Hemispatial neglect - Wikipedia

Hemispatial neglect is a neuropsychological condition in which, after damage to one hemisphere of the brain is sustained, a deficit in attention to and ... Hemispatialneglect FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch MedicalconditionHemispatialneglectOthernamesHemiagnosia,hemineglect,unilateralneglect,spatialneglect,contralateralneglect,unilateralvisualinattention,[1]hemi-inattention,[1]neglectsyndrome,one-sideneglect,[2]orcontralateralhemispatialagnosiaHemispatialneglectismostfrequentlyassociatedwithalesionoftherightparietallobe(inyellow,attop).SpecialtyPsychiatry,Neurology Hemispatialneglectisaneuropsychologicalconditioninwhich,afterdamagetoonehemisphereofthebrainissustained,adeficitinattentiontoandawarenessofonesideofthefieldofvisionisobserved.Itisdefinedbytheinabilityofapersontoprocessandperceivestimuliononesideofthebodyorenvironment,wherethatinabilityisnotduetoalackofsensation.[1]Hemispatialneglectisverycommonlycontralateraltothedamagedhemisphere,butinstancesofipsilesionalneglect(onthesamesideasthelesion)havebeenreported.[3] Contents 1Presentation 1.1Effects 2Causes 3Theoriesofmechanism 3.1Spatialattention 3.2Spatialrepresentation 4Diagnosis 4.1Neglecttest 4.2Varieties 4.2.1Type 4.2.2Range 4.2.3Axis 4.2.4Orientation 5Treatment 6Seealso 7References 8Furtherreading Presentation[edit] Hemispatialneglectresultsmostcommonlyfromstrokesandbrainunilateralinjurytotherightcerebralhemisphere,withratesinthecriticalstageofupto80%causingvisualneglectoftheleft-handsideofspace.Neglectisoftenproducedbymassivestrokesinthemiddlecerebralarteryregionandisvariegated,sothatmostsufferersdonotexhibitallofthesyndrome'straits.[4]Right-sidedspatialneglectisrarebecausethereisredundantprocessingoftherightspacebyboththeleftandrightcerebralhemispheres,whereasinmostleft-dominantbrainstheleftspaceisonlyprocessedbytherightcerebralhemisphere.Althoughitmoststrikinglyaffectsvisualperception('visualneglect'),neglectinotherformsofperceptioncanalsobefound,eitheraloneorincombinationwithvisualneglect.[5] Forexample,astrokeaffectingtherightparietallobeofthebraincanleadtoneglectfortheleftsideofthevisualfield,causingapatientwithneglecttobehaveasiftheleftsideofsensoryspaceisnonexistent(althoughtheycanstillturnleft).Inanextremecase,apatientwithneglectmightfailtoeatthefoodonthelefthalfoftheirplate,eventhoughtheycomplainofbeinghungry.Ifsomeonewithneglectisaskedtodrawaclock,theirdrawingmightshowonlythenumbers12to6,orall12numbersmightbeononehalfoftheclockfacewiththeotherhalfdistortedorblank.Neglectpatientsmayalsoignorethecontralesionalsideoftheirbody;forinstance,theymightonlyshave,orapplymake-upto,thenon-neglectedside.Thesepatientsmayfrequentlycollidewithobjectsorstructuressuchasdoorframesonthesidebeingneglected.[1] Neglectmayalsopresentasadelusionalform,wherethepatientdeniesownershipofalimboranentiresideofthebody.Sincethisdelusionoftenoccursalone,withouttheaccompanimentofotherdelusions,itisoftenlabeledasamonothematicdelusion.[citationneeded] Neglectnotonlyaffectspresentsensationbutmemoryandrecallperceptionaswell.Apatientsufferingfromneglectmayalso,whenaskedtorecallamemoryofacertainobjectandthendrawsaidobject,drawonlyhalfoftheobject.Itisunclear,however,ifthisisduetoaperceptivedeficitofthememory(tothepatienthavinglostpiecesofspatialinformationofthememory)orwhethertheinformationwithinthememoryiswholeandintactbutsimplybeingignored,thesamewayportionsofaphysicalobjectinthepatient'spresencewouldbeignored.