Analyses of human object recognition abilities led to the hypothesis that 2 kinds of spatial relation representations are used in human vision. Evidence for the distinction between abstract categorical spatial relation representations and specific coordinate spatial relation representations was provided in 4 experiments. These results indicate that Ss make categorical judgments--on/off, left/right, and above/below--faster when stimuli are initially presented to the left cerebral hemisphere, whereas they make evaluations of distance--in relation to 2 mm, 3 mm, or 1 in. (2.54 cm)--faster when stimuli are initially presented to the right cerebral hemisphere. In addition, there was evidence that categorical representations developed with practice.

IMPORTANCE Many patients receive suboptimal rehabilitation therapy doses after stroke owing to limited access to therapists and difficulty with transportation, and their knowledge about stroke is often limited. Telehealth can potentially address these issues.OBJECTIVES To determine whether treatment targeting arm movement delivered via a home-based telerehabilitation (TR) system has comparable efficacy with dose-matched, intensity-matched therapy delivered in a traditional in-clinic (IC) setting, and to examine whether this system has comparable efficacy for providing stroke education. DESIGN, SETTING, AND PARTICIPANTSIn this randomized, assessor-blinded, noninferiority trial across 11 US sites, 124 patients who had experienced stroke 4 to 36 weeks prior and had arm motor deficits (Fugl-Meyer [FM] score, 22-56 of 66) were enrolled between September 18, 2015, and December 28, 2017, to receive telerehabilitation therapy in the home (TR group) or therapy at an outpatient rehabilitation therapy clinic (IC group). Primary efficacy analysis used the intent-to-treat population.INTERVENTIONS Participants received 36 sessions (70 minutes each) of arm motor therapy plus stroke education, with therapy intensity, duration, and frequency matched across groups.MAIN OUTCOMES AND MEASURES Change in FM score from baseline to 4 weeks after end of therapy and change in stroke knowledge from baseline to end of therapy.RESULTS A total of 124 participants (34 women and 90 men) had a mean (SD) age of 61 ( 14) years, a mean (SD) baseline FM score of 43 (8) points, and were enrolled a mean (SD) of 18.7 (8.9) weeks after experiencing a stroke. Among those treated, patients in the IC group were adherent to 33.6 of the 36 therapy sessions (93.3%) and patients in the TR group were adherent to 35.4 of the 36 assigned therapy sessions (98.3%). Patients in the IC group had a mean (SD) FM score change of 8.36 (7.04) points from baseline to 30 days after therapy (P < .001), while those in the TR group had a mean (SD) change of 7.86 (6.68) points (P < .001). The covariate-adjusted mean FM score change was 0.06 (95% CI, -2.14 to 2.26) points higher in the TR group (P = .96). The noninferiority margin was 2.47 and fell outside the 95% CI, indicating that TR is not inferior to IC therapy. Motor gains remained significant when patients enrolled early (<90 days) or late (Ն90 days) after stroke were examined separately.CONCLUSIONS AND RELEVANCE Activity-based training produced substantial gains in arm motor function regardless of whether it was provided via home-based telerehabilitation or traditional in-clinic rehabilitation. The findings of this study suggest that telerehabilitation has the potential to substantially increase access to rehabilitation therapy on a large scale.

Age differences were examined in 4 aspects of visual mental imagery, namely, image generation, maintenance, scanning, and rotation. The results suggested that one or more distinct processes are used to carry out each aspect of imagery, and that this is true for 5-year-olds, 8-year-olds, 14-year-olds, and adults. There was no evidence that younger children have fewer processing components, which become differentiated into more specialized subsystems over age. In addition, the results suggested that younger children are relatively poor at scanning, rotating, and generating objects in images, but are relatively good at maintaining images.

Objective To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Design Inception cohort Setting Inpatient rehabilitation facility (IRF) Participants 108 individuals with unilateral brain damage after their first stroke were assessed at the times of IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect, as measured with the Kessler Foundation Neglect Assessment Process (KF-NAP™). Interventions Usual and standard IRF care. Main Outcome Measures Functional Independence Measure (FIM™), Conley Scale, number of falls, length of stay (LOS), and discharge disposition. Results The greater severity of spatial neglect (higher KF-NAP scores) at IRF admission, the lower FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and slower FIM improvement rate. The presence of spatial neglect (KF-NAP > 0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. Conclusions Spatial neglect following a stroke is a prevalent problem, and may negatively affect rehabilitation outcome, risk of falls, and length of hospital stay.