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Hans-otto Karnath - One of the best experts on this subject based on the ideXlab platform.
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The Anatomy Of Spatial Neglect After Posterior Cerebral Artery Stroke
Brain Communications, 2020Co-Authors: Christoph Sperber, Jacob Clausen, Thomas Benke, Hans-otto KarnathAbstract:Abstract Spatial Neglect is a common consequence of stroke in the territory of the right middle cerebral artery. Damage to a perisylvian fronto-temporo-parietal network has been demonstrated to underlie this disorder. Less common, stroke to the posterior cerebral artery territory may also lead to Spatial Neglect. This study aimed to uncover the anatomical underpinnings of Spatial Neglect after posterior cerebral artery infarction. A sample of 50 posterior cerebral artery infarct patients was screened for Spatial Neglect. Neural correlates of Neglect were investigated both with voxel-based lesion behaviour mapping and with region-of-interest analyses. Brain damage neither to the splenium, nor to the parahippocampal gyrus, nor to the thalamus was predictive of Spatial Neglect. Only damage to the perisylvian fronto-temporo-parietal network of Spatial Neglect was significantly associated with Neglect severity. We conclude that both posterior and middle cerebral artery stroke induce Spatial Neglect after damage to the same perisylvian brain network. The findings contradict previous theories that postulated neural correlates of Spatial Neglect specifically supplied by the posterior cerebral artery. In posterior cerebral artery stroke patients, affected parts of this network are located at the border zone between the posterior and middle cerebral artery territories. Inter-individual variability in the localization of the border between both artery territories appears to mediate the occurrence of Spatial Neglect after posterior cerebral artery stroke.
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Spatial attention systems in Spatial Neglect.
Neuropsychologia, 2015Co-Authors: Hans-otto KarnathAbstract:It has been established that processes relating to 'Spatial attention' are implemented at cortical level by goal-directed (top-down) and stimulus-driven (bottom-up) networks. Spatial Neglect in brain-damaged individuals has been interpreted as a distinguished exemplar for a disturbance of these processes. The present paper elaborates this assumption. Functioning of the two attentional networks seem to dissociate in Spatial Neglect; behavioral studies of patients' orienting and exploration behavior point to a disturbed stimulus-driven but preserved goal-directed attention system. When a target suddenly appears somewhere in space, Neglect patients demonstrate disturbed detection and orienting if it is located in contralesional direction. In contrast, if Neglect patients explore a scene with voluntarily, top-down controlled shifts of Spatial attention, they perform movements that are oriented into all Spatial directions without any direction-specific disturbances. The paper thus argues that not the top-down control of Spatial attention itself, rather a body-related matrix on top of which this process is executed, seems affected. In that sense, the traditional role of Spatial Neglect as a stroke model for 'Spatial attention' requires adjustment. Beyond its insights into the human stimulus-driven attentional system, the disorder most notably provides vistas in how our brain encodes topographical information and organizes Spatially oriented action - including the top-down control of Spatial attention - in relation to body position.
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The anatomy underlying acute versus chronic Spatial Neglect: a longitudinal study
Brain, 2010Co-Authors: Hans-otto Karnath, Johannes Rennig, Leif Johannsen, Chris RordenAbstract:Our aim was to examine how brain imaging in the initial phase of a stroke could predict both acute/subacute as well as chronic Spatial Neglect. We present the first voxel-wise longitudinal lesion-behaviour mapping study, examining acute/subacute as well as chronic performance in the same individuals. Acute brain imaging (acquired on average 6.2 days post-injury) was used to evaluate Neglect symptoms at the initial (mean 12.4 days post-stroke) and the chronic (mean 491 days) phase of the stroke. Chronic Neglect was found in about one-third of the patients with acute Neglect. Analysis suggests that lesion of the superior and middle temporal gyri predict both acute/subacute as well as chronic Neglect. At the subcortical level, the basal ganglia as well as the inferior occipitofrontal fasciculus/extreme capsule appear to play a significant role for both acute/subacute as well as chronic Neglect. Beyond, the uncinate fasciculus was critically related to the emergence of chronic Spatial Neglect. We infer that individuals who experience Spatial Neglect in the initial phase of the stroke yet do not have injury to these cortical and subcortical structures are likely to recover, and thus have a favourable prognosis.
