Unilateral Neglect: Assessment and Rehabilitation

Abstract

Over 795,000 individuals in the U.S. suffer from strokes annually, with 610,000 accounting for first attacks. Stroke represents the fifth leading cause of death and resulting long-term disability in the United States. Unilateral neglect (UN) is a disabling characteristic of stroke, occurring from lesion damage to one hemisphere of the brain. Individuals with UN do not respond normally to objects, stimuli, and people located to their contralesional side. Right hemispheric lesions exhibit the greatest impairment. Incidence rates of UN vary from 13%-81%. Impairment of this condition impedes an individual's capacity to execute activities of daily living. Diagnosis can be challenging and if left untreated, results in poorer patient outcomes. While standardized test battery covering multiple domains have demonstrated enhanced detection for diagnosis over single test methods, and combination treatment modalities have shown promise in procuring symptom abatement, there is a paucity of evidence on the long-term effects of neglect therapy and its transferability into daily life. Stroke expenditures impose a significant economic encumbrance on healthcare systems with costs estimated at $34 billion per annum in the U.S. alone. Effectively delineating and treating UN would enhance integrated stroke services, improve patient outcomes and reduce the lifetime cost of stroke.

Immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the unilateral spatial neglect model

“…Unilateral spatial neglect (USN) is a common disabling condition following right brain damage, is typically characterized by a failure to respond to stimuli and realize on the contralateral side and unable to use extremities opposite the lesion [1][2][3] . This neglect condition caused impaired mobility, decreased long-term functional outcomes, limited ability to complete daily activities, and restricted social participation 4,5) . Various training modalities and therapeutic interventions have been devel-oped to overcome complex USN problems 6,7) .…”

The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol

“…Unilateral spatial neglect is a lateralised attention disorder characterised by the failure to orient to, attend to, respond to, or report stimuli appearing on the contralesional hemispace (Buxbaum et al, 2004; Vuilleumier, 2013), despite having intact sensory abilities (Howard & Rowe, 2018). It is commonplace, long-lasting, but highly variable following stroke (Kaufmann, Cazzoli, Muri, Nef, & Nyffeler, 2020a; Kaufmann et al, 2020b; Harvey, Learmonth, Rossit, & Chen, 2021; Ringman, Saver, Woolson, Clarke, & Adams, 2004) and results in long-term major disability (Checketts et al, 2020; Conti & Amone, 2016; Wee & Hopman, 2008). Lateralised frontoparietal neuroanatomical networks, especially in the right hemisphere, are strongly implicated in the pathology (He et al, 2007; Pedrazzini & Ptak, 2020; Wu et al, 2016).…”

Efficacy of Repetitive Transcranial Magnetic Stimulation Combined With Visual Scanning Treatment on Cognitive-Behavioral Symptoms of Unilateral Spatial Neglect in Patients With Traumatic Brain Injury: Study Protocol for a Randomized Controlled Trial

“…Rehabilitation methods for LHSN associated symptoms were extensively investigated in persons with right cerebral stroke (4)(5)(6)(7)(8). Previous studies showed the efficacy of 1 Hz inhibitory repetitive Transcranial Magnetic Stimulation (i-rTMS) on visuospatial symptoms in persons with an ischemic lesion of the right hemisphere.…”