Prism Adaptation Improves Ego-Centered but Not Allocentric Neglect in Early Rehabilitation Patients
Prism Adaptation Improves Ego-Centered but Not Allocentric Neglect in Early Rehabilitation Patients
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DOI：
10.1177/1545968313478489
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发表时间：
2013-07-01
影响因子：
4.2
通讯作者：
Hildebrandt, Helmut
中科院分区：
文献类型：
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作者：
Gossmann, Anja;Kastrup, Andreas;Hildebrandt, Helmut
背景和目标。由于顶颞额叶损伤引起的单侧忽视对康复的成功有负面影响，棱镜适应（PA）可促进忽视的恢复。然而，目前尚不清楚这种影响是否也适用于严重受损的患者和/或康复的急性期后阶段。此外，它是不知道是否PA影响忽视恢复或自我为中心的空间定向的所有方面。方法. 16例急性期后患者（大面积右侧脑血管卒中后平均36天）进入一系列单病例设计研究，其中4项测量：PA治疗1周前2项，治疗1周后2项。所有患者都有严重的忽视（显示躯干，头部和眼睛偏离;在视觉取消测试中取消不到20%的目标）。将病变转移到标准大脑中以分析大小和位置。结果患者在提示身体定向和取消任务中，即在以自我为中心的忽视中有所改善。然而，没有一个用于评估忽视左侧的对象，无论他们的位置在右侧或左侧的病人（allocentric忽视）的措施显示出改善。治疗效果不受总病变大小的影响，但病变，包括中央后皮质与较小的恢复增益。结论PA有助于治疗急性期后严重受损的患者，但效果仅限于自我中心忽视。中央后皮质（中枕颞区、中颞区和后顶叶区）的病变似乎限制了PA的作用。
Background and Objective. Unilateral neglect due to parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, and prism adaptation (PA) enhances recovery from neglect. However, it is unclear if this effect holds also in severely impaired patients and/or in the postacute phase of rehabilitation. Moreover, it is not known whether PA affects all aspects of neglect recovery or ego-centered spatial orientation only. Methods. Sixteen patients in a postacute stage (on average 36 days after a large right cerebrovascular stroke) were entered into a series of single case design studies with 4 measurements: 2 before and 2 after 1 week of PA treatment. All patients had severe neglect (showing trunk, head, and eye deviation; canceling less than 20% of targets in a visual cancellation test). Lesions were transferred to a standard brain to analyze size and location. Results. Patients improved in cued body orientation and in the cancellation task, that is, in ego-centered neglect. However, none of the measures used to evaluate neglect of left side of objects irrespective of their position on the right or left side of the patient (allocentric neglect) showed an improvement. Treatment effects were not influenced by total lesion size, but lesions including the postcentral cortex were related to smaller recovery gains. Conclusion. PA is helpful in treating severely impaired patients in the postacute phase, but the effect is restricted to ego-centered neglect. Lesions in the postcentral cortex (middle occipito-temporal, middle temporal, and posterior parietal areas) seem to limit the effect of PA.