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In the acute phase of stroke, patients with left visual neglect (VN) automatically orient to the right hemispace. This study examined the presence of rightward bias after right hemisphere stroke within 10 days of stroke onset and after 6 months. Our sample comprised 43 patients and 49 healthy controls. Presence of VN was evaluated with the six conv...
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... Severity of neglect was defined based on CBS scores of 1-10, 11-20, and 21-30 (Oh-Park, Hung, Chen, & Barrett, 2014). Although neglect was not detected from the paper and pencil test scores, there are reports of existing neglect symptoms when starting the cancellation task from the upper right (Laura et al., 2010;Kettunen, Nurmi, Dastidar, & Jehkonen, 2012). ...
Here, we developed a method that randomly generates balloons in the left-right, up-down, and near-far spaces on a monitor using a head-mounted display. In this study, we evaluated a lack of stimulus-driven attention case that was undetected by conventional assessments such as the Behavioral Inattention Test. We could identify mild neglect with our virtual reality method, as later confirmed using the Catherine Bergego scale. After repeated practice under a tilted background space condition, the patient demonstrated a reduction in the time needed to perceive the appearing balloons, suggesting a therapeutic effect.
... Indeed, several studies have shown that at the acute phase of stroke, some RH patients who do not exhibit neglect in conventional measures do nonetheless demonstrate initial ipsilateral orienting bias (Erez et al., 2009;Gainotti et al., 1991;Jalas, Lindell, Brunila, Tenovuo, & Hämäläinen, 2002;Nurmi et al., 2010) and/or slowed processing speed (van Kessel et al., 2010). Similarly, many patients who according to traditional tests have recovered from neglect still show initial ipsilateral orienting bias (Bartolomeo, 1997;Bartolomeo & Chockron, 2002;Bonato, 2012;Kettunen, Nurmi, Dastidar, & Jehkonen, 2012;Mattingley, Bradshaw, Bradshaw, & Nettleton, 1994) and/or slowed processing speed (Bonato, 2012;Friedrich & Margolin, 1993;Robertson & Eglin, 1993;Samuelsson et al., 1998;Taylor, 2003;Viken, 2013) as residual neglect symptoms long after stroke. ...
... Initial ipsilateral orienting bias, on the other hand, is often present for 6 to 7 (Bonato, 2012;Kettunen et al., 2012;Samuelsson et al., 1996), even 12 months (Mattingley et al., 1994) after stroke, despite the recovered ability to reorient attention toward the contralesional side. Similarly, slow processing speed has been seen as a residual symptom in clinically recovered neglect patients for 3 to 7 months post-stroke (Harvey & Gilchrist, 2002;Samuelsson et al., 1998;Viken, 2013). ...
... They also support previous findings that neglect patients may show ipsilateral orienting bias 6 to 12 months after stroke (Bonato, 2012;Kettunen et al., 2012;Mattingley et al., 1994;Samuelsson et al., 1996). However, only limited scientific attention has previously been devoted to the recovery of patients with initially milder inattention symptoms (i.e., MLI +), but no actual neglect after stroke. ...
Objectives:
To examine the occurrence of and recovery from visual neglect-related symptoms with the focus on neglect laterality, ipsilateral orienting bias, and slowed processing speed in right hemisphere (RH) infarct patients during a 1-year follow-up. Furthermore, to propose guidelines for assessing processing speed alongside the Behavioural Inattention Test (BIT).
Methods:
We studied three RH patient groups: neglect (N+), mild left inattention (MLI+), and non-neglect (N-) patients, and healthy controls. The BIT with some additional analyses was conducted at the acute phase and at 6 and 12 months.
Results:
The N+ group's BIT score increased and originally lateralized omissions became more evenly distributed during the follow-up. The N+ and MLI+ groups' starting points were more rightward located than the healthy group's at the acute phase and at 6, and partly at 12 months. Patient groups were slower than the controls in performing cancellation tests at the acute phase. The N+ and MLI+ groups remained slower than the controls throughout the follow-up.
Conclusions:
During the first year after RH infarct, originally left-sided manifestation of neglect shifted toward milder non-lateralized attentional deficit. Ipsilateral orienting bias and slowed processing speed appeared to be rather persistent neglect-related symptoms both in neglect patients and patients with initially milder inattention. We propose some effortless, tentative ways of examining processing speed and ipsilateral orienting bias alongside the BIT to better recognize these neglect-related symptoms, and highlight the need to assess and treat patients with initially milder inattention, who have been under-recognized and under-treated in clinical work. (JINS, 2018, 24, 1-12).
... Of note, even after rehabilitation, patient P25's performance on paper and pencil tests with the presence of ipsilesional items was particularly impaired. This patient also showed perseverations on these tests, as well as a rightward starting point, which is one of the most sensitive markers of the presence (Azouvi et al., 2002) and persistence (Kettunen et al., 2012) of left neglect. ...
