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Rehabilitation and management of visual dysfunction following traumatic brain injury
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Groswasser et al.36 reported bilateral visual field defects in 14% of severe TBI patients. Ocular–motor defects in these patients were associated with poor recovery as defined by return to work or school. Bilateral visual field defects were more common in the poor recovery group, but this finding was not significant. A 15-year follow-up study of U.S. Vietnam veterans with penetrating head injuries showed that visual field loss and visual memory loss were negatively correlated with return to work.37 In an assessment of successful versus unsuccessful TBI clients in a supported employment program, Wehman et al.38 evaluated the functional limitations of those clients rated most difficult and least difficult to maintain in employment. The two areas of functional limitations that were significantly different between these groups were visual impairment and fine motor impairment. Najenson et al.39 found that performance on the Raven Matrices Test—which is heavily loaded for visuospatial performance—was highly correlated with successful performance in the rehabilitated TBI patient’s working life. McKenna et al.19 examined the incidence of visual perceptual impairment in patients with severe TBI and found, using the Occupational Therapy Adult Perceptual Screening Test, visual–spatial neglect in 45% of their sample. Visual–spatial neglect is frequently underdiagnosed in the brain injury population as the patient is unaware of the deficit, and it may or may not be concurrent with a motor neglect that cues the clinician into realizing that there is a problem.
Disorders of Sensation, Motion, and Body Schema
Published in Rolland S. Parker, Concussive Brain Trauma, 2016
Unilateral brain lesions may cause spatial neglect, which is considered to be a disorder of spatial attention, that is, profound inability to attend to contralateral personal and extrapersonal space, or hesitancy to initiate movement in contralesional space with or without stimulation. The most profound deficits are observed in right hemisphere lesions in right-handed persons (Nunez, 2002; Reynolds et al. 2003). Neglect of sensory stimulation arising from the limbs or from one side of the body can be attributable to right parietal damage (somesthetic dysfunctioning), although it has also been attributed to the nearby temporal gyrus (Andersen & Buneo, 2002). It is likely to be accompanied by inappropriate euphoria or indifference, patients may fail to perceive left-sided stimuli, and may dress, wash, or groom only the right side of the body, misperceive the side that is being stimulated, and so on (Joseph, 1988).
ENTRIES A–Z
Published in Philip Winn, Dictionary of Biological Psychology, 2003
The neurological syndrome of spatial neglect consists of a group of symptoms which are partially dissociable from each other, and which occur most frequently following a STROKE or other form of brain disease that affects the region surrounding the junction between OCCIPITAL LOBE, TEMPORAL LOBE and PARIETAL LOBE of the RIGHT HEMISPHERE. In most cases, these symptoms recover with days or weeks, but in some cases they persist for long periods. The most striking constituent of the syndrome is often known as HEMISPATIAL NEGLECT, though the terminology is inconsistent. Here the patient will ignore items in the left side of SPACE (whether explored visually or through TOUCH). This failure is not due to BLINDNESS in the left half of the VISUAL FIELD, since that is not always present, and in any case many patients who do have such blindness do not show neglect. The classic demonstrations of Bisiach and his colleagues provide graphic evidence that hemispatial neglect is a rather high-level disorder. For example, an abstract shape passing behind a vertical slit is perceived as a whole by normal observers; and hemispatial neglect patients make errors in recognizing the leftward parts of such shapes. Thus part of a shape can be neglected despite never having appeared as an image on the retina . A more famous example is given by the efforts of hemispatial neglect patients to describe from memory the buildings around the famous Cathedral Square in Milan, from each of two opposite perspectives. They only named buildings on the right side of their imaginary view, even when their viewpoint was reversed by the examiner. It is difficult to understand these high-level neglect phenomena other than as a distortion of, or other form of interference with, representational processes in the brain.
Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke
Published in Neuropsychological Rehabilitation, 2022
Helen Morse, Laura Biggart, Valerie Pomeroy, Stéphanie Rossit
Around 20-40% of the 1.2 million stroke survivors currently living in the UK (Stroke Association, 2018) are estimated to have spatial neglect (Puig-Pijoan et al., 2018; Ringman et al., 2004; Rowe et al., 2019). Spatial neglect is a severe neuropsychological syndrome generally defined as a failure to respond to stimuli on the side of the space opposite to the side of the brain lesion. The clinical impact of spatial neglect is substantial with 40% of people showing neglect symptoms even more than a year post-stroke (Nijboer et al., 2013) and its presence being a major predictor of disability (e.g., Gillen et al., 2005). In line with this, previous research has found that stroke survivors, carers and clinicians identified visual problems as one of the top 10 priorities in stroke research (Pollock et al., 2014). Numerous rehabilitation methods have been developed for spatial neglect (Azouvi et al., 2017; Bowen et al., 2013; Gammeri et al., 2020). These can be divided into bottom-up approaches (e.g., prism adaptation, eye-patching and limb activation training) and top-down approaches (e.g., visual scanning training, sustained attention training and mental practice; Bowen et al., 2013). These methods seem to be chosen above others by experts worldwide to treat spatial neglect (Chen et al., 2018), however there is currently no specific recommended rehabilitation method for the condition due to lack of high-quality clinical trials with significant positive results (Bowen et al., 2013).
Prism adaptation effects in complex regional pain syndrome: A therapo-physiological single case experimental design exploratory report
Published in Neuropsychological Rehabilitation, 2022
A. Foncelle, L. Christophe, P. Revol, L. Havé, S. Jacquin-Courtois, Y. Rossetti, E. Chabanat
One of the most common and disabling features of CRPS is underuse of the affected limb. This feature of the syndrome has been related to motor neglect (Laplane & Degos, 1983), the clinical description of which is hypokinetic, bradykinetic, and hypometric movements of the affected arm (Galer et al., 1995). The use of the term “neglect-like” to qualify these deficits has led to an ever-increasing number of publications speculating on the parallel between spatial neglect following stroke and body representation disturbances in CRPS patients (Acerra et al., 2007; Filippopulos et al., 2015; Förderreuther et al., 2004; Frettlöh et al., 2006; Kolb et al., 2012; Moseley et al., 2009; Reinersmann et al., 2012; Sumitani et al., 2007a). Indeed, spatial neglect includes a variety of symptoms, one of the most striking of which is perceptual neglect, i.e., difficulties detecting, responding to, or orienting attention towards stimuli presented on the contralesional side of space (Legrain et al., 2012; Rode et al., 2017). For example, after a right hemisphere lesion, patients can fail to eat the food on the left side of their plate, to make up or shave the left side of their face, can bump their left arm when passing through doorways, and exhibit less auditory attention to their left side (Jacquin-Courtois et al., 2010). Despite the fact that CRPS patients have no brain lesion and do not usually exhibit such a severe attentional bias, the parallel between these two syndromes has been repeatedly drawn and several publications have investigated perceptual neglect symptoms in CRPS.
Current clinical practice in the screening and diagnosis of spatial neglect post-stroke: Findings from a multidisciplinary international survey
Published in Neuropsychological Rehabilitation, 2021
Matthew Checketts, Mauro Mancuso, Helena Fordell, Peii Chen, Kimberly Hreha, Gail A Eskes, Patrik Vuilleumier, Andy Vail, Audrey Bowen
Spatial neglect is a multifaceted and disabling cognitive syndrome that commonly follows stroke and other brain injury or neurodegenerative disease (Andrade et al., 2010; Bender, 2011). It is clinically characterized as no or insufficient attention especially towards contralesional space, and manifests in many stroke survivors – particularly those with right hemisphere damage (Corbetta & Shulman, 2011; Rode et al., 2017). The academic literature provides distinctions between “subtypes” of spatial neglect, usually depending on the domain and/or the spatial frame(s) in which symptoms manifest (although it is not obvious that this knowledge has translated into routine clinical practice of screening for neglect). One example that describes subtypes of neglect is a study of 166 inpatients and outpatients with right hemisphere stroke, which found that 48% of these patients had spatial neglect (Buxbaum et al., 2004). 1% exhibited signs of personal (i.e., bodily reference frame) neglect, 27% of peripersonal (i.e., visual space within an arm’s reach) neglect, 17% motor neglect, and 21% showed perceptual (i.e., allocentric) neglect. The authors also found that 12 different combinations of subtype signs were present in the sample.