Dataset Information

Musical Neglect Training for Chronic Persistent Unilateral Visual Neglect Post-stroke.

ABSTRACT: Unilateral visual neglect from right hemispheric stroke is a condition that reduces a person's ability to attend to and process stimuli in their left visual field, resulting in neglect and inattention to the left side of their environment. This perceptual processing deficit can negatively affect individuals' daily living which in turn reduces functional independence. Musical Neglect Training (MNT) has been developed based on previous research evidence to improve left visual field processing. Two individuals with persistent chronic unilateral visual neglect participated in this study. Participants underwent six individual MNT sessions. Active MNT was used involving exercises on musical equipment (tone bars) to complete musical patterns emphasizing attentional focus toward the neglect visual field. Two standardized assessments (Albert's and Line Bisection Test) were used. The assessments were administered immediately before and after each of the 6 MNT sessions to assess the within-session effect of MNT. Follow-up testing was done 1 week after their 6th session to examine the longer-lasting effects of MNT. Paired t-test and Wilcoxon signed rank test were used to examine results. Both participants showed significant improvement pre vs. posttest on the Albert's Test but not on the Line Bisection Test. The current study presents the positive potential of MNT for patients with chronic persistent visual neglect. In particular, effects were shown for exploratory visuomotor neglect (Albert's test), but not for egocentric perceptive neglect (Line Bisection Test), and substantiated for within-session effects only. The predictable auditory stimulus patterns associated with object sequences (tone bars) to provide feedback, direct spatial attention and orientation, and initiate intention for movement into the neglect field may offer specific advantages to reduce persistent perceptual attention deficits.

SUBMITTER: Kang K

PROVIDER: S-EPMC6517600 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Musical Neglect Training for Chronic Persistent Unilateral Visual Neglect Post-stroke.

Kang Kyurim K Thaut Michael H MH

Frontiers in neurology 20190508

Unilateral visual neglect from right hemispheric stroke is a condition that reduces a person's ability to attend to and process stimuli in their left visual field, resulting in neglect and inattention to the left side of their environment. This perceptual processing deficit can negatively affect individuals' daily living which in turn reduces functional independence. Musical Neglect Training (MNT) has been developed based on previous research evidence to improve left visual field processing. Two ...[more]

PMID: 31139135

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Project description:INTRODUCTION:Eye movements and spatial attention are closely related, and eye-tracking can provide valuable information in research on visual attention. We investigated the pathology of overt attention in right hemisphere (RH) stroke patients differing in their severity of neglect symptoms by using eye-tracking during a dynamic attention task. METHODS:Eye movements were recorded in 26 RH stroke patients (13 with and 13 without unilateral spatial neglect, and a matched group of 26 healthy controls during a Multiple Object Tracking task. We assessed the frequency and spatial distributions of fixations, as well as frequencies of eye movements to the left and to the right side of visual space so as to investigate individuals' efficiency of visual processing, distribution of attentional processing resources, and oculomotoric orienting mechanisms. RESULTS:Both patient groups showed increased fixation frequencies compared to controls. A spatial bias was found in neglect patients' fixation distribution, depending on neglect severity (indexed by scores on the Behavioral Inattention Test). Patients with more severe neglect had more fixations within the right field, while patients with less severe neglect had more fixations within their left field. Eye movement frequencies were dependent on direction in the neglect patient group, as they made more eye movements toward the right than toward the left. CONCLUSION:The patient groups' higher fixation rates suggest that patients are generally less efficient in visual processing. The spatial bias in fixation distribution, dependent on neglect severity, suggested that patients with less severe neglect were able to use compensational mechanisms in their contralesional space. The observed relation between eye movement rates and directions observed in neglect patients provides a measure of the degree of difficulty these patients may encounter during dynamic situations in daily life and supports the idea that directional oculomotor hypokinesia may be a relevant component in this syndrome.

Project description:BackgroundUnilateral spatial neglect (USN) is common and associated with poor motor and cognitive outcomes as well as impaired quality of life following stroke. Traditionally, the neural substrates underlying USN have been thought to be cortical areas, such as the posterior parietal cortex. However, patients with stroke involving only subcortical structures may also present with USN. While only a few studies have reported on USN in subcortical stroke, the involvement of white matter tracts related to brain networks of visuospatial attention is one possible explanation for subcortical neglect. Therefore, this study aimed to investigate which specific white matter tracts are neural substrates for USN in patients with subcortical stroke.MethodsTwenty-two patients with subcortical stroke without cortical involvement who were admitted to the Department of Rehabilitation Medicine at Seoul National University Bundang Hospital were retrospectively enrolled. Nine subjects were subclassified into a "USN(+)" group, as they had at least two positive results on three tests (the Schenkenberg line bisection test, Albert's test, and house drawing test) and a score of 1 or higher on the Catherine Bergego scale. The remaining 13 subjects without abnormalities on those tests were subclassified into the "USN(-)" group. Stroke lesions on MRI were manually drawn using MRIcron software. Lesion overlapping and atlas-based analyses of MRI images were conducted. The correlation was analyzed between the overlapped lesion volumes with white matter tracts and the severity of USN (in the Albert test and the Catherine Bergego scale).ResultsLesions were more widespread in the USN(+) group than in the USN(-) group, although their locations in the right hemisphere were similar. The atlas-based analyses identified that the right cingulum in the cingulate cortex, the temporal projection of the superior longitudinal fasciculus, and the forceps minor significantly overlapped with the lesions in the USN(+) group than in the USN(-) group. The score of the Catherine Bergego scale correlated with the volume of the involved white matter tracts.ConclusionIn this study, white matter tracts associated with USN were identified in patients with subcortical stroke without any cortical involvement. Our study results, along with previous findings on subcortical USN, support that USN may result from damage to white matter pathways.

Dataset Information

Musical Neglect Training for Chronic Persistent Unilateral Visual Neglect Post-stroke.

Publications

Musical Neglect Training for Chronic Persistent Unilateral Visual Neglect Post-stroke.

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