Multisensory stimulation for the rehabilitation of unilateral spatial neglect

Virtual reality for the assessment and rehabilitation of neglect: where are we now? A 6-year review update

“…Depending on location, type, and severity of the cerebrovascular occlusion, patients typically exhibit two main categories of impairments following the acute phase of a stroke: (i) motor disability, manifested with the inability to walk, problematic coordination and balance, hemiplegia or hemiparesis; (ii) cognitive and neuropsychological impairments, including aphasia, amnesia, executive dysfunctions, apraxia, impaired visuospatial abilities, and mood disorders (Sundar and Adwan 2010 ; Chen et al, 2013 ; Sun et al, 2014 ; Pedroli et al, 2015 ; Jokinen et al, 2015 ; Cipresso et al, 2018a ). Approximately, 50% of patients who suffered from right-brain stroke manifest unilateral spatial neglect (USN), a complex and heterogeneous attentional-perceptual syndrome characterized by a difficulty or inability to pay attention, detect, and orient toward stimuli presented in the contralesional side (Heilman, et al, 2000 ; Tsirlin et al, 2009 ; Pedroli et al, 2015 ; Rode et al, 2017 ; Zigiotto et al, 2020 ). USN can be divided into several subcategories, depending on whether the behavior is elicited by a sensory, motor, or representational modality, or whether it involves one’s peripersonal, extra-personal, or spatial representation (Plummer et al, 2003 ; Buxbaum et al, 2004 ; Grattan and Woodbury, 2017 ).…”

“…Studies that employed functional magnetic resonance imaging (fMRI) on VSN patients’ brains have also shown lesions in the right superior and medio-temporal gyri, the basal ganglia, as well as white matter tracts damages in both uncinate fasciculus and inferior occipitofrontal (Karnath et al, 2011 ; Vuilleumier, 2013 ; Lunven et al, 2015 ; Wahlin et al, 2019 ). Furthermore, the deficits include the ventral and dorsal areas of the attention networks, placed in the fronto-parietal portion of the brain; the ventral attention network (VAN) includes the temporo-parietal and inferior-frontal right cortex and accounts for the detection of unexpected, relevant stimuli, whereas the dorsal attention network (DAN) accounts for the top-down selection of stimuli and comprises portions of the intraparietal and superior frontal cortex (Corbetta et al, 2005 ; Ogourtsova et al, 2018a , 2018b ; Wahlin et al 2019 ; Zigiotto et al, 2020 ).…”

“…At a behavioral level, USN can manifest when patients rotate their head and eyes to the impaired side and focus their attention on the central, unaffected visual field to register information (thus manifesting visuospatial recognition impairment and visual field defects, VFD; Sugihara et al, 2016 ). USN patients fail to orient their attention and detect contralesional auditory, visual, and somatosensory stimuli, as well as to collect and purposely use information located in their contralesional side (Booth, 1982 ; Heilman et al, 2000 ; Tsirlin et al, 2009 ; Aravind and Lamontagne 2018 ; Wahlin et al 2019 ; Zigiotto et al, 2020 ). Moreover, patients affected by USN can collide with static or moving people or objects placed on the contralesional near or far space while performing tasks (Tsirlin et al, 2009 ; Aravind and Lamontagne, 2014 , 2018 ; Aravind et al, 2015 ).…”

“…Furthermore, USN patients manifest different degrees of unawareness of their impairments (i.e., anosognosia) and this condition is associated with motor, cognitive, and sensory deficits. This could result in longer rehabilitation periods, the need for a constant supervision and, overall, poorer prognosis along with a reduced possibility to benefit from rehabilitative interventions (Cherney et al, 2001 ; Azouvi et al, 2003 ; Di Monaco et al, 2011 ; Nijboer et al, 2008 , 2014 ; Tobler-Ammann 2017a , 2017b ; Glize et al, 2017 ; Cipresso et al, 2018a ; Zigiotto et al, 2020 ). This entails the need for a prompt assessment and rehabilitation of USN, in order to reduce its detrimental effects over patients’ functioning and quality of life.…”

May I Smell Your Attention: Exploration of Smell and Sound for Visuospatial Attention in Virtual Reality

“…Focusing on USN treatments, VR-based methods proved in some cases to be even more sensitive in the assessment, especially for mild patients who may not be detected by standard paper-and-pencil test (Kim et al, 2011), while other studies showed better outcomes after VR-based rehabilitation sessions compared with classical methods (Buxbaum et al, 2008;Dawson et al, 2008). Moreover, multisensory stimulation is increasingly recognized and adopted as an effective USN rehabilitation method (Zigiotto et al, 2020), and VR technology constitutes the perfect tool to control and integrate different sensory modalities. Nevertheless, VR implementations of USN rehabilitation methods are focused mainly on visual and auditory stimuli (Tsirlin et al, 2009), and more rarely they include haptic interactions (Baheux et al, 2006;Teruel et al, 2015).To date and to the best knowledge of the authors, there has not been any investigation using olfactory stimuli with neuropsychological visual cancellation task, and this study represents an initial step toward the creation of VR multisensory environments that include olfactory stimulations.…”