[citationneeded] Someformsofneglectmayalsobeverymild—forexample,inaconditioncalledextinctionwherecompetitionfromtheipsilesionalstimulusimpedesperceptionofthecontralesionalstimulus.Thesepatients,whenaskedtofixateontheexaminer'snose,candetectfingersbeingwiggledontheaffectedside.Iftheexaminerweretowigglehisorherfingersonboththeaffectedandunaffectedsidesofthepatient,thepatientwillreportseeingmovementonlyontheipsilesionalside.[6] Effects[edit] Thoughitisfrequentlyunderappreciated,unilateralneglectcanhavedramaticconsequences.Ithasmorenegativeeffectonfunctionalability,asmeasuredbytheBarthelADLindex,thanage,sex,power,sideofstroke,balance,proprioception,cognition,andpremorbidADLstatus.Itspresencewithinthefirst10daysofastrokeisastrongerpredictorofpoorfunctionalrecoveryafteroneyearthanseveralothervariables,includinghemiparesis,hemianopsia,age,visualmemory,verbalmemory,andvisuoconstructionalability.Neglectisprobablyamongthereasonspatientswithrighthemispheredamagearetwiceaslikelytofallasthosewithleft-sidebraindamage.Patientswithneglecttakelongertorehabilitateandmakelessdailyprogressthanotherpatientswithsimilarfunctionalstatus.Patientswithneglectarealsolesslikelytoliveindependentlythanpatientswhohavebothsevereaphasiaandrighthemiparesis.[citationneeded] Causes[edit] Brainareasintheparietalandfrontallobesareassociatedwiththedeploymentofattention(internally,orthrougheyemovements,headturnsorlimbreaches)intocontralateralspace.Neglectismostcloselyrelatedtodamagetothetemporo-parietaljunctionandposteriorparietalcortex.[7]Thelackofattentiontotheleftsideofspacecanmanifestinthevisual,auditory,proprioceptive,andolfactorydomains.Althoughhemispatialneglectoftenmanifestsasasensorydeficit(andisfrequentlyco-morbidwithsensorydeficit),itisessentiallyafailuretopaysufficientattentiontosensoryinput.[citationneeded] Althoughhemispatialneglecthasbeenidentifiedfollowinglefthemispheredamage(resultingintheneglectoftherightsideofspace),itismostcommonafterdamagetotherighthemisphere.[8]Thisdisparityisthoughttoreflectthefactthattherighthemisphereofthebrainisspecializedforspatialperceptionandmemory,whereasthelefthemisphereisspecializedforlanguage-thereisredundantprocessingoftherightvisualfieldsbybothhemispheres.Hencetherighthemisphereisabletocompensateforthelossoflefthemispherefunction,butnotviceversa.[9] Neglectisnottobeconfusedwithhemianopsia.Hemianopsiaarisesfromdamagetotheprimaryvisualpathwayscuttingofftheinputtothecerebralhemispheresfromtheretinas.Neglectisdamagetotheprocessingareas.Thecerebralhemispheresreceivetheinput,butthereisanerrorintheprocessingthatisnotwellunderstood.[citationneeded] Theoriesofmechanism[edit] Researchershavearguedwhetherneglectisadisorderofspatialattentionorspatialrepresentation.[10] Spatialattention[edit] Spatialattentionistheprocesswhereobjectsinonelocationarechosenforprocessingoverobjectsinanotherlocation.[11]Thiswouldimplythatneglectismoreintentional.Thepatienthasanaffinitytodirectattentiontotheunaffectedside.[12]Neglectiscausedbyadecreaseinstimuliinthecontralesionalsidebecauseofalackofipsilesionalstimulationofthevisualcortexandanincreasedinhibitionofthecontralesionalside.[13] Inthistheory,neglectisseenasdisorderofattentionandorientationcausedbydisruptionofthevisualcortex.Patientswiththisdisorderwilldirectattentionandmovementstotheipsilesionalsideandneglectstimuliinthecontralesionalsidedespitehavingpreservedvisualfields.Theresultofallofthisisanincreasedsensitivityofvisualperformanceintheunaffectedside.[13]Thepatientshowsanaffinitytotheipsilesionalsidebeingunabletodisengageattentionfromthatside.[14] Spatialrepresentation[edit] Spatialrepresentationisthewayspaceisrepresentedinthebrain.[6]Inthistheory,itisbelievedthattheunderlyingcauseofneglectistheinabilitytoformcontralateralrepresentationsofspace.