Visual neglect is a disabling consequence of right hemisphere damage, whereby patients fail to detect left-sided objects. Its precise mechanisms are debated, but there is some consensus that distinct component deficits may variously associate and interact in different patients. Here we used a touch-screen based procedure to study two putative component deficits of neglect, rightward "magnetic" attraction of attention and impaired spatial working memory, in a group of 47 right brain-damaged patients, of whom 33 had signs of left neglect. Patients performed a visual search task on three distinct conditions, whereby touched targets could (1) be tagged, (2) disappear or (3) show no change. Magnetic attraction of attention was defined as more left neglect on the tag condition than on the disappear condition, where right-sided disappeared targets could not capture patients' attention. Impaired spatial working memory should instead produce more neglect on the no change condition, where no external cue indicated that a target had already been explored, than on the tag condition. Using a specifically developed analysis algorithm, we identified significant differences of performance between the critical conditions. Neglect patients as a group performed better on the disappear condition than on the no change condition and also better in the tag condition comparing with the no change condition. No difference was found between the tag condition and the disappear condition. Some of our neglect patients had dissociated patterns of performance, with predominant magnetic attraction or impaired spatial working memory. Anatomical results issued from both grey matter analysis and fiber tracking were consistent with the typical patterns of fronto-parietal and occipito-frontal disconnection in neglect, but did not identify lesional patterns specifically associated with one or another deficit, thus suggesting the possible co-localization of attentional and working memory processes in fronto-parietal networks. These findings give support to the hypothesis of the co-occurrence of distinct cognitive deficits in visual neglect and stress the necessity of multi-component models of visuospatial disorders.
KEYWORDS:
clinical anatomical correlations; magnetic attraction of attention; neglect; stroke; tractography; working memory
PMID: 29203204 DOI: 10.1016/j.neuropsychologia.2017.11.034
... In previous studies this skewed tendency has been significantly associated with neglect. [33,40,50,62,[83][84][85][86] Manly and colleagues [62] concluded, after analysing video-recordings of 18 patients with neglect and scoring their star cancellation starting point, that a simple left-right starting point criterion would correctly pinpoint more patients with neglect than the traditional overall lateralized and target omission score. This echoes our findings. ...
Purpose:
To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home.
Methods:
A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke, <1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a 'mixing matrix' and integrated by 'following threads'. Finally, a synthesis was written into a vignette.
Results:
The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants.
Conclusion:
Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect. Implications for Rehabilitation Findings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation. Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient's own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient's daily life context. The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying.
... Previous studies have highlighted the clinical importance of spontaneous rightward capture of attention in the neglect phenomenon (Azouvi et al., 2002, 2006; Corbetta & Shulman, 2011; Gainotti et al., 1991, 2010; Jalas et al., 2002; Karnath, 1988; Karnath & Rorden, 2012; Kettunen et al., 2012; Kinsbourne, 1993; Nurmi et al., 2010; Samuelsson et al., 1996) and of impairments in temporal processing capacity (Husain & Rorden, 2003; Husain et al., 1997; Robertson et al., 1998; Samuelsson, Hjelmquist, Jensen, Ekholm, & Blomstrand, 1998). The results of the current study suggest that the relative importance of right capture of attention and slow speed of visual processing are not only important symptoms of the VSN phenomenon per se, but that they also are important predictors of functional dependency. ...
Visuospatial neglect (VSN) predicts unfavorable functional outcome in stroke patients. This study examined the relative importance of different core symptoms of VSN as predictors of functional dependency. A consecutive series of 105 right hemisphere stroke patients were tested early after stroke on three basic symptoms of VSN (omissions, asymmetry of omissions and ipsilesional bias of attention) and on two symptoms related to VSN (processing speed and repetitive target detections in visual search). Neurological deficits were also assessed. Functional outcome was measured 3 months and 2 years after stroke with the modified Rankin Scale. Univariate analyses revealed significant relationships with functional outcome for both core and related symptoms of VSN and for neurological deficits. Area under the curve statistics and stepwise logistic regressions showed that the most important predictors assessed early after stroke were presence of ipsilesional bias for dependency at 3 months and visual processing speed for dependency at 2 years after stroke. These results show that valuable prognostic information regarding dependency after right hemisphere stroke can be obtained by assessing fundamental sub-components of VSN early after stroke. The development of standardized clinical methods for investigation of sub-components, such as a right capture of attention and processing speed, is essential.
Background:
Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time-limited clinical environments.
Methods:
Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations.
Results:
512 articles were screened with 42 included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copy, reading/writing, and behavioural. Cancellation tasks were most frequently used (97.6% of studies) followed by bisection, copy, behavioural, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible.
Conclusions:
This study provides consensus recommendations for rapid bedside detection of neglect in real-world, clinical environments.
Dr. Saa studied the trajectory of cognitive function after stroke. He mapped when cognitive recovery is more likely to happen, and with what interventions. His research has implications for clinical practice and research through the incorporation of machine-learning tools to aid the prediction of cognitive recovery over time at the individual level.
