Visuospatial neglekt. Mesulam s test. Test ur BIT

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1 Visuospatial neglekt Mesulam s test Test ur BIT 1

2 Ex Patient What are the characteristic key symptoms of neglect? 1) Initial ipsi-lesional bias 2) Inattention 3) An asymmetric inattention 4) Unawareness of the inattention Viken, J., Jood, K., Jern, C., Blomstrand, C., & Samuelsson, H. (2014). Ipsilesional bias and processing speed in visual search are important predictors of functional dependency following a right hemisphere stroke. The Clinical Neuropsychologist. 28(6), Samuelsson, H., Hjelmquist, E., Naver, H., & Blomstrand, C.. Visuospatial neglect and an ipsilesional bias during the start of performance in conventional tests of neglect. Clinical Neuropsychologist, 10(1), Samuelsson, H., Hjelmquist, E. K. E., Jensen, C., & Blomstrand, C. (2002). Search pattern in a verbally reported visual scanning test in patients showing spatial neglect. Journal of the International Neuropsychological Society, 8(3), Broeren, J., Samuelsson, H., Stibrant-Sunnerhagen, K., Blomstrand, C., & Rydmark, M. (2007). Neglect assessment as an application of virtual reality. Acta Neurologica Scandinavica, 116(3),

3 Visuospatial neglect After a stroke: 20-23% After a right hemisphere stroke: 32-44% After a left hemisphere stroke: 8-20% Samuelsson, H, Hjelmquist, EKE, et al. (1997; ) Pedersen, PM; Jørgensen, HS, et al. (1997); Ringman, JM, Saver, JL, et al. (2004); Appelros, P; Karlsson, GM, et al (2002) Husain and Rorden, Nature reviews, Neuroscience, volume 4 jan

4 Additional phenomenon that we have identified as important clinical symptoms following neglect 1) A general decrease in processing speed / reaction time 2) An unsystematic visual search-pattern Samuelsson, H., Hjelmquist, E. K. E., Jensen, C., & Blomstrand, C. (2002). Search pattern in a verbally reported visual scanning test in patients showing spatial neglect. Journal of the International Neuropsychological Society, 8(3), Broeren, J., Samuelsson, H., Stibrant-Sunnerhagen, K., Blomstrand, C., & Rydmark, M. (2007). Neglect assessment as an application of virtual reality. Acta Neurologica Scandinavica, 116(3), Non-spatial tasks. Regions activated in: Sustained attention (red) Spatial updating across saccades (green) Salience (blue) These areas, activated in non-spatial tasks, are also the regions commonly damaged in neglect patients. Husain and Rorden, Nature reviews, Neuroscience, volume 4 jan

5 Ventral and dorsal networks of attention CLINICAL NEUROPSYCHOLOGY - Christopher Rorden - Masud Husain - Samuelsson H, et al. - Hans-Otto Karnath Brain damage and behavior COGNITIVE NEUROCIENCE Brain imaging and experimental studies Brain networks of attention Maurizio Corbetta B. T. Thomas Yeo Michael I. Posner COGNITIVE PSYCHOLOGY Experimental studies of attention: -Attention blindness Neural mechanisms of conscious experiences Geraint Rees Stanislas Dehaene Arien Mack and Irvin Rock Neglekt - orsakat av en skada på två olika system för orientering av spatial uppmärksamhet Varna för viktig information utanför focus Flytta fokus för uppmärksamheten (Corbetta, Kincade et al., 2000; Corbetta & Shulman 2002) 5

6 Spatial (rumslig) uppmärksamhet Två system Ett system för orientering av uppmärksamheten Både hö o vä hjärnhalva (Corbetta, Kincade et al., 2000; Corbetta & Shulman 2002) Ett system som i bakgrunden avläser stimuli som kommer in till hjärnan - Ett system för att automatiskt avbryta pågående inriktning och re-orientera uppmärksamheten till ett nytt område Hö hjärnhalva dominant Vid neglekt Hyperattention 6