[11]Inthistheory,neglectpatientsdemonstrateafailuretodescribethecontralesionalsideofafamiliarscene,fromagivenpoint,frommemory.[citationneeded] Tosupportthistheory,evidencefromBisiachandLuzzatti'sstudyofPiazzadelDuomocanbeconsidered.Forthestudy,patientswithhemispatialneglect,thatwerealsofamiliarwiththelayoutofthePiazzadelDuomosquare,wereobserved.Thepatientswereaskedtoimaginethemselvesatvariousvantagepointsinthesquare,withoutphysicallybeinginthesquare.Theywerethenaskedtodescribedifferentlandmarksaroundthesquare,suchasstores.Ateachseparatevantagepoint,patientsconsistentlyonlydescribedlandmarksontherightside,ignoringtheleftsideoftherepresentation.However,theresultsoftheirmultipledescriptionsatthedifferentvantagepointsshowedthattheyknewinformationaroundtheentiresquare,butcouldonlyidentifytherightsideoftherepresentedfieldatanygivenvantagepoint.Whenaskedtoswitchvantagepointssothatthescenethatwasonthecontralesionalsideisnowontheipsilesionalsidethepatientwasabletodescribewithdetailsthescenetheyhadearlierneglected.[14] Thesamepatternscanbefoundwithcomparingactualvisualstimulitoimaginginthebrain(Rossettietal.,2010).[15]AneglectpatientwhowasveryfamiliarwiththemapofFrancewasaskedtonameFrenchtownsonamapofthecountry,bothbyamentalimageofthemapandbyaphysicalimageofthemap.Theimagewasthenrotated180degrees,bothmentallyandphysically.Withthementalimage,theneglectstayedconsistentwiththeimage;thatis,whenthemapwasinitsoriginalorientation,thepatientnamedtownsmostlyontheEastsideofFrance,andwhentheymentallyrotatedthemaptheynamedtownsmostlyontheWestsideofFrancebecausetheWestcoastwasnowontherightsideoftherepresentedfield.However,withthephysicalcopyofthemap,thepatient'sfocuswasontheEastsideofFrancewitheitherorientation.Thisleadsresearcherstobelievethatneglectforimagesinmemorymaybedisassociatedfromtheneglectofstimuliinextrapersonalspace.[11]Inthiscasepatientshavenolossofmemorymakingtheirneglectadisorderofspatialrepresentationwhichistheabilitytoreconstructspatialframesinwhichthespatialrelationshipofobjects,thatmaybeperceived,imaginedorremembered,withrespecttothesubjectandeachotherareorganizedtobecorrectlyactedon.[14] Thistheorycanalsobesupportedbyneglectindreams(Figliozzietal.,2007).[16]Thestudywasrunonaneglectpatientbytrackinghiseyemovementswhileheslept,duringtheREMcycle.Resultsshowedthatthemajorityoftheeyemovementswereaimedtohisrightside,indicatingthattheimagesrepresentedinhisdreamswerealsoaffectedbyhemispatialneglect.[citationneeded] Anotherexamplewouldbealeftneglectpatientfailingtodescribeleftturnswhiledescribingafamiliarroute.Thisshowsthatthefailuretodescribethingsinthecontralesionalsidecanalsoaffectverbalitems.Thesefindingsshowthatspacerepresentationismoretopologicalthansymbolic.[14]Patientsshowacontralesionallossofspacerepresentationwithadeviationofspatialreferencetotheipsilesionalside.[6]Inthesecasesweseealeft-rightdissimilarityofrepresentationratherthanadeclineofrepresentationalcompetence.[12] Diagnosis[edit] Neglecttest[edit] Someoftheneglecttests. Lettersearchneglecttest Lettersearchneglecttestresult Linecancellationneglecttest Linecancellationneglecttestresult TheAllochiriaphenomenamightberevealedbytherequesttodrawaclock. Thepatientshastomarkthehalfoftheline. Inordertoassessnotonlythetypebutalsotheseverityofneglect,doctorsemployavarietyoftests,mostofwhicharecarriedoutatthepatient'sbedside.Perhapsoneofthemost-usedandquickestisthelinebisection.Inthistest,alineafewincheslongisdrawnonapieceofpaperandthepatientisthenaskedtodissectthelineatthemidpoint.Patientsexhibiting,forexample,left-sