Stroke: A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Controlled Trials. Neural Plast 2018; 2018:1638763. [PMID: 30050569 PMCID: PMC6046134 DOI: 10.1155/2018/1638763] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Unilateral spatial neglect (USN) is the most frequent perceptual disorder after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve perception and functional capacity. Objective To assess the impact of NIBS on USN after stroke. Methods An extensive search was conducted up to July 2016. Studies were selected if they were controlled and noncontrolled trials examining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS) in USN after stroke, with outcomes measured by standardized USN and functional tests. Results Twelve RCTs (273 participants) and 4 non-RCTs (94 participants) proved eligible. We observed a benefit in overall USN measured by the line bisection test with NIBS in comparison to sham (SMD -2.35, 95% CI -3.72, -0.98; p = 0.0001); the rTMS yielded results that were consistent with the overall meta-analysis (SMD -2.82, 95% CI -3.66, -1.98; p = 0.09). The rTMS compared with sham also suggested a benefit in overall USN measured by Motor-Free Visual Perception Test at both 1 Hz (SMD 1.46, 95% CI 0.73, 2.20; p < 0.0001) and 10 Hz (SMD 1.19, 95% CI 0.48, 1.89; p = 0.54). There was also a benefit in overall USN measured by Albert's test and the line crossing test with 1 Hz rTMS compared to sham (SMD 2.04, 95% CI 1.14, 2.95; p < 0.0001). Conclusions The results suggest a benefit of NIBS on overall USN, and we conclude that rTMS is more efficacious compared to sham for USN after stroke.
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Affiliation(s)
- Flávio Taira Kashiwagi
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Regina El Dib
- Science and Technology Institute, Universidade Estadual Paulista (UNESP), São José dos Campos, SP, Brazil
| | - Huda Gomaa
- Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
| | - Nermeen Gawish
- Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
| | | | - Taís Regina da Silva
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Fernanda Cristina Winckler
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Juli Thomaz de Souza
- Science and Technology Institute, Universidade Estadual Paulista (UNESP), São José dos Campos, SP, Brazil
| | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Rodrigo Bazan
- Neurology Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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Abstract
Some individuals with superior memory, such as the mnemonist Shereshevskii (Luria, 1968), are known to have synaesthesia. However, the extent to which superior memory is a general characteristic of synaesthesia is unknown, as is the precise cognitive mechanism by which synaesthesia affects memory. This study demonstrates that synaesthetes tend to report subjectively better than average memory and that these reports are borne out with objective testing. Synaesthetes experiencing colours for words show better memory than matched controls for stimuli that induce synaesthesia (word lists) relative to stimuli that do not (an abstract figure). However, memory advantages are not limited to material that elicits synaesthesia because synaesthetes demonstrate enhanced memory for colour per se (which does not induce a synaesthetic response). Our results suggest that the memory enhancement found in synaesthetes is related to an enhanced retention of colour in both synaesthetic and nonsynaesthetic situations. Furthermore, this may account for the fact that synaesthetic associations, once formed, remain highly consistent.
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Raza SA, Frankel MR, Rangaraju S. Abbreviation of the Follow-Up NIH Stroke Scale Using Factor Analysis. Cerebrovasc Dis Extra 2017; 7:120-129. [PMID: 28968607 PMCID: PMC5730111 DOI: 10.1159/000479933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/22/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The NIH Stroke Scale (NIHSS) is a 15-item measure of stroke-related neurologic deficits that, when measured at 24 h, is highly predictive of long-term functional outcome. We hypothesized that a simplified 24-h scale that incorporates the most predictive components of the NIHSS can retain prognostic accuracy and have improved interrater reliability. METHODS In a post hoc analysis of the Interventional Management of Stroke-3 (IMS-3) trial, we performed principal component (PC) analysis to resolve the 24-h NIHSS into PCs. In the PCs that explained the largest proportions of variance, key variables were identified. Using these key variables, the prognostic accuracies (area under the curve [AUC]) for good outcome (3-month modified Rankin Scale [mRS] 0-2) and poor outcome (mRS 5-6) of various abbreviated NIHSS iterations were compared with the total 24-h NIHSS. The results were validated in the NINDS intravenous tissue plasminogen activator (NINDS-TPA) study cohort. Based on previously published data, interrater reliability of the abbreviated 24-h NIHSS (aNIHSS) was compared to the total 24-h NIHSS. RESULTS In 545 IMS-3 participants, 2 PCs explained 60.8% of variance in the 24-h NIHSS. The key variables in PC1 included neglect, arm and leg weakness; while PC2 included level-of-consciousness (LOC) questions, LOC commands, and aphasia. A 3-variable aNIHSS (aphasia, neglect, arm weakness) retained excellent prognostic accuracy for good outcome (AUC = 0.90) as compared to the total 24-h NIHSS (AUC = 0.91), and it was more predictive (p < 0.001) than the baseline NIHSS (AUC = 0.73). The prognostic accuracy of the aNIHSS for good outcome was validated in the NINDS-TPA trial cohort (aNIHSS: AUC = 0.89 vs. total 24-h NIHSS: 0.92). An aNIHSS >9 predicted very poor outcomes (mRS 0-2: 0%, mRS 4-6: 98.5%). The estimated interrater reliability of the aNIHSS was higher than that of the total 24-h NIHSS across 6 published datasets (mean weighted kappa 0.80 vs. 0.73, p < 0.001). CONCLUSIONS At 24 h following ischemic stroke, aphasia, neglect, and arm weakness are the most prognostically relevant neurologic findings. The aNIHSS appears to have excellent prognostic accuracy with higher reliability and may be clinically useful.
