neglect rehabilitation

8/8/2019 neglect rehabilitation

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Rehabilitation in practice:

Hemispatial neglect:

Approaches to rehabilitation

Clin RehabilAugust 2010 24: 675-

684,

Victoria Singh-Curry and Masud Husain


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What is Hemispatial Neglect?


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Hemispatial Neglect

Syndrome commonly follows unilateral brain

injury, especially RIGHT hemisphere stroke.

Inability to orient towards and attend tostimuli in the contralesional space (Left side if

right hemisphere lesions)

Anosognosia

Difficult to rehabilitate


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Contributing Factors

Spatial A bias in the gradient of spatial attention

towards the ipsilesional (towards the right in

patients with right hemisphere lesions) side of

space

Difficulty disengaging attention fromipsilesional (right-sided) and shifting it to

contralesional (left-sided) locations

A pathological spatial bias, in which

contralesional (left-sided) items lose in the

competition for attention to ipsilesional (right-

sided) stimuli

Directional motor deficits in which patientshave difficulty directing movements into the

contralesional (left) side of space

Problems with spatial working memory,i.e.

keeping track of spatial locations over time

A disordered egocentric representation of

space

Non - Spatial Difficulties in sustaining attention over time,

even when items are presented at a central

location

Impairments in selective attention, which may

occur in both left and right sides of space and atcentral locations.

Neglect patients can demonstrate bilateral

attentional impairments, even though the most

obvious abnormality is a bias towards

ipsilesional (usually right-sided) space


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What test/s to do?

A full neuropsychological (as well as physical) examination wouldideally be required in all stroke patients, particularly those withright hemisphere lesions.

No single test provides an adequate screening tool. Instead abattery of standardized measures (such as from the Behavioural

Inattention Test) Examination for visual and somatosensory extinction

Assessment of functional activities (for example the Barthel Indexor Functional Independence Measure) are needed to fully evaluatethe syndrome in an individual patient.

This information, along with an appreciation of the underlying lesionanatomy, could be used to guide attempts at effective rehabilitation


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Rehabilitation Technique


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Three Categories

1. Purely behavioural strategies;

2. Techniques employing devices or specializedequipment; and

3. Pharmacological manipulations.


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Behavioural Strategies

Most Common

1. Visual scanning or visuospatial training

cueing right-hemisphere patients to makeleftward eye or head movements

facilitate the orientation of attention into the

contralesional, neglected side of space

Example:

asking the subject to locate the left hand margin of the page before

reading the next line.


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2. Sustained Attention

sorting of objects such as coins

intermittently verbally prompt patients to attendduring the task

gradually pt were trained to prompt themselves

subvocally


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3. Limb activation therapy

making leftward movements with the left arm can

activate poorly attended areas in extrapersonal

space and thereby improve neglect

constrained by the fact that some control over the

often hemiparetic arm is required

passive movements if large enough can lead tosome improvement of neglect


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Therapies that use specialized devices

1. neglect alerting device

2. functional electrical stimulation(FES)

3. computerized training tasks4. Rotation of the head or trunk

5. Neck muscle vibration (NMV)

6. Optokinetic stimulation7. Prism adaptation


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Pharmacological Therapies

Dopaminergic drugs

Bromocriptine given daily for 34 weeks, levodopaand the other apomorphine has been found to effect

an improvement in measures of neglect some reports have failed to demonstrate any benefit

Noradrenergic compounds (Guanfacine)

improves planning and working memory performance

in healthy human participants sustain attention for longer periods of time on the

visual exploration task


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Thank You

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