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Neuroimaging of eye position reveals Spatial Neglect
Brain, 2010Co-Authors: Elisabeth Becker, Hans-otto KarnathAbstract:Conjugate eye deviation describes the tonic horizontal deviation of the eyes in acute stroke patients. Here we investigate whether measuring patients' eye-in-head position in clinical magnetic resonance imaging or computed tomography scans obtained at admission shows a specific relationship to Spatial Neglect. We investigated 124 continuously admitted subjects with unilateral, first-ever left- or right-sided stroke. To control for the possibility that the degree of eye deviation is related to lesion size rather than Spatial Neglect, overall lesion volume was used as a covariate in the statistical analysis. Horizontal eye-in-head deviation on clinical brain scans appeared to be associated with Spatial Neglect rather than with brain damage per se. In contrast to the subject groups without the disorder, the patients with Spatial Neglect showed an eye-in-head position that was significantly deviated towards the ipsilesional right. Evaluation of eye-in-head position on clinical scans thus may be an additional helpful tool for diagnosing Spatial Neglect, particularly in the very early period of the stroke.
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Damage to White Matter Fiber Tracts in Acute Spatial Neglect
Cerebral cortex (New York N.Y. : 1991), 2009Co-Authors: Hans-otto Karnath, Chris Rorden, Luca Francesco TiciniAbstract:Previous statistical voxelwise lesion-behavior mapping (VLBM) studies have demonstrated that Spatial Neglect is associated with cortical and subcortical gray matter damage. However, it has also been suggested that the disorder may result from white matter injury. Our aim was to investigate the white matter connectivity in a large sample of 140 stroke patients. We combined a VLBM approach with the histological maps of the human white matter fiber tracts provided by the Julich probabilistic cytoarchitectonic atlas. We found that damage of right perisylvian white matter connections—the superior longitudinal fasciculus, the inferior occipitofrontal fasciculus, and the superior occipitofrontal fasciculus—is a typical finding in patients with Spatial Neglect. However, the analysis also revealed that the largest portion of the lesion area, namely between 89.1% and 96.6%, affected brain structures other than the perisylvian white matter fiber tracts. Predominantly, these included gray matter structures such as the superior temporal, inferior parietal, inferior frontal, and insular cortices, as well as subcortically the putamen and the caudate nucleus. Damage of gray matter structures thus appears to be a strong predictor of Spatial Neglect.
Sumio Ishiai - One of the best experts on this subject based on the ideXlab platform.
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Unilateral Spatial Neglect in Alzheimer's disease. A line bisection study.
Acta Neurologica Scandinavica, 2009Co-Authors: Sumio Ishiai, Yasumasa Koyama, Ryoichi Okiyama, Keiko SekiAbstract:Neuropsychological studies on Alzheimer's disease (AD) have rarely mentioned about unilateral Spatial Neglect in spite of widespread use of visuoSpatial tasks. We reported a 62-year-old woman with probable AD who showed moderate dementia with left unilateral Spatial Neglect and relatively preserved language function. An extensive line bisection study with either hand confirmed her having left unilateral Spatial Neglect. Single photon emission computed tomography revealed relative hypoperfusion in the right temporal and parietal regions. AD patients with disproportionate right hemisphere dysfunction may exhibit left unilateral Spatial Neglect if tested adequately in the stage of mild to moderate dementia. We consider that application of the line bisection test to AD patients contributes to estimation of their right hemisphere function.
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Unilateral Spatial Neglect in AD: significance of line bisection performance.
