Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients

Abstract

Objectives: The evolutionary pattern of spontaneous recovery from acute neglect was studied by assessing cognitive deficits and motor impairments. Detailed lesion reconstruction was also performed to correlate the presence of and recovery from neglect to neural substrates. Methods: A consecutive series of right brain-damaged (RBD) patients with and without neglect underwent weekly tests in the acute phase of the illness. The battery assessed neglect deficits, neglect-related deficits, and motor impairment. Age-matched normal subjects were also investigated to ascertain the presence of non lateralised attentional deficits. Some neglect patients were also available for later investigation during the chronic phase of their illness. Results: Partial recovery of neglect deficits was observed at the end of the acute period and during the chronic phase. Spatial attention was impaired in acute neglect patients, while non spatial attentional deficits were present in RBD patients with and without acute neglect. A strong association was found between acute neglect and fronto-parietal lesions. Similar lesions were associated with neglect persistence. In the chronic stage, neglect recovery was paralleled by improved motor control of the contralesional upper limb, thus emphasising that neglect is a negative prognostic factor in motor functional recovery. Conclusions: These findings show that spatial attention deficits partially improve during the acute phase of the disease in less than half the patients investigated. There was an improvement in left visuospatial neglect at a later, chronic stage of the disease, but this recovery was not complete. N eglect patients most frequently fail in the acute phase to respond to contralesional stimuli following right hemisphere damage, 1-3 although many patients may ignore contralesional stimuli for months or even years after the lesion. [4][5][6][7][8] Despite the theoretical relevance of neglect evolution and its practical implications for rehabilitation, little is known about the pattern of spontaneous recovery of neglect. This study addressed four main questions. First, which attentional component (for example, spatial, sustained) is specifically impaired in acute neglect? Second, which aspects of the syndrome recover spontaneously in the acute phase (,6 weeks after stroke)? Third, how many patients recover in the acute and more chronic phases (.3 months after stroke), and which characteristics differentiate these patients from those who do not recover? Fourth, what are the anatomical correlates of acute and persistent neglect?Regarding the first issue, both spatial and non spatial deficits were investigated.9-12 If disorders of sustained and divided attention play a specific role in determining neglect, then right brain-damaged (RBD) patients with neglect should be more impaired than patients without neglect in tests probing these attentional components.Second, the spontaneous recovery patterns of spatial and non spatial attention were studied for a 2 week period during the acute ph...

Effectiveness of Prism Adaptation in Neglect Rehabilitation

“…The ANOVA conducted on cancellation tasks scores with the factor session showed similar results; the main effect of session was significant (F [2,18]ϭ13.52; PϽ0.0003; ϭ0.77). Post hoc tests showed that although an improvement was found between baseline (42%) and post-NP (57%; PϽ0.05) scores, the improvement was much stronger after PA (meanϭ77%; SDϭ18; PϽ0.008 for both comparisons).…”

“…Post hoc tests showed that although an improvement was found between baseline (42%) and post-NP (57%; PϽ0.05) scores, the improvement was much stronger after PA (meanϭ77%; SDϭ18; PϽ0.008 for both comparisons). Finally, the ANOVA conducted on reading accuracy scores showed a significant effect of session (F [2,18]ϭ7.58; PϽ0.005; ϭ0.60); reading accuracy was not significantly different before (77%) and after NP (81%; Pϭ0.09), whereas it was significantly higher after PA (meanϭ85%; SDϭ24; PϽ0.05 for both comparisons).…”

“…An ANOVA was conducted with the within-subjects factors session (session of prism exposure from 1 to 10) and trial (T1, T2, and T3) and the between-subjects factor group. A significant effect of trial (F [2,36]ϭ35.48; PϽ0.00001) demonstrates that pointing errors were progressively reduced from the first 30 trials of PA (T1ϭ0.84°) to the middle trials 31 to 60 (T2ϭ0.16), and to the last 30 trials (T3ϭ0.09; PϽ0.002 in all comparisons). This result shows that patients wearing prisms typically exhibit an initial rightward deviation in their pointing, which is progressively reduced to compensate for the prismatic optical displacement.…”

“…An ANOVA performed on BIT scores in patients in the NP group, with 2 within-subjects factors of session (baseline, post-NP, and post-PA) and scale (BIT-B and BIT-C), showed a significant effect of session (F [2,18]ϭ25.42; PϽ0.000001; ϭ0.85). In comparison to the baseline session (71), patients' scores improved both after NP (81; PϽ0.02) and after PA (meanϭ98; SDϭ11; PϽ0.0002); however, the scores obtained after PA were significantly better than those after NP (PϽ0.0005; see Figure 2).…”

“…Although some spontaneous recovery occurs in the majority of cases, 1,2 neglect symptoms remain severe in many patients. 1,2 Such symptoms may persist chronically [2][3][4] with debilitating impact on everyday life. 5 A variety of rehabilitation techniques have been explored 6,7 and the prism adaptation technique (PA) in particular has been shown to ameliorate neglect symptoms in large populations of patients.…”