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Affiliation(s)
| | | | - Srikant Rangaraju
- *Srikant Rangaraju, Department of Neurology, Emory University, Suite 505B, 615 Michael Street, Whitehead Research Building, Decatur, GA 30322 (USA), E-Mail
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Leyland LA, Godwin HJ, Benson V, Liversedge SP. Neglect Patients Exhibit Egocentric or Allocentric Neglect for the Same Stimulus Contingent upon Task Demands. Sci Rep 2017; 7:1941. [PMID: 28512354 PMCID: PMC5434059 DOI: 10.1038/s41598-017-02047-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/10/2017] [Indexed: 11/08/2022] Open
Abstract
Hemispatial Neglect (HN) is a failure to allocate attention to a region of space opposite to where damage has occurred in the brain, usually the left side of space. It is widely documented that there are two types of neglect: egocentric neglect (neglect of information falling on the individual's left side) and allocentric neglect (neglect of the left side of each object, regardless of the position of that object in relation to the individual). We set out to address whether neglect presentation could be modified from egocentric to allocentric through manipulating the task demands whilst keeping the physical stimulus constant by measuring the eye movement behaviour of a single group of neglect patients engaged in two different tasks (copying and tracing). Eye movements and behavioural data demonstrated that patients exhibited symptoms consistent with egocentric neglect in one task (tracing), and allocentric neglect in another task (copying), suggesting that task requirements may influence the nature of the neglect symptoms produced by the same individual. Different task demands may be able to explain differential neglect symptoms in some individuals.
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Affiliation(s)
- Louise-Ann Leyland
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights Campus, Reading, RG6 7BE, UK.
| | - Hayward J Godwin
- School of Psychology, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Valerie Benson
- School of Psychology, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Simon P Liversedge
- School of Psychology, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
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Gilaie-Dotan S, Doron R. Developmental visual perception deficits with no indications of prosopagnosia in a child with abnormal eye movements. Neuropsychologia 2017; 100:64-78. [PMID: 28400326 DOI: 10.1016/j.neuropsychologia.2017.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 11/19/2022]
Abstract
Visual categories are associated with eccentricity biases in high-order visual cortex: Faces and reading with foveally-biased regions, while common objects and space with mid- and peripherally-biased regions. As face perception and reading are among the most challenging human visual skills, and are often regarded as the peak achievements of a distributed neural network supporting common objects perception, it is unclear why objects, which also rely on foveal vision to be processed, are associated with mid-peripheral rather than with a foveal bias. Here, we studied BN, a 9 y.o. boy who has normal basic-level vision, abnormal (limited) oculomotor pursuit and saccades, and shows developmental object and contour integration deficits but with no indication of prosopagnosia. Although we cannot infer causation from the data presented here, we suggest that normal pursuit and saccades could be critical for the development of contour integration and object perception. While faces and perhaps reading, when fixated upon, take up a small portion of central visual field and require only small eye movements to be properly processed, common objects typically prevail in mid-peripheral visual field and rely on longer-distance voluntary eye movements as saccades to be brought to fixation. While retinal information feeds into early visual cortex in an eccentricity orderly manner, we hypothesize that propagation of non-foveal information to mid and high-order visual cortex critically relies on circuitry involving eye movements. Limited or atypical eye movements, as in the case of BN, may hinder normal information flow to mid-eccentricity biased high-order visual cortex, adversely affecting its development and consequently inducing visual perceptual deficits predominantly for categories associated with these regions.