Neurology, 2000Co-Authors: Sumio Ishiai, Yasumasa Koyama, N. Sodeyama, Eisuke Ozawa, Satoshi Orimo, S. Watabiki, M. Takahashi, Keiko Seki, Ryoichi OkiyamaAbstract:Background: Unilateral Spatial Neglect has been rarely reported in patients with AD, although they often have right and left asymmetry of temporoparietal dysfunction. Objective: To investigate if patients with AD would show unilateral Spatial Neglect in the line bisection test, and to reveal the relationship between their Neglect and the area of cerebral dysfunction. Method:— Thirty-two patients with mild to moderate AD and 32 age-matched healthy control subjects underwent an extensive line bisection test. SPECT was also obtained for the patients. Results: Rightward bisection errors exceeded the normal range in 25% of patients with AD. They exhibited greater rightward errors for the longer lines in the left hemispace than in the right hemispace, and with the right hand than with the left hand; this corresponds to the characteristics of Neglect seen after right hemisphere lesions. All patients who bisected 200 mm lines with errors over 10 mm showed disproportionate lowering of performance IQ and asymmetric right hemisphere hypoperfusion, especially in the temporoparietal region. Seventy-five percent of the patients performed normally in the center presentation but erred slightly toward the body midline in the right and left hemispaces. Conclusion: Left unilateral Spatial Neglect in mild to moderate AD may be rather common if tested with the line bisection test. Rightward errors over 10 mm suggest right temporoparietal dysfunction. In AD, three or more bisections of 200 mm lines in the center presentation are recommended for detection of Neglect. Patients with AD but without Neglect may have difficulty in shifting attention into the peripheral sector of the egocentric space.
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Disappearance of unilateral Spatial Neglect following a simple instruction
Journal of neurology neurosurgery and psychiatry, 1997Co-Authors: Sumio Ishiai, Yasumasa Koyama, Keiko Seki, Yorimichi IzumiAbstract:OBJECTIVES—To clarify the reason why patients with left unilateral Spatial Neglect fail to copy the left side of a daisy like flower, not continuing to draw petals all around. METHODS—A flower was simplified and a figure was made that consisted of a large central circle and small circles surrounding it. Four patients with typical left unilateral Spatial Neglect performed copying and arrangement tasks to make this figure. In the arrangement task, they were instructed to arrange small circles all around the printed central circle. RESULTS—The patients' identification of the composition seemed flawless. In the copying task, they showed Neglect, leaving a space on the left side. They seemed to adhere to their plan to place the same number of small circles as those of the model figure. By contrast, Neglect disappeared in the arrangement task. CONCLUSION—Patients with Neglect can draw the figure satisfactorily if they use a Spatial strategy to arrange small circles all around. This strategy seems to improve motivation for drawing and awareness for the left space. It is considered that in the copying of figures such as a daisy, failure to use a Spatial strategy plays an important part in the appearance of left unilateral Spatial Neglect.
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Diverse patterns of performance in copying and severity of unilateral Spatial Neglect
Journal of Neurology, 1996Co-Authors: Keiko Seki, Sumio IshiaiAbstract:We analysed the performances of 69 patients with left unilateral Spatial Neglect in copying a multi-object figure, as well as their performance of the line cancellation and line bisection tests. Three patterns of copying were mainly observed. The first pattern was almost satisfactory performance in copying the central figure with occasional omission of the elements located more laterally to the left. The second pattern was omission of the left half of the whole figure, which was the pattern expected of patients with typical left unilateral Spatial Neglect. The third pattern was left unilateral Spatial Neglect when copying the central figure, with favourable copying of left lateral objects; this may be regarded as “object-centred” Neglect. Performance of the line cancellation test, which requires exploratory ability, was significantly better for the patients with the third pattern than for those with the second pattern. A significant difference was also observed between the two groups of patients in performance of the line bisection test, in which exploratory ability plays a more minor role. No significant difference was found in performance of the line cancellation and line bisection tests between the patients with the third and first patterns, in spite of remarkable differences in their copying performances. No distinctive characteristics were found for any group of patients as regards lesion, age, duration after onset, education, and WAJS scores. Therefore we concluded that in most of our patients with Neglect, these diverse patterns of copying deficits resulted from different levels of Neglect severity but not from different types of unilateral Spatial Neglect.
