Articolo Riabilitazione del neglect

Virtual Environment Training System for Rehabilitation of Stroke Patients with Unilateral Neglect: Crossing the Virtual Street.
By: Jaehun Kim; Kwanguk Kim; Deog Young Kim; Won Hyek Chang; Chang-Il Park; Suk Hoon Ohn; Kiwan Han; Jeonghun Ku; Sang Won Nam; In Young Kim; Kim, Sun I.. CyberPsychology & Behavior, Feb2007, Vol. 10 Issue 1, p7-15, 9p, 3 charts, 3 diagrams, 2 graphs, 5 bw Abstract: In this paper, we propose a system for training of stroke patients with unilateral neglect by using technology of virtual reality (VR). The proposed system is designed to compensate for unilateral neglect. This system contains the calibration of unilateral neglect and the training of this disease. The calibration procedure is implemented by aligning the virtual object at a subjective middle line. The training procedure is implemented by completing the missions that are used to keep the virtual avatar safe during crossing the street in a virtual environment. The results of this study show that the proposed system is effective to train unilateral neglect. The left to right ratio scores extracted from this system gradually decrease as the sessions of training are repeated. To validate the VR system parameters, the parameters are analyzed by correlation with those of traditional unilateral neglect assessment methods (such as the line bisection test and the cancellation test). [ABSTRACT FROM AUTHOR] DOI: 10.1089/cpb.2006.9998 (AN 24075369)

Recovery from hemiparesis and unilateral spatial neglect after neonatal stroke. Case report and rehabilitation of an infant.
By: Bollea, Larissa; Rosa, Giuseppe Di; Gisondi, Antonio; Guidi, Patrizia; Petrarca, Maurizio; Giannarelli, Paola; Castelli, Enrico. Brain Injury, Jan2007, Vol. 21 Issue 1, p81-91, 11p Abstract: Primary objective: To report rehabilitation of neglect in a child through task contexts. Methods and procedures: A 7-month-old boy with hemiparesis and neglect following neonatal stroke was evaluated with standard assessments during the first year of intervention. The intervention included timely training of each upper limb's movement (reaching, grasping, lifting, rotating, releasing, etc.), balance training and Constraint-Induced Movement Therapy (CIMT). We promoted the storing of spatial representation through enriched environment by meaningful sensory inputs engaging spatial localization/orientation and eye movements. Main outcomes: During intervention the child developed reaching and grasping and other new motor behaviours (holding, releasing, lifting, rotating, transferring, pulling, manipulating objects, gesturing, self-feeding, walking). In parallel he also exhibited a decrease of neglect. Conclusion: Infants with stroke should be routinely checked for neglect. Especially those with hemiparesis and neglect challenge the rehabilitation team for the complexity of the treatment directly focused on addressing integration at more conscious levels of upper limb paresis and neglect. [ABSTRACT FROM AUTHOR] DOI: 10.1080/02699050601148882 (AN 24155122)

Visual restoration in cortical blindness: Insights from natural and TMS-induced blindsight.
By: Ro, Tony; Rafal, Robert. Neuropsychological Rehabilitation, Aug2006, Vol. 16 Issue 4, p377-396, 19p, 2 diagrams, 1 graph Abstract: Unilateral damage to visual cortex of the parietal or occipital lobe can cause the patient to be unaware of contralesional visual information due to either hemispatial neglect or hemianopia. It is now known that both neglect and hemianopia result from the disruption of a dynamic interaction between cortical visual pathways and more phylogenetically primitive visual pathways to the midbrain. We consider the therapeutic implications of these cortical–subcortical interactions in the rehabilitation of hemianopia. We start with the pheonmenon of “blindsight”, in which patients with hemianopia can be shown, by implicit measures of visual detection or discrimination, to process visual information without conscious awareness. Some variants of blindsight have been postulated to recruit subcortical processes, while others may reflect compensatory optimisation of processing of spared visual cortex. Both mechanisms may offer opportunities for innovative strategies for rehabilitation of visual field defects. We relate the neural mechanisms that have been proposed to underlie blindsight to those that have been suggested to underlie the recovery of visual function after rehabilitation. It is suggested that the similarity and overlap of the neural processes supporting blindsight and recovery of visual function might provide insights for effective rehabilitation strategies for restoring visual functions. [ABSTRACT FROM AUTHOR] DOI: 10.1080/09602010500435989 (AN 21808501)

