Birschel, Philip

Castle, Pauline

Duncan, George

Harvey, Monika

Hogg, Caroline

Jackson, Hazel

Learmonth, Gemma

Livingstone, Katrina

Muir, Keith

Reeves, Ian

Roberts, Margaret

Rossit, Stephanie

Behavioural Neurology

English

Monika Harvey

Keith Muir

Ian Reeves

George Duncan

Philip Birschel

Margaret Roberts

Katrina Livingstone

Hazel Jackson

Caroline Hogg

Pauline Castle

Gemma Learmonth

Stéphanie Rossit

Directory of Open Access Journals

Long Term Improvements in Activities of Daily Living in Patients with Hemispatial Neglect

First paragraph:  Stroke is the 3rd commonest cause of death and the most frequent cause of severe adult disability in Scotland (SIGN guidelines, 119, June 2010). Up to 80% of right hemisphere damaged stroke patients experience neglect, an inability to respond to events in the left half of their subjective space. Although the majority of these patients recover spontaneously, the early presence of neglect is the strongest predictor of overall poor recovery from stroke and sub-acute neglect patients have a much-reduced quality of life compared to other stroke patients. Although the last 40 years have seen huge efforts in the field of neglect rehabilitation, what is currently lacking are interventions that demonstrate a generalisation to tasks that assess a patient’s ability to function in activities relevant to their and their carer's lives