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Mechanisms of unilateral Spatial Neglect in copying a single object
Neuropsychologia, 1996Co-Authors: Sumio Ishiai, Yasumasa Koyama, Keiko Seki, Tsukasa YokotaAbstract:Abstract The present study examined 13 patients with typical left unilateral Spatial Neglect to explore the mechanisms of Neglect in copying a single object. All patients identified the figure of a sunflower as a flower that had petals all around the central circle. Besides, in the free viewing of the flowers prepared by the examiner, 10 of the 13 patients could discriminate between the presence and absence of the left-sided petals. When copying the flower, however, they always left the left side unfinished without noticing the incompleteness. Whether perception in the left visual field was impaired or not was irrelevant to the performances in the copying and the free viewing of the flowers. We consider the mechanism of left unilateral Spatial Neglect in copying a flower as follows. Small leftward shift of attention may take place during the free observation of the stimulus flower. While copying, however, Neglect patients pay attention exclusively to the right-sided petals they are drawing. The strong engagement of attention to the right side results in the lack of discovery of the left-sided omission. The close integration of attentional and premotor mechanisms seems to be crucial for the appearance of unilateral Spatial Neglect in copying a single object. Copyright © 1996 Elsevier Science Ltd
Anna M. Barrett - One of the best experts on this subject based on the ideXlab platform.
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Update on the Clinical Approach to Spatial Neglect.
Current neurology and neuroscience reports, 2019Co-Authors: Anna M. Barrett, Kevin E. HoustonAbstract: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. 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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The cingulate cortex and Spatial Neglect
Handbook of clinical neurology, 2019Co-Authors: Anna M. Barrett, Andrew Abdou, Meghan D. CaulfieldAbstract:Abstract Spatial Neglect is asymmetric attention, orienting, and action causing functional disability. It is linked to higher-order cortical sensory processing; however, Spatial motor “Aiming” processing is critical to fundamental, adaptive environmental movement and daily life function. The cingulate cortex, in particular the anterior cingulate and anterior midcingulate cortex, is strongly linked to Spatial Aiming deficits and likely to predict daily life disability in Spatial Neglect. The authors review the impact and mechanisms of Spatial Neglect and then describe specific symptoms associated with Spatial Neglect that are theoretically linked to cingulate cortical functions or associated with lesions extending to cingulate regions in a well-characterized Spatial Neglect cohort. The treatment implications for a link between cingulate cortex Spatial Aiming Neglect and therapies that improve Spatial action, arousal, and persistence are discussed. Clinicians may want to consider theoretically motivated treatments targeted at specific symptoms as well as use treatments supported for Spatial Neglect based on unselected and uncharacterized groups.
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Disruption of the ascending arousal system and cortical attention networks in post-stroke delirium and Spatial Neglect.
Neuroscience and biobehavioral reviews, 2017Co-Authors: Olga Boukrina, Anna M. BarrettAbstract:Delirium is an acute attention and cognitive dysfunction, adversely affecting functional outcomes and mortality. As many as half of hospitalized right brain stroke survivors may develop delirium. Further, about 50% of right stroke patients experience Spatial Neglect, impairing safety and recovery. In this review we explore the brain mechanisms, which may explain the high incidence of delirium and Spatial Neglect after right-brain stroke. We suggest that brain networks for Spatial attention and arousal, composed of ascending projections from the midbrain nuclei and integrating dorsal and ventral cortical and limbic components, may underlie impairments in delirium and Spatial Neglect. We propose that lateralized deficits in Spatial Neglect may arise because cortical and limbic components of these functional networks are disproportionally impaired by right-brain strokes, and that Spatial Neglect may lower the threshold for developing delirium. An improved understanding of the brain basis of delirium and Spatial Neglect could provide a critical biomarker for initiating preventive care in stroke patients at high risk of hospital morbidity and loss of independence.
