Posts Tagged visuospatial neglect

[Abstract] Computer-Based Cognitive Rehabilitation in Patients with Visuospatial Neglect or Homonymous Hemianopia after Stroke

Abstract

Objectives: The purpose of this pilot study was to investigate the feasibility and effects of computer-based cognitive rehabilitation (CBCR) in patients with symptoms of visuospatial neglect or homonymous hemianopia in the subacute phase following stroke.

Method: A randomized, controlled, unblinded cross-over design was completed with early versus late CBCR including 7 patients in the early intervention group (EI) and 7 patients in the late intervention group (LI). EI received CBCR training immediately after inclusion (m = 19 days after stroke onset) for 3 weeks and LI waited for 3 weeks after inclusion before receiving CBCR training for 3 weeks (m = 44 days after stroke onset).

Results: CBCR improved visuospatial symptoms after stroke significantly when administered early in the subacute phase after stroke. The same significant effect was not found when CBCR was administered later in the rehabilitation. The difference in the development of the EI and LI groups during the first 3 weeks was not significant, which could be due to a lack of statistical power. CBCR did not impact mental well-being negatively in any of the groups. In the LI group, the anticipation of CBCR seemed to have a positive impact of mental well-being.

Conclusion: CBCR is feasible and has a positive effect on symptoms in patients with visuospatial symptoms in the subacute phase after stroke. The study was small and confirmation in larger samples with blinded outcome assessors is needed.

via Computer-Based Cognitive Rehabilitation in Patients with Visuospatial Neglect or Homonymous Hemianopia after Stroke – ScienceDirect

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[REVIEW] Spatial neglect – Full Text HTML

Abstract

The syndrome of visuospatial neglect is a common consequence of unilateral brain injury. It is most often associated with stroke and is more severe and persistent following right hemisphere damage, with reported frequencies in the acute stage of up to 80%. Neglect is primarily a disorder of attention whereby patients characteristically fail to orientate, to report or to respond to stimuli located on the contralesional side. Neglect is usually caused by large strokes in the middle cerebral artery territory and is heterogeneous, such that most patients do not manifest every feature of the syndrome. A number of treatments may improve neglect, but there is no widely accepted universal approach to therapy. Although most patients recover spontaneously, the evidence suggests that they continue to have significant cognitive impairments, particularly relating to attention.

Introduction

The syndrome of spatial neglect is relatively common. Several pathological processes may cause it, including neurodegenerative disease,1 ,2 neoplasia3 and trauma,4 although it is most common in the context of hemispheric stroke.5 Because of its implications for the understanding of the perception and representation of space, neglect has been of considerable interest to neuroscientists, psychologists and philosophers.6–8 However, it is also very important to clinicians as it may profoundly affect recovery from stroke; indeed,Figure 2 neglect’s negative effects on rehabilitation outcome may be even greater than those of hemiplegia.9 ,10 Neglect may follow right hemisphere stroke in up to 82% of patients5 in the acute stage, but most studies describe rates closer to 50%.11

The terms unilateral neglect, hemineglect and spatial neglect are used interchangeably. They are generally defined as an inability to perceive, report and orient to sensory events towards one side of space, contralateral to the side of the lesion, with or without a primary sensory deficit.12 Neglect is more common and longer-lasting after right hemisphere stroke, most likely because of the right hemisphere’s key role in attentional processes; thus, most of the discussion below refers to neglect for the left side of space.13

Figure 2

Schematic representation of how a visual scene might appear to people with left homonymous hemianopia (middle panel) and left neglect (bottom panel). Whereas hemianopia obeys the midline and affects only the contralesional visual field, neglect affects parts of the ipsilesional field in addition to the contralesional field, such that there is a lateralised bias of attention towards the side of the lesion.

Continue Full Text HTML —>  Spatial neglect — Li and Malhotra — Practical Neurology.

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[ARTICLE] Abstract – Assessment of visual impairment in stroke survivors

…A novel, tablet-based application (app) has been developed to act as a screening tool for visual impairment in stroke survivors; The Stroke Vision app. The app includes assessments for visual acuity, visual fields and visuospatial neglect, as well as novel tools for the education of patients, carers and staff. The app has been devised by experts in the field to address two important deficiencies; firstly a set of visual assessment tools to support and improve evaluation and rehabilitation of visual impairments in stroke survivors, and secondly to provide education for staff and information to carers about their relatives visual disabilities…

via IEEE Xplore Abstract (Abstract) – Assessment of visual impairment in stroke survivors.

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