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Affiliation(s)
- Sharon Gilaie-Dotan
- Department of Optometry and Visual Science, Bar Ilan University, Ramat Gan, Israel; UCL Institute of Cognitive Neuroscience, London, UK.
| | - Ravid Doron
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel; Goldschleger Eye Research Institute, Sackler Faculty of Medicine, Tel-A viv University, Tel-Hashomer, Israel
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Abstract
There are indications that subjects with schizotypal personality have a lower Body Mass Index. Also schizotypal personality is linked to a higher incidence of paranormal belief. In this study we examined whether low Body Mass Index is also linked to paranormal belief. In a pilot study 48 students of psychology (85.4% women) between the ages of 20 and 27 years were administered a questionnaire assessing weight, height, and paranormal belief. Analysis suggested an association between belief in paranormal phenomena and low Body Mass Index. In a follow-up study with 300 subjects and equal sex distribution, the relationship was examined under control of schizotypy. The results for Body Mass Index could not be confirmed; however, paranormal belief was heavily associated with the cognitive-perceptual component of schizotypy.
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Affiliation(s)
- Andreas Hergovich
- Department of Psychological Basic Research, Faculty of Psychology, The University in Vienna, Austria.
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Abstract
People with sequence-space synesthesia (SSS) report stable visuo-spatial forms corresponding to numbers, days, and months (amongst others). This type of synesthesia has intrigued scientists for over 130 years but the lack of an agreed upon tool for assessing it has held back research on this phenomenon. The present study builds on previous tests by measuring the consistency of spatial locations that is known to discriminate controls from synesthetes. We document, for the first time, the sensitivity and specificity of such a test and suggest a diagnostic cut-off point for discriminating between the groups based on the area bounded by different placement attempts with the same item.
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Affiliation(s)
- Nicolas Rothen
- School of Psychology and Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - Kristin Jünemann
- School of Psychology and Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - Andy D Mealor
- School of Psychology and Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - Vera Burckhardt
- School of Psychology and Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - Jamie Ward
- School of Psychology and Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.
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50
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Luvizutto GJ, Fogaroli MO, Theotonio RM, de Carvalho Nunes HR, de Lima Resende LA, Bazan R. Standardization of the face-hand test in a Brazilian multicultural population: prevalence of sensory extinction and implications for neurological diagnosis. Clinics (Sao Paulo) 2016; 71:720-724. [PMID: 28076517 PMCID: PMC5175293 DOI: 10.6061/clinics/2016(12)08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/07/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE: The face-hand test is a simple, practical, and rapid test to detect neurological syndromes. However, it has not previously been assessed in a Brazilian sample; therefore, the objective of the present study was to standardize the face-hand test for use in the multi-cultural population of Brazil and identify the sociodemographic factors affecting the results. METHODS: This was a cross sectional study of 150 individuals. The sociodemographic variables that were collected included age, gender, race, body mass index and years of education. Standardization of the face-hand test occurred in 2 rounds of 10 sensory stimuli, with the participant seated to support the trunk and their vision obstructed in a sound-controlled environment. The face-hand test was conducted by applying 2 rounds of 10 sensory stimuli that were applied to the face and hand simultaneously. The associations between the face-hand test and sociodemographic variables were analyzed using Mann-Whitney tests and Spearman correlations. Binomial models were adjusted for the number of face-hand test variations, and ROC curves evaluated sensitivity and specificity of sensory extinction. RESULTS: There was no significant relationship between the sociodemographic variables and the number of stimuli perceived for the face-hand test. There was a high relative frequency of detection, 8 out of 10 stimuli, in this population. Sensory extinction was 25.3%, which increased with increasing age (OR=1.4[1:01-1:07]; p=0.006) and decreased significantly with increasing education (OR=0.82[0.71-0.94]; p=0.005). CONCLUSION: In the Brazilian population, a normal face-hand test score ranges between 8-10 stimuli, and the results indicate that sensory extinction is associated with increased age and lower levels of education.
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Affiliation(s)
- Gustavo José Luvizutto
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Neuro reabilitação, Botucatu/SP, Brazil
| | - Marcelo Ortolani Fogaroli
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Estudante de Medicina, Botucatu/SP, Brazil
| | - Rodolfo Mazeto Theotonio
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Estudante de Medicina, Botucatu/SP, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Saúde Pública, Botucatu/SP, Brazil
| | - Luiz Antônio de Lima Resende
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento Neurologia, Psicologia e Psiquiatria, Botucatu/SP, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento Neurologia, Psicologia e Psiquiatria, Botucatu/SP, Brazil
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