Motor neglect: Implications for movement and rehabilitation following stroke.
By: Punt, T.; Riddoch, M.. Disability & Rehabilitation, Jul2006, Vol. 28 Issue 13/14, p857-864, 8p, 1 graph, 1 bw Abstract: Purpose . The syndrome of unilateral neglect following stroke is associated with poor outcome and presents significant challenges to those providing therapy for affected individuals. In contrast to a number of reviews which have recently appeared in therapy and rehabilitation journals relating to sensory aspects of neglect, this review focuses on ‘motor neglect’. Search strategy . We searched the clinical and scientific literature for papers concerning motor neglect. The search included the databases Web of Science, Pubmed and Cinahl, primarily using the term ‘motor neglect’. There was also a large degree of secondary searching involved. Discussion . Motor neglect refers to the under-utilization of a limb opposite a brain lesion that cannot be fully explained by primary sensory and motor deficits. The paper discusses classical descriptions of motor neglect and highlights the difficulties in disentangling motor neglect from hemiparesis. The related problem of motor extinction is introduced as a useful clinical measure of neglect-related movement difficulties and a significant clinical problem in its own right. Conclusion . Motor neglect is a relatively under-recognized deficit which may have a significant impact on patient performance and recovery following stroke. We conclude with a discussion of the implications of motor neglect for rehabilitation, including the relative contributions that may be made by Constraint-induced movement therapy and Bilateral movement therapy in managing patients with neglect-related movement problems. [ABSTRACT FROM AUTHOR] DOI: 10.1080/09638280500535025 (AN 21194216)

Enhancing Visuomotor Adaptation by Reducing Error Signals: Single-step (Aware) versus Multiple-step (Unaware) Exposure to Wedge Prisms.
By: Michel, Carine; Pisella, Laure; Prablanc, Claude; Rode, Gilles; Rossetti, Yves. Journal of Cognitive Neuroscience, Feb2007, Vol. 19 Issue 2, p341-350, 10p Abstract: Neglect patients exhibit both a lack of awareness for the spatial distortions imposed during visuomanual prism adaptation procedures, and exaggerated postadaptation negative after-effects. To better understand this unexpected adaptive capacity in brain-lesioned patients, we investigated the contribution of awareness for the optical shift to the development of prism adaptation. The lack of awareness found in neglect was simulated in a multiple-step group where healthy subjects remained unaware of the optical deviation because of its progressive stepwise increase from 2° to 10°. We contrasted this method with the classical single-step group in which subjects were aware of the visual shift because they were directly exposed to the full 10° shift. Because the number of pointing trials was identical in the two groups, the total amount of deviation exposure was 50% larger in the single-step group. Negative after-effects were examined with an open-loop pointing task performed with the adapted hand, and generalization was tested with open-loop pointing with the nonexposed hand to visual and auditory targets. The robustness of adaptation was assessed by an open-loop pointing task after a simple deadaptation procedure. The progressive, unaware condition was associated with larger negative after-effects, transfer to the nonexposed hand for the visual and auditory pointing tasks, and greater robustness. The amount of adaptation obtained remained, nevertheless, lower than the exaggerated adaptive capacity seen in patients with neglect. Implications for the functional mechanisms and the anatomical substrates of prism adaptation are discussed. [ABSTRACT FROM AUTHOR] (AN 24378203)

Action errors and dressing disability after stroke: An ecological approach to neuropsychological assessment and intervention.
By: Sunderland, Alan; Walker, Christina M.; Walker, Marion F.. Neuropsychological Rehabilitation, Dec2006, Vol. 16 Issue 6, p666-683, 18p, 3 charts, 2 graphs Abstract: A combination of detailed observation of dressing behaviour and neuropsychological assessment was used to identify the cognitive barriers to independent dressing in a series of eight stroke patients. For those with right hemisphere damage, dressing was disrupted by visuospatial problems or poor sustained attention. Those with left hemisphere damage and ideomotor apraxia were unable to learn the correct procedure to compensate for hemiparesis when dressing. The value of a therapeutic approach based on these observations was assessed in a single-blind randomised multiple-baseline experiment. A baseline phase of conventional dressing therapy which takes no account of individual patterns of cognitive impairment was contrasted with an approach which was formulated for each case. A permutation test demonstrated that there was a significant treatment effect for the right hemisphere cases but there was no therapy-related improvement for those with left or bilateral damage and apraxia. Observation of a naturalistic but controlled task (dressing with a standard item of clothing) appears to allow greater insight into the impact of specific neuropsychological deficits than has been found for more complex naturalistic tasks. The benefits of this ecological approach over conventional approaches to dressing therapy need to be evaluated further in a randomised clinical trial. [ABSTRACT FROM AUTHOR] DOI: 10.1080/09602010500204385 (AN 23220283)

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Guglielmo