7 Vid neglekt CLINICAL NEUROPSYCHOLOGY Brain damage and behavior Samuelsson H, Jensen C, Ekholm S et al. Hans-Otto Karnath and Christopher Rorden Masud Husain COGNITIVE NEUROCIENCE Brain imaging and experimental studies Brain networks of attention Maurizio Corbetta B. T. Thomas Yeo COGNITIVE PSYCHOLOGY Experimental studies of attention: -Inattentional blindness Neural mechanisms of conscious experiences Geraint Rees Stanislas Dehaene Arien Mack and Irvin Rock 7

8 Inattentional blindness Arien Mack and Irvin Rock Inattentional blindness Arien Mack and Irvin Rock, Inattentional blindness, MIT Press, 1998 The illusion of attention Christopher Chabris and Daniel Simons, The invisible gorilla, Crown Archetype,

9 Film Emotional processing and its impact on unilateral neglect and extinction. Neuropsychologia 50 (2012) Domínguez-Borràsa, Saja, Armonyc, and Vuilleumier. Emotional processing and its impact on unilateral neglect and extinction. Neuropsychologia 50 (2012)

10 Spatialt neglekt Kan visa sig på många olika sätt I yttre rummet -vs- I inre föreställning ( representational ) Visuellt - - Auditivt Inom räckhåll -vs- Utom räckhåll ( peripersonal ) ( extrapersonal ) Kroppscentrerat -vs- Objektscentrerat (egocentric) (allocentric) Perceptual -vs- Motor-intentional Mapping the functional neuroanatomy of spatial neglect and human parietal lobe functions: progress and challenges. Vuilleumier, P. Ann. N.Y. Acad. Sci (2013) Meta-analysis of 20 lesion-mapping studies of neglect symptoms. The likelihood of lesion peaks is illustrated on an inflated brain template 10

11 Allocentric neglect The apple cancellation test 11

12 Cognitive rehabilitation for spatial neglect following stroke A Cochrane review Bowen A, Hazelton C, Pollock A, Lincoln NB Published in The Cochrane Library, 2013, Issue 7 Our review of 23 studies involving 628 participants with stroke found - Insufficient evidence - some limited evidence but the quality of this evidence was poor and more research is needed A systematic review Luaute, Halligan el al. (2006) Träningsmetoder med bäst vetenskapligt stöd = Studier som mätt functional outcome och som visat bestående förändringar i kliniskt relevanta funktionsområden minst 4-6 veckor efter träningsperioden. Skall vara: gruppstudier med en kontrollgrupp eller Single case studies with baseline studies 12

13 Träningsmetoder med bäst vetenskapligt stöd Visual scanning training Visual scanning training+trunk rotation Visual scanning training+neck muscle vibration Video feedback training Prism adaptation 13

14 Rehabilitating Patients With Left Spatial Neglect by Prism Exposure During a Visuomotor Activity Paola Fortis et al. Neuropsychology, 2010, Vol. 24, No. 6, Conclusions: Daily life visuomotor activities, associated with prism exposure, are a useful tool for rehabilitating USN patients. This new treatment may widen the compliance with prism exposure treatments and their feasibility within homebased programs. 14

15 The SAHLSIS and stroke research group Christina Jern Katarina Jood Christian Blomstrand Gunilla Forsberg-Wärleby Hans Samuelsson Lisbeth Claesson Tara Stanne Gunnel Carlsson Charlotte Blomgren Christer Jensen Caisa Hofgren Ingrid Eriksson Jenny Ödquist Jo Viken Joel Gerafi Josefine Persson Lukas Holmegaard Petra Redfors Susanne Nilsson Sven-Öjvind Swahn Thomas Linden Anders Gummesson Anke Brederlau Annika Nordanstig Åsa Rejnö Annie Pedersen Tamara Abzhandadze Martina Olsson Saideh Rajaei 15

16 Spatial Neglect: A Clinical Handbook for Diagnosis and Treatment by Peter W Halligan and Ian Robertson 16