Research from JAMA Neurology — Assessing Financial Capacity in Patients With Alzheimer Disease — A Conceptual Model and Prototype Instrument. Treatment of Visual Neglect in Elderly Patients With Stroke: A Single-Subject Series Using Either a Scanning and Cueing Strategy or a Left-Limb Activation Strategy. Autism 2016 welcomes attendees, presenters, and exhibitors from all over the world to Chicago, USA. We are Glad to invite you all to attend and register for the “ 2 nd International Conference on Autism” which is going to. Treatment of Visual Neglect in Elderly Patients With Stroke: A Single- Subject Series Using Either a Scanning and Cueing Strategy or a Left- Limb Activation Strategy. Abstract. Background and Purpose. The presence of unilateral visual neglect (UVN) may adversely affect functional recovery, and rehabilitation strategies that are practical for use in clinical settings are needed. The purpose of this study was to evaluate the use of 2 approaches to reduce UVN in people who have had strokes. Seven elderly patients with stroke and severe left UVN, aged 6. A nonconcurrent, multiple- baselines- across- subjects approach, with an A- B- A treatment- withdrawal single- subject experimental design, was used. This individual differences study examined the separability of three often postulated executive functions—mental set shifting (“Shifting”), information updating and monitoring (“Updating”), and inhibition of. 1 Department of Neuropsychology, Wascana Rehabilitation Centre, 2180—23rd Avenue, Regina, Saskatchewan, Canada S4S 0A5 2 Functional Rehabilitation Program, Wascana Rehabilitation Centre, 2180—23rd Avenue, Regina. We have sought to include neurocognitive tasks where nonhuman primate studies or human neuroimaging studies implicate frontal-striatal circuits and dopaminergic function. Visual Puzzles, Figure Weights, and Cancellation: Some Preliminary Hypotheses on the Functional and Neural Substrates of These Three New WAIS-IV Subtests. Five subjects received a scanning and cueing approach, and 2 subjects received a contralesional limb activation approach, for 1. In the former approach, active scanning to the left was encouraged by the therapist, using visual and verbal cues and a mental imagery technique, during reading and copying tasks and simple board games. In the latter approach, functional and goal- oriented left upper- limb activities in neglected hemispace were encouraged. Unilateral visual neglect was examined by a masked (blinded) examiner throughout all phases using the Star Cancellation Test, the Line Bisection Test, and the Baking Tray Task. Data were analyzed using visual and inferential statistical techniques. Amsterdam Neuropsychological Tasks ProgramsBoth subjects who received limb activation and 3 of the 5 subjects who received scanning and cueing showed a reduction in UVN in one or more tests. This improvement was maintained during the withdrawal phase. Discussion and Conclusion. Both approaches had a positive effect of reducing aspects of UVN in some subjects relative to no- treatment baselines. However, causality cannot be assured in the absence of controls. The approaches are practical for use in rehabilitation settings. These procedures warrant further replication across subjects, settings, and therapists. Unilateral visual neglect (UVN), a common perceptual deficit found after stroke,1 manifests as an inability to direct attention to stimuli when they are located on the side contralateral to the lesion. Unilateral visual neglect is a component of the “hemineglect syndrome,” which can include manifestations of neglect other than visual (eg, motor, sensory). Hemineglect is more severe and longer lasting following right- sided as opposed to left- sided brain damage,3 which has been attributed to the right hemisphere playing a primary role in spatial attention. The presence of UVN may adversely affect functional recovery,5 and it is associated with rehabilitation taking longer and being less complete than in patients without UVN. Treatments thought to ameliorate UVN involving artificial manipulation of proprioceptive or visual input have been referred to in detail elsewhere. However, using such techniques, reduction of visual neglect has only been demonstrated during or immediately following such treatment sessions, and long- term carryover has not been demonstrated. Additionally, such treatments may require specialized equipment and technical support, and they do not easily lend themselves to application in real- life clinical situations. Robertson and colleagues. The training involved the trainer first giving direct verbal feedback to the subject to attend to the task, progressing to the subject being required to provide his or her own verbal feedback to attend. However, the self- alerting procedures they used often required a degree of insight, memory, and cooperation from their subjects, which many elderly patients who have had strokes may not possess. Other strategies, which may be more practical for use in rehabilitation settings, include the use of scanning and cueing. Scanning encourages the subject's attention to be directed to neglected hemispace, and cueing, provided by the trainer or internally self- generated by the subject, facilitates such direction of attention. In our study, we examined 2 different treatment approaches for patients with UVN, one using a scanning and cueing strategy and one using a left- limb activation (LLA) strategy. We used a series of single- system designs. The Use of Cues and Visual Scanning to Direct Attention to Left Hemispace. Gordon and colleagues. More systematic attempts to rehabilitate visual neglect by visual scanning training have been described. Typically, training involves visual scanning of rows of lights across a board using slow and systematic searches from left to right, with use of visual and verbal cues to direct attention to the left side of the board. Reduction of visual neglect has not been a consistent research finding across different studies, and there has been little or no generalization to untrained tasks. Some researchers have successfully used cueing to reduce visual neglect immediately after a training session. Ladavas et al. 21 trained 1. UVN for 3. 