Stirling Online Research Repository

Behavioural Neurology 23 (2010) 237–239 237DOI 10.3233/BEN-2010-0304IOS PressLong term improvements in activities of dailyliving in patients with hemispatial neglectMonika Harveya,∗, Keith Muirb, Ian Reevesc, George Duncanc, Philip Birschelc, Margaret Robertsc,Katrina Livingstoned, Hazel Jacksone, Caroline Hoggf , Pauline Castlef , Gemma Learmonthg andSt́ephanie RossithaSchool of Psychology, University of Glasgow, Glasgow, UKbInstitute of Neurological Sciences, Southern General Hospital, Glasgow, UKcDepartment of Medicine for the Elderly, Southern General Hospital, Glasgow, UKdStroke Discharge and Rehabilitation Team, Southern General Hospital, Glasgow, UKeStroke Unit, Southern General Hospital, Glasgow, UKfMansion House Unit, Glasgow, UKgVictoria Infirmary, Glasgow, UKhDepartment of Psychology, University of Western Ontario, London, CanadaStroke is the 3rd commonest cause of death and themost frequent cause of severe adult disability in Scot-land (SIGN guidelines, 119, June 2010). Up to 80%of right hemisphere damaged stroke patients experi-ence neglect, an inability to respond to events in theleft half of their subjective space. Although the ma-jority of these patients recover spontaneously, the earlypresence of neglect is the strongest predictor of overallpoor recovery from stroke and sub-acute neglect pa-tients have a much-reduced quality of life compared toother stroke patients. Although the last 40 years haveseen huge efforts in the field of neglect rehabilitation,what is currently lacking are interventions that demon-strate a generalisation to tasks that assess a patient’sability to function in activities relevant to their and theircarer’s lives.In this study we applied visuomotor feedback andcontrol training to a group of patients suffering fromhemispatial neglect. The training was based on∗Corresponding author: Monika Harvey, School of Psychology,University of Glasgow, Glasgow G12 8QB, Scotland, UK. Tel.:+44141 330 6174; Fax: +44 141 330 4606; E-mail: M.Harvey@psy.gla.ac.uk.the established theoretical approach by Milner andGoodale [8]. This model of vision proposes that thereare two major parallel visual systems within the brain:the occipito-temporal ‘ventral stream’ which providesthe hardware for analysing the visual input to furnisha rich representation of the scene; and the occipito-parietal ‘dorsal stream’ (in particular the superior pari-etal lobe) which mediates the transformation of visualinputs into action. In line with this model, fMRI studieshave identified the location of the human homologue ofthe anterior intraparietal area, a region strongly activeduring visually guided grasping movements (e.g., Cul-ham et al. [2]). This fits well with a study by Binkofskiet al. [1], who demonstrated that lesions in the ante-rior part of the intraparietal sulcus are associated withimpairments in visually-guided grasping. However, le-sions resulting in neglect symptoms are typically locat-ed more inferiorly in the parietal [7] or even the tem-poral lobe (Karnath et al. [6]), typically sparing thesedorsal stream regions. Secondly, Robertson et al. [9]found that neglect patients showed significantly fewerbisection errors when asked tograspa rod at its mid-point than when asked topoint to the rod’s midpoint.Later studies with groups of neglect patients did in-deed find no evidence for deficits in grasping behaviourISSN 0953-4180/10/$27.50 2010 – IOS Press and the authors. All rights reserved238 M. Harvey et al. / Long term improvements in activities of daily living in patients with hemispatial neglectFig. 1. ADL/IADL scores for intervention and control groupsat baseline, after the 2 week home-based training, and at 4 months follow up (N =15 patients).in these patients (Harvey et al. [4]), further indicat-ing that the dorsal visual stream may be driving thisintact/preserved behaviour. Furthermore, our group(Harvey et al. [5]) found that the simple training of cen-tral grasping and lifting responses to left-right orient-ed rods resulted in significant improvements in chronicneglect patients (average 12 months post stroke).In the current study, a neglect intervention group wasagain asked to reach, lift and balance rods at the cen-tre readjusting until satisfied with the judged centralgrip, whilst the patients in the control group reachedand lifted the right-hand side of rods only. The in-tervention group therefore received proprioceptive, aswell as visual feedback, on how well they grasped thecentre of the rod; however both groups received a com-parable amount of motor experience of reaching andlifting rods. Participants having mastered the exercisefor two days, with the experimenter present, embarkedon a home-based intervention of 2 weeks, in whichthey repeated the training independently. Effects ofthe training were explored with neglect measures (Be-havioural Inattention Test; Wilson et al. [10]), but wealso assessed the intervention’s impact on activities ofdaily living as measured with the Stroke Impact Scale(Duncan et al. [3]). This outcome assessment was doneafter the home-based period as well as 4 months post-intervention and compared to the performance beforetraining (baseline).We found that compared to the control group, theintervention group improved in neglect measures bothafter the home-based and the 4 months testing period.More importantly,after 4 months the intervention groupmarkedly ameliorated their score in the activities of thedaily living domain (ADL/IADL) of the Stroke ImpactScale, whilst the control group reverted to baseline (seeFig. 1).The ADL/IADL domain of the scale assesses impor-tant aspects of the patient’s daily routine including eat-ing, dressing, personal hygiene, household tasks, fam-ily role and the ability to control their own life. As faras we are aware no controlled intervention has so farbeen able to generalise recovery to these measures. Wepostulate that the grasping movements towards objectsinvolved in this form of rehabilitation allow ‘leakage’of information of the object via the unaffected dorsalvisual stream.To conclude, visuomotor feedback training reducedneglect symptoms and increased the patients’ qualityof life. The procedure is easy to apply in any clin-ical setting (carers, or medical staff could be trainedin the space of a couple of hours), non-intrusive (theprocedure is behavioural only) and precludes the needof pricey equipment handled by qualified staff. Webelieve that the current results are most promising andwarrant a promotion of this technique in a more generalclinical setting.M. Harvey et al. / Long term improvements in activities of daily living in patients with hemispatial neglect 239AcknowledgmentsThis work was funded by grants (SFRH/BD/23230/2005; SFRH/BPD/65951/2009) from the PortugueseFoundation for Science and Technology to S Rossit.References[1] F. Binkofski, C. Dohle, S. Posse, K.M. Stephan, H. Hefter,R.J. Seitz and H.J. Freund, Human anterior intraparietal areasubserves prehension: a combined lesion and functional MRIactivation study,Neurology50 (1998), 1253–1259.[2] J. Culham, Human brain imaging reveals a parietal area sp-cialized for grasping, in:Functional Neuroimaging of Visu-al Cognition: Attention and Performance XX, N. Kanwisherand J. Duncan, eds, Oxford: Oxford University Press, 2004,pp. 417–438.[3] P.W. Duncan, R.K. Bode, S.M. Lai and S. Perera, Rasch anal-ysis of a new stroke-specific outcome scale: the Stroke ImpactScale,Archives of Physical Medicine and Rehabilitation84(2003), 950–963.[4] M. Harvey, S.R. Jackson, R. Newport, T. Krämer, D.L. Mor-ris and L. Dow, Is grasping impaired in hemispatial neglect?Behavioural Neurology13 (2001), 17–28.[5] M. Harvey, B. Hood, A. North and I.H. Robertson, The effectsof visuomotor feedback training on the recovery of hemispatialneglect symptoms: assessment of a 2-week and follow-upintervention,Neuropsychologia41 (2003), 886–893.[6] H.-O. Karnath, M.F. Berger, W. K̈uker and C. Rorden, Theanatomy of spatial neglect based on Voxelwise StatisticalAnalysis: A Study of 140 Patients,Cerebral Cortex14 (2004),1164–1172.[7] D.J. Mort, P. Malhotra, S.K. Mannan, C. Rorden, A. Pam-bakian, C. Kennard and M. Husain, The anatomy of visualneglect,Brain 126 (2003), 1986–1997.[8] A.D. Milner and M.A. Goodale,The visual brain in action,Oxford University Press, Oxford, 2006.[9] I.H. Robertson, D. Nico and B.M. Hood, The intention to actimproves unilateral left neglect: two demonstrations,Neu-roreport 7 (1995), 246–248.[10] B.A. Wilson, J. Cockburn and P. Halligan,Behavioural Inat-tention Test, Titchfield, Thames Valley Test Company, 1987.Submit your manuscripts athttp://www.hindawi.comStem CellsInternationalHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014MEDIATORSINFLAMMATIONofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Behavioural NeurologyEndocrinologyInternational Journal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Disease MarkersHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014BioMed Research InternationalOncologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oxidative Medicine and Cellular LongevityHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014PPAR ResearchThe Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Journal ofObesityJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014 Computational and  Mathematical Methods in MedicineOphthalmologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Diabetes ResearchJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Research and TreatmentAIDSHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Gastroenterology Research and PracticeHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Parkinson’s DiseaseEvidence-Based Complementary and Alternative MedicineVolume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

Long term improvements in activities of daily living in patients with hemispatial neglect

Crossref

Behavioural Neurology 23 (2010) 237–239 237DOI 10.3233/BEN-2010-0304IOS PressLong term improvements in activities of dailyliving in patients with hemispatial neglectMonika Harveya,∗, Keith Muirb, Ian Reevesc, George Duncanc, Philip Birschelc, Margaret Robertsc,Katrina Livingstoned, Hazel Jacksone, Caroline Hoggf , Pauline Castlef , Gemma Learmonthg andSte´phanie RossithaSchool of Psychology, University of Glasgow, Glasgow, UKbInstitute of Neurological Sciences, Southern General Hospital, Glasgow, UKcDepartment of Medicine for the Elderly, Southern General Hospital, Glasgow, UKdStroke Discharge and Rehabilitation Team, Southern General Hospital, Glasgow, UKeStroke Unit, Southern General Hospital, Glasgow, UKfMansion House Unit, Glasgow, UKgVictoria Infirmary, Glasgow, UKhDepartment of Psychology, University of Western Ontario, London, CanadaStroke is the 3rd commonest cause of death and themost frequent cause of severe adult disability in Scot-land (SIGN guidelines, 119, June 2010). Up to 80%of right hemisphere damaged stroke patients experi-ence neglect, an inability to respond to events in theleft half of their subjective space. Although the ma-jority of these patients recover spontaneously, the earlypresence of neglect is the strongest predictor of overallpoor recovery from stroke and sub-acute neglect pa-tients have a much-reduced quality of life compared toother stroke patients. Although the last 40 years haveseen huge efforts in the field of neglect rehabilitation,what is currently lacking are interventions that demon-strate a generalisation to tasks that assess a patient’sability to function in activities relevant to their and theircarer’s lives.In this study we applied visuomotor feedback andcontrol training to a group of patients suffering fromhemispatial neglect. The training was based on∗Corresponding author: Monika Harvey, School of Psychology,University of Glasgow, Glasgow G12 8QB, Scotland, UK. Tel.: +44141 330 6174; Fax: +44 141 330 4606; E-mail: M.Harvey@psy.gla.ac.uk.the established theoretical approach by Milner andGoodale [8]. This model of vision proposes that thereare two major parallel visual systems within the brain:the occipito-temporal ‘ventral stream’ which providesthe hardware for analysing the visual input to furnisha rich representation of the scene; and the occipito-parietal ‘dorsal stream’ (in particular the superior pari-etal lobe) which mediates the transformation of visualinputs into action. In line with this model, fMRI studieshave identified the location of the human homologue ofthe anterior intraparietal area, a region strongly activeduring visually guided grasping movements (e.g., Cul-ham et al. [2]). This fits well with a study by Binkofskiet al. [1], who demonstrated that lesions in the ante-rior part of the intraparietal sulcus are associated withimpairments in visually-guided grasping. However, le-sions resulting in neglect symptoms are typically locat-ed more inferiorly in the parietal [7] or even the tem-poral lobe (Karnath et al. [6]), typically sparing thesedorsal stream regions. Secondly, Robertson et al. [9]found that neglect patients showed significantly fewerbisection errors when asked to grasp a rod at its mid-point than when asked to point to the rod’s midpoint.Later studies with groups of neglect patients did in-deed find no evidence for deficits in grasping behaviourISSN 0953-4180/10/$27.50  2010 – IOS Press and the authors. All rights reserved238 M. Harvey et al. / Long term improvements in activities of daily living in patients with hemispatial neglectFig. 1. ADL/IADL scores for intervention and control groups at baseline, after the 2 week home-based training, and at 4 months follow up (N =15 patients).in these patients (Harvey et al. [4]), further indicat-ing that the dorsal visual stream may be driving thisintact/preserved behaviour. Furthermore, our group(Harvey et al. [5]) found that the simple training of cen-tral grasping and lifting responses to left-right orient-ed rods resulted in significant improvements in chronicneglect patients (average 12 months post stroke).In the current study, a neglect intervention group wasagain asked to reach, lift and balance rods at the cen-tre readjusting until satisfied with the judged centralgrip, whilst the patients in the control group reachedand lifted the right-hand side of rods only. The in-tervention group therefore received proprioceptive, aswell as visual feedback, on how well they grasped thecentre of the rod; however both groups received a com-parable amount of motor experience of reaching andlifting rods. Participants having mastered the exercisefor two days, with the experimenter present, embarkedon a home-based intervention of 2 weeks, in whichthey repeated the training independently. Effects ofthe training were explored with neglect measures (Be-havioural Inattention Test; Wilson et al. [10]), but wealso assessed the intervention’s impact on activities ofdaily living as measured with the Stroke Impact Scale(Duncan et al. [3]). This outcome assessment was doneafter the home-based period as well as 4 months post-intervention and compared to the performance beforetraining (baseline).We found that compared to the control group, theintervention group improved in neglect measures bothafter the home-based and the 4 months testing period.More importantly,after 4 months the intervention groupmarkedly ameliorated their score in the activities of thedaily living domain (ADL/IADL) of the Stroke ImpactScale, whilst the control group reverted to baseline (seeFig. 