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Which perseverative behaviors are symptoms of Spatial Neglect
Brain and cognition, 2017Co-Authors: Meghan D. Caulfield, Peii Chen, Michele M. Barry, Anna M. BarrettAbstract:Spatial Neglect is a characterized by a failure to attend or make movements towards left-sided stimuli. Common paper-and-pencil tasks to diagnose Spatial Neglect are sensitive to perseverative errors, including additional marks over already cancelled targets and "scribbling" out a target. Here, we examine whether functionally distinct perseverative behaviors are related to Spatial Neglect. Line cancellation tasks of 45 healthy controls and 220 right-hemisphere stroke survivors were examined for recurrent marks (RM) and continuous marks (CM) perseverations. We found that RM perseveration correlated with Neglect severity, while CM perseveration did not. Examination of lesion profiles for the two groups indicated distinct anatomical correlates, with RM lesions overlapping regions implicated in Spatial Neglect including the rolandic operculum, superior temporal gyrus, and inferior parietal lobule.
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Impact of Spatial Neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility.
Archives of physical medicine and rehabilitation, 2015Co-Authors: Peii Chen, Kimberly Hreha, Yekyung Kong, Anna M. BarrettAbstract:Abstract Objective To examine the impact of Spatial Neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Design Inception cohort. Setting Inpatient rehabilitation facility (IRF). Participants Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of Spatial Neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP). Interventions Usual and standard IRF care. Main Outcome Measures The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition. Results The greater the severity of Spatial Neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of Spatial Neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with Spatial Neglect fell 6.5 times more often than those without symptoms. More severe Neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took Spatial Neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. Conclusions Spatial Neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS.
Marianne Dieterich - One of the best experts on this subject based on the ideXlab platform.
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Spatial Neglect a vestibular disorder
Brain, 2006Co-Authors: Hans-otto Karnath, Marianne DieterichAbstract:The phenomenon of Spatial Neglect after right brain damage greatly helps our understanding of the normal mechanisms of directing and maintaining Spatial attention, of Spatial orientation, and the characteristics of neural representation of space. The intriguing symptom is a spontaneous orientation bias towards the right leading to Neglect of objects or persons on the left. Interestingly, we observe similar symptoms namely a spontaneous bias of eyes and head along the horizontal dimension of space in patients with unilateral vestibular dysfunction. Further similarities concern anatomical findings. Both Spatial Neglect and vestibular processing at cortical level show dominance in the right hemisphere and involve common brain areas. Lesion studies in human and monkey, electrical and transcranial magnetic stimulation, as well as functional imaging results have revealed the superior temporal cortex, insula and the temporo-parietal junction to be substantial parts of the multisensory (vestibular) system as well as to be affected in Spatial Neglect. We argue that these structures are not strictly 'vestibular' but rather have a multimodal character representing a significant site for the neural transformation of converging vestibular, auditory, neck proprioceptive and visual input into higher order Spatial representations. Neurons of these regions provide us with redundant information about the position and motion of our body in space. They seem to play an essential role in adjusting body position relative to external space. This view may initiate further development of those strategies to treat Spatial Neglect that use routes to rehabilitation based on specific manipulations of sensory input feeding into this system.
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Spatial Neglect—a vestibular disorder?
Brain, 2005Co-Authors: Hans-otto Karnath, Marianne DieterichAbstract:The phenomenon of Spatial Neglect after right brain damage greatly helps our understanding of the normal mechanisms of directing and maintaining Spatial attention, of Spatial orientation, and the characteristics of neural representation of space. The intriguing symptom is a spontaneous orientation bias towards the right leading to Neglect of objects or persons on the left. Interestingly, we observe similar symptoms namely a spontaneous bias of eyes and head along the horizontal dimension of space in patients with unilateral vestibular dysfunction. Further similarities concern anatomical findings. Both Spatial Neglect and vestibular processing at cortical level show dominance in the right hemisphere and involve common brain areas. Lesion studies in human and monkey, electrical and transcranial magnetic stimulation, as well as functional imaging results have revealed the superior temporal cortex, insula and the temporo-parietal junction to be substantial parts of the multisensory (vestibular) system as well as to be affected in Spatial Neglect. We argue that these structures are not strictly 'vestibular' but rather have a multimodal character representing a significant site for the neural transformation of converging vestibular, auditory, neck proprioceptive and visual input into higher order Spatial representations. Neurons of these regions provide us with redundant information about the position and motion of our body in space. They seem to play an essential role in adjusting body position relative to external space. This view may initiate further development of those strategies to treat Spatial Neglect that use routes to rehabilitation based on specific manipulations of sensory input feeding into this system.
A. M. Barrett - One of the best experts on this subject based on the ideXlab platform.
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Update on the Clinical Approach to Spatial Neglect
Current Neurology and Neuroscience Reports, 2019Co-Authors: A. M. Barrett, Kevin E. HoustonAbstract: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. Summary 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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kessler foundation Neglect assessment process uniquely measures Spatial Neglect during activities of daily living
Archives of Physical Medicine and Rehabilitation, 2015Co-Authors: Peii Chen, A. M. Barrett, Kimberly Hreha, Christine C Chen, Kelly M GoedertAbstract:Abstract Objectives To explore the factor structure of the Kessler Foundation Neglect Assessment Process (KF-NAP), and evaluate the prevalence and clinical significance of Spatial Neglect among stroke survivors. Design Inception cohort. Setting Inpatient rehabilitation facility (IRF). Participants Participants (N=121) with unilateral brain damage from their first stroke were assessed within 72 hours of admission to an IRF, and 108 were assessed again within 72 hours before IRF discharge. Interventions Usual and standard IRF care. Main Outcome Measures During each assessment session, occupational therapists measured patients' functions with the KF-NAP, FIM, and Barthel Index (BI). Results The KF-NAP showed excellent internal consistency with a single-factor structure. The exploratory factor analysis revealed the KF-NAP to be unique from both the FIM and BI even though all 3 scales were correlated. Symptoms of Spatial Neglect (KF-NAP>0) were present in 67.8% of the participants at admission and 47.2% at discharge. Participants showing the disorder at IRF admission were hospitalized longer than those showing no symptoms. Among those presenting with symptoms, the regression analysis showed that the KF-NAP scores at admission negatively predicted FIM scores at discharge, after controlling for age, FIM at admission, and length of stay. Conclusions The KF-NAP uniquely quantifies symptoms of Spatial Neglect by measuring functional difficulties that are not captured by the FIM or BI. Using the KF-NAP to measure Spatial Neglect, we found the disorder persistent after inpatient rehabilitation, and replicated previous findings showing that Spatial Neglect adversely affects rehabilitation outcome even after prolonged IRF care.