0 hours using computer- generated left- sided visual cues. There was no randomization, and there were only 4 subjects in each of the control and experimental groups, with no masking (blinding) of outcome. Riddoch et al. 22 used a left- sided colored sticker and the explicit reporting of this visual cue to reduce visual neglect in a single subject during a reading and copying task. Despite the negative results of some studies,2. These methods also were used by Paolucci and co- workers,1. UVN. Improvements were “time- locked” to the period of specific, targeted training for neglect. They randomly assigned 2. UVN to immediate (mean age=6. SD=7. 1. 9) and delayed (mean age=7. SD=5. 4. 6) treatment groups. Forty hours of scanning and cueing training reduced visual neglect and improved function in both groups, compared with the subjects' performance during a “general cognitive” intervention. Function was assessed by the Barthel Index. BI) (for activities of daily living) and the Rivermead Mobility Index. RMI) (for mobility in bed activities, transfers, standing, and walking). No information was given by Paolucci and colleagues as to which particular tasks in these batteries showed improvements in response to the specific treatment intervention. In general, no follow- up data have been reported following cueing studies, although Lennon. UVN to avoid left- sided collisions in the gymnasium by use of colored markers on edges to be avoided. Unfortunately, the patient required further retraining within his home environment. This retraining was successful, and eventually he did not need the visual cues. Effects of Contralesional Limb Activation on Hemineglect. In patients with right- hemisphere brain damage, motor responses are usually made using the right arm because most people are right- hand dominant and the left arm may be paralyzed. Kinsbourne. 26 proposed that visual neglect results from an attentional imbalance rather then an attentional deficit, with the right hemisphere being dominant for spatial attention. In addition, he argued that activation of one hemisphere would tend to inhibit the activity of the other hemisphere. Because the right arm is controlled by the intact left hemisphere, using this arm may exacerbate visual neglect, because activation of the left hemisphere (by right arm use) would tend to further inhibit the already damaged right hemisphere. Conversely, LLA would lead to increased activity in the right hemisphere. Hemispheric activation has been used to account for the reduction in visual neglect found in several studies. Robertson and North. LLA on the left side, rather than the limb acting as a visual cue, was important in the reduction of visual neglect. In contrast, Cubelli and co- workers. Robertson and North. Cubelli et al found that only 1 of 1. A randomized controlled trial by Kalra and colleagues. LLA, or “spatio- motor cueing,” combined with emphasis on functional activity, reduced visual neglect and length of hospital stay in a group of 2. Bobath approach. The hemispheric activation explanation has been challenged by the results from a study by Ladavas et al,3. They found that passive movement of the left index finger in left space (with vision of the hand reflected in a mirror that inverted right and left space) reduced visual neglect. This finding supported a proprioceptive, as opposed to visuospatial, cueing explanation. More recently, Samuel et al. LLA combined with use of the left arm as a “visual anchor” (subjects were trained to look at and move their left arm if they were unable to find the target in an exercise) during activity for a total of 1. A- B- A- B design. The 2 subjects had reduction in their visual neglect, as well as improved functional ability, which had not improved with previous scanning training. Many limb activation studies have included a “neglect alert device,” worn by the subject during different activities and therapies. This device buzzes at intervals and must be switched off by the subject, using the left arm, thus encouraging activation of the left limb. Other researchers. Some authors. 12,2. LLA. In other studies,1. Studies That May Lend Themselves to the Clinical Situation. In many studies,1. In our view, the use of such equipment limits the practical application of scanning and cueing. In other studies,8,1. A number of researchers. Strategies used in all of these studies (in addition to the computer- based scanning training included by some researchers. Visual imagery, consisting of asking patients to imagine their eyes as beams from a lighthouse,3. This compensatory strategy encourages them to generate cues (the mental image of the “lighthouse beam scanning the horizon”) for themselves. Measurements of outcome in this study,3. Reduction of visual neglect was maintained for 5 months posttreatment in 7 of the 1. Pizzamiglio and colleagues. Other researchers. However, maintenance of positive effects was not assessed after the subjects' steady improvement that occurred during the 8- week treatment period. Several limb activation strategies have been used in rehabilitation settings.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
October 2017
Categories |