Recent trends in rehabilitation interventions for visual neglect and anosognosia for hemiplegia following right hemisphere stroke

Abstract

This article highlights the most recent findings regarding the rehabilitation interventions for the syndromes of visual neglect and anosognosia for hemiplegia that occur following right hemisphere stroke. We review papers published in the past 4 years pertaining to therapeutic approaches for these two syndromes in order to identify the trends in the development of effective interventions.Overall, it appears well recognized that visual neglect syndromes and awareness syndromes frequently co-occur and both include complex, multifaceted impairments leading to significant difficulties in daily life functioning following stroke. Thus, the interventions for these syndromes must be multifaceted in order to address the complex interplay of cognitive-behavioral-emotional components. There appears to be a trend for using combination therapeutic interventions that address these components. Keywordsanosognosia; awareness; intervention; neglect; rehabilitation; stroke Neglect and anosognosia for hemiplegia (AHP) are two neuropsychological syndromes that occur following right hemisphere stroke with regular frequency [1,2]. Neglect is an impairment in attention or response to stimuli in the hemispace contralateral to the lesion not attributable to a primary sensory or motor deficit [3], whereas AHP is an unawareness of motor impairment and the changes in functioning that result from that motor impairment. Incidence rates range from 13 to 85% of cases of right hemisphere stroke for neglect syndromes and 17-28% for AHP [4]. Notably, hemispatial neglect has been found to occur after left hemisphere stroke, but is often under-recognized and has drawn less clinical and research attention [5].

Impaired insight into illness and cognitive insight in schizophrenia spectrum disorders: Resting state functional connectivity

“…Future research is required to replicate these findings and to determine if they are generalizable to other neuropsychiatric disorders that may exhibit impaired clinical or cognitive insight. Noninvasive techniques, including transcranial magnetic, direct current or caloric vestibular stimulation—shown to induce spatial hemineglect in healthy controls, transiently reverse anosognosia in right hemisphere damaged stroke patients, and improve clinical insight in schizophrenia spectrum and bipolar disorders (Cappa et al, 1987; Oliveri et al, 2001; Miller and Ngo, 2007; Sparing et al, 2009; Kortte and Hillis, 2011; Levine et al, 2012), can be used to further investigate the theory of interhemispheric imbalance of clinical insight in schizophrenia spectrum disorders.…”

Another perspective on anosognosia: Self-observation in video replay improves motor awareness

“…As outlined in the introduction, there have been recent advances in the management of AHP by providing specific rehabilitation guidelines and strategies (see Jenkinson et al, 2011 andMorrene-Stupinsky, 2010, for reviews), with temporary remission of AHP also recently being reported using a combination of techniques (see Beschin et al, 2012). Unfortunately, despite these rehabilitation efforts, there is currently no known, efficacious intervention for permanent restoration of motor awareness in patients with AHP (Kortte & Hills, 2011;Jenkinson et al, 2011).…”

Making It Right? Some Thoughts about the Future of Treatment for Right Hemisphere Cognitive-Communication Disorders

“…7 I also predict continued growth in the clinical community's understanding of complex conditions and of less conventional treatment options. Knowledge of the diversity and many facets of disorders that have significant consequences for patient outcomes, like neglect and anosognosia, 8 will become more common, along with an awareness of the wealth of treatment possibilities for these impairments. 1,8 The multiple techniques developed to address neglect, for example, including several elaborated in the Emerging Technologies section that follows, have gone far beyond the time-worn exhortations for the patient to "look to the left" or putting a red line on the left side of a page.…”

“…Knowledge of the diversity and many facets of disorders that have significant consequences for patient outcomes, like neglect and anosognosia, 8 will become more common, along with an awareness of the wealth of treatment possibilities for these impairments. 1,8 The multiple techniques developed to address neglect, for example, including several elaborated in the Emerging Technologies section that follows, have gone far beyond the time-worn exhortations for the patient to "look to the left" or putting a red line on the left side of a page. 1,8 I predict that speech-language clinicians will be better versed in these newer techniques and more credibly bring their talents to multidisciplinary treatment teams as a result.…”

“…1,8 The multiple techniques developed to address neglect, for example, including several elaborated in the Emerging Technologies section that follows, have gone far beyond the time-worn exhortations for the patient to "look to the left" or putting a red line on the left side of a page. 1,8 I predict that speech-language clinicians will be better versed in these newer techniques and more credibly bring their talents to multidisciplinary treatment teams as a result. I also expect speech-language clinicians to become more knowledgeable of interventions that can improve functioning in people who are not aware of their deficits, including those that build on procedural learning, 1,9,10 and I hope that this knowledge reduces the therapeutic nihilism that can penalize patients who have anosognosia.…”