Analysis of Brain Lesion Impact on Balance and Gait Following Stroke

Falls are a leading cause of serious injury and restricted participation among persons with stroke (PwS). Reactive balance control is essential for fall prevention, however, only a few studies have explored the effects of lesion characteristics (location and extent) on balance control in PwS. We aimed to assess the impact of lesion characteristics on reactive and anticipatory balance capacity, gait, and hemiparetic lower limb function, in PwS. Forty-six subacute PwS were exposed to forward, backward, right and left unannounced horizontal surface translations in six increasing intensities while standing. Fall threshold (i.e., perturbation intensity that results in a fall into the harness system) was measured. In addition, the Berg Balance Scale (BBS), 6 Minute Walk Test (6MWT) and Lower Extremity Fugl-Meyer (LEFM) were measured. Lesion effects were analyzed separately for left and right hemisphere damaged (LHD, RHD) patients, using voxel-based lesion-symptom mapping (VLSM). Our results show that voxel clusters where damage exerted a significant impact on balance, gait and lower-limb function were found in the corticospinal tract (CST), in its passage in the corona radiata and in the posterior limb of the internal capsule. An additional significant impact was found to lesions affecting the putamen and the external capsule (EC). Balance, gait, and hemiparetic lower limb function showed much overlap of the corresponding “significant” voxel clusters. Test scores of RHD and LHD patients were affected largely by damage to homologous regions, with the LHD group showing a wider distribution of “significant” voxels. The study corroborates and extends previous findings by demonstrating that balance control, gait, and lower limb function are all affected mainly by damage to essentially the same brain structures, namely—the CST and adjacent structures in the capsular-putaminal region

No Disillusions in Auditory Extinction: Perceiving a Melody Comprised of Unperceived Notes

The formation of coherent percepts requires grouping together spatio-temporally disparate sensory inputs. Two major questions arise: (1) is awareness necessary for this process; and (2) can non-conscious elements of the sensory input be grouped into a conscious percept? To address this question, we tested two patients suffering from severe left auditory extinction following right hemisphere damage. In extinction, patients are unaware of the presence of left side stimuli when they are presented simultaneously with right side stimuli. We used the ‘scale illusion’ to test whether extinguished tones on the left can be incorporated into the content of conscious awareness. In the scale illusion, healthy listeners obtain the illusion of distinct melodies, which are the result of grouping of information from both ears into illusory auditory streams. We show that the two patients were susceptible to the scale illusion while being consciously unaware of the stimuli presented on their left. This suggests that awareness is not necessary for auditory grouping and non-conscious elements can be incorporated into a conscious percept

The Sidney Licht Lectureship Award 2017: Novel Options for Restoration of Discrete Functions Following Brain Damage

The presence of aphasia following left hemisphere damage and of spatial neglect following right hemisphere damage are both associated with a significant negative impact on the functional outcome of stroke patients referred to rehabilitation. In aphasia, interpersonal variance in structure-function mapping, and findings related to pragmatics, points to exciting new options for rehabilitation research. In the case of neglect rehabilitation, promising novel options are pointed by experiments showing abolishment of neglect when spatial attention is modulated shortly after stimulus capture (at a stage where perceptual information is maintained in the iconic buffer) and by studies showing amelioration following electroencephalogram-biofeedback treatment aimed to enhance the level of arousal in perilesional cortex

Basal ganglia play a unique role in task switching within the frontal-subcortical circuits: evidence from patients with focal lesions

Abstract & The performance of patients with lesions involving the basal ganglia (BG) was compared to that of patients with prefrontal (PFC) lesions, thalamic (TH) lesions, and age-matched controls in order to examine the specific role of the BG within the frontal-subcortical circuits (FSCC) in task switching. All the BG patients and none of the other participants showed a marked increase in error rate in incongruent trials where correct responses depended upon the choice of the correct task rule. Some BG patients erred in failing to switch tasks and others failed despite their attempt to switch tasks. Additionally, reaction time results indicate abnormal response repetition effects among the BG patients; failure in benefiting from advance task information among all the patients; and increased task mixing costs following PFC lesions. The authors conclude that although the frontal-subcortical circuits jointly determine some behaviors (such as benefiting from preparation), the BG play a unique role within the FSCC in action selection and/or the inhibition of irrelevant information. &amp

Spatial Vision, Vol. 13, No. 4, pp. 403 -- 414 (2000)

Extinction is manifested in conditions of bilateral simultaneous stimulation, as a failure to detect the stimulus contra-lateral to the side of a cerebral lesion, while the same stimulus is correctly detected there when presented in isolation. The phenomenon is usually interpreted in terms of impaired mobilization of attention from an attended to an unattended object. We have recently shown, using pairs of Gabor patches as stimuli, that pair detection is maximally improved in conditions where the two stimuli presented simultaneously to the two halves of the visual # eld are co-oriented and co-axial and their location is not too eccentric. Here we add new information by showing that contrast isotropy of the stimulus pair is important in producing this orientation-similarity gain. The further advantage of co-oriented co-linear stimuli over co-oriented parallel (vertical) stimuli was shown exclusively with iso-contrast stimulus pairs, and was signi# cantly enhanced when the contrast level of the stimulus pair was low. Stimulus properties producing reduced extinction seem to correlate with the selectivity pattern and contrast dependence of (a) spatial lateral facilitation observed in psychophysical studies with normal observers, and (b) long-range interactions observed in the primary visual cortex. Thus, two remote visual stimuli seem to be processed as a single object when the corresponding neuronal activities are linked via long-range lateral interactions. The present demonstration of contrast dependency in such processing, strengthens our previous conjecture that even in the presence of signi# cant, extinction producing, parietal damage, the primary visual cortex preserves the capacity to encode, using long-range lateral interactions, an image description in which visual..