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lateral eye deviation and post stroke Spatial Neglect p1 208
Neurology, 2015Co-Authors: Peii Chen, A. M. Barrett, Shreyas Shirodkar, Brian YaoAbstract:OBJECTIVE: We tested two hypotheses: 1) patients with Spatial Neglect have more rightward eye deviation than those without Neglect, and 2) Neglect severity correlates with rightward eye deviation. BACKGROUND: Spatial Neglect, failure to respond to/report contralesional stimuli after stroke, is associated with poor stroke outcomes, prolonged hospitalizations, and caregiver burden. Yet, many people with Spatial Neglect are not diagnosed. Rightward eye deviation on brain imaging might identify Spatial Neglect; this might be more feasible than behavioral evaluation, which requires a trained clinician. DESIGN/METHODS: We reviewed 90 brain scans (42 women, 76 right stroke, mean age 66.1) from Spatial Neglect research 2008-2014. A blinded rater calculated average eye deviation angle using Becker and Karnath9s (2010) method. Neglect was defined by either paper and pencil (Behavioral Inattention Test, BIT) or functional performance assessment(Catherine Bergego Scale via KF-NAP™, CBS). RESULTS: We replicated Becker and Karnath for the CBS (Neglect n = 55; eyes mean 10.7 degrees rightward, SD 17.67; no Neglect n = 17, eyes mean 1.3 degrees rightward, SD 5.15; independent samples unequal variance t test, p < 0.01), but not the BIT (Neglect n=49; eyes 9.7 degrees rightward, SD 16.92; no Neglect n = 11; eyes 11.7 degrees rightward, SD 18.53; p = 0.7, n.s.). Neither CBS nor BIT score correlated with eye deviation. CONCLUSIONS: Why CBS-defined and BIT-defined Neglect resulted in different patterns of eye deviation is unclear. This could reflect greater sensitivity of functional performance testing for Neglect, or greater relation of spontaneous behavior assessed by the CBS with eye deviation, as contrasted with responses directly elicited during neuropsychological testing. Research to identify specific mechanisms predisposing patients to rightward eye deviation may be helpful to develop a more complex model to evaluate for potential clinical screening. Study Supported by: NIH, NIDRR, Kessler Foundation, Wallerstein Foundation Disclosure: Dr. Barrett has received personal compensation for activities with Medscape/emedicine. Dr. Barrett9s institution has received research support from NIH, NIDRR, the Healthcare Foundation of NJ, the Mabel H. Flory Trust, the Wallerstein Foundation for Geria Dr. Shirodkar has nothing to disclose. Dr. Yao has nothing to disclose. Dr. Chen has nothing to disclose.
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severity of Spatial Neglect during acute inpatient rehabilitation predicts community mobility after stroke
Pm&r, 2014Co-Authors: Mooyeon Ohpark, Peii Chen, Cynthia Hung, A. M. BarrettAbstract:Objective To examine whether stroke survivors with more severe Spatial Neglect during their acute inpatient rehabilitation had poorer mobility after returning to their communities. Design A prospective observational study. Setting Acute inpatient rehabilitation and follow-up in the community. Participants Thirty-one consecutive stroke survivors with right-brain damage (women, n = 15 [48.4%]), with the mean (standard deviation) age of 60 ± 11.5 years, were included in the study if they demonstrated Spatial Neglect within 2 months after stroke. Methods Spatial Neglect was assessed with the Behavioral Inattention Test (BIT) (range, 0-146 [a lower score indicates more severity]) and the Catherine Bergego Scale (range, 0-30 [a higher score indicates more severity]). A score of the Behavioral Inattention Test 0 defined the presence of Spatial Neglect. Main Outcome Measurements The outcome measure is community mobility, defined by the extent and frequency of traveling within the home and in the community, and is assessed with the University of Alabama at Birmingham Study of Aging Life-Space Assessment (range, 0-120 [a lower score indicates less mobile]). This measure was assessed after participants returned home ≥6 months after stroke. The covariates were age, gender, functional independence at baseline; follow-up interval; and depressed mood, which may affect the relationship between Spatial Neglect and community mobility. Results A lower Behavioral Inattention Test score was a significant predictor of a lower Life-Space Assessment score after controlling for all the covariates (β = 0.009 [95% confidence interval, 0.008-0.017]); P = .020). The proportion of participants unable to travel independently beyond their homes was 0%, 27.3%, and 72.7% for those with mild, moderate, and severe acute Neglect, respectively (Catherine Bergego Scale range, 1-10, 11-20, and 21-30, respectively). Conclusions Our result indicates that acute Spatial Neglect has a negative impact on regaining of functional mobility in the community. Specific screening and treatment of Spatial Neglect during acute stroke care may be necessary to improve long-term mobility recovery.