1).The ADL/IADL domain of the scale assesses impor-tant aspects of the patient’s daily routine including eat-ing, dressing, personal hygiene, household tasks, fam-ily role and the ability to control their own life. As faras we are aware no controlled intervention has so farbeen able to generalise recovery to these measures. Wepostulate that the grasping movements towards objectsinvolved in this form of rehabilitation allow ‘leakage’of information of the object via the unaffected dorsalvisual stream.To conclude, visuomotor feedback training reducedneglect symptoms and increased the patients’ qualityof life. The procedure is easy to apply in any clin-ical setting (carers, or medical staff could be trainedin the space of a couple of hours), non-intrusive (theprocedure is behavioural only) and precludes the needof pricey equipment handled by qualified staff. Webelieve that the current results are most promising andwarrant a promotion of this technique in a more generalclinical setting.M. Harvey et al. / Long term improvements in activities of daily living in patients with hemispatial neglect 239AcknowledgmentsThis work was funded by grants (SFRH/BD/23230/2005; SFRH/BPD/65951/2009) from the PortugueseFoundation for Science and Technology to S Rossit.References[1] F. Binkofski, C. Dohle, S. Posse, K.M. Stephan, H. Hefter,R.J. Seitz and H.J. Freund, Human anterior intraparietal areasubserves prehension: a combined lesion and functional MRIactivation study, Neurology 50 (1998), 1253–1259.[2] J. Culham, Human brain imaging reveals a parietal area spe-cialized for grasping, in: Functional Neuroimaging of Visu-al Cognition: Attention and Performance XX, N. Kanwisherand J. Duncan, eds, Oxford: Oxford University Press, 2004,pp. 417–438.[3] P.W. Duncan, R.K. Bode, S.M. Lai and S. Perera, Rasch anal-ysis of a new stroke-specific outcome scale: the Stroke ImpactScale, Archives of Physical Medicine and Rehabilitation 84(2003), 950–963.[4] M. Harvey, S.R. Jackson, R. Newport, T. Kra¨mer, D.L. Mor-ris and L. Dow, Is grasping impaired in hemispatial neglect?Behavioural Neurology 13 (2001), 17–28.[5] M. Harvey, B. Hood, A. North and I.H. Robertson, The effectsof visuomotor feedback training on the recovery of hemispatialneglect symptoms: assessment of a 2-week and follow-upintervention, Neuropsychologia 41 (2003), 886–893.[6] H.-O. Karnath, M.F. Berger, W. Ku¨ker and C. Rorden, Theanatomy of spatial neglect based on Voxelwise StatisticalAnalysis: A Study of 140 Patients, Cerebral Cortex 14 (2004),1164–1172.[7] D.J. Mort, P. Malhotra, S.K. Mannan, C. Rorden, A. Pam-bakian, C. Kennard and M. Husain, The anatomy of visualneglect, Brain 126 (2003), 1986–1997.[8] A.D. Milner and M.A. Goodale, The visual brain in action,Oxford University Press, Oxford, 2006.[9] I.H. Robertson, D. Nico and B.M. Hood, The intention to actimproves unilateral left neglect: two demonstrations, Neu-roreport 7 (1995), 246–248.[10] B.A. Wilson, J. Cockburn and P. Halligan, Behavioural Inat-tention Test, Titchfield, Thames Valley Test Company, 1987.Submit your manuscripts athttp://www.hindawi.comStem CellsInternationalHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014MEDIATORSINFLAMMATIONofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Behavioural NeurologyEndocrinologyInternational Journal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Disease MarkersHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014BioMed Research InternationalOncologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oxidative Medicine and Cellular LongevityHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014PPAR ResearchThe Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Journal ofObesityJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014 Computational and  Mathematical Methods in MedicineOphthalmologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Diabetes ResearchJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Research and TreatmentAIDSHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Gastroenterology Research and PracticeHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Parkinson’s DiseaseEvidence-Based Complementary and Alternative MedicineVolume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

In this study we applied visuomotor feedback and control training to a group of patients suffering from hemispatial neglect. The training was based on the established theoretical approach by Milner andGoodale [8]. This model of vision proposes that thereare two major parallel visual systems within the brain: the occipito-temporal ‘ventral stream’ which provides the hardware for analysing the visual input to furnish a rich representation of the scene; and the occipito-parietal ‘dorsal stream’ (in particular the superior pari-etal lobe) which mediates the transformation of visual inputs into action

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Long-term improvements in activities of daily living in patients with hemispatial neglect

Stirling Online Research Repository (RIOXX)

Harvey, M.

Muir, K.

Reeves, I.

Duncan, G.

Birschel, P.

Roberts, M.A.

Jackson, H.

Hogg, C.

Castle, P.

Learmonth, G.

Rossit, S.

Enlighten: Publications

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University of East Anglia digital repository

http://dspace.stir.ac.uk/retrieve/04c96034-7e36-4be3-8014-865523736034/253161.pdf

Long term improvements in activities of daily living in patients with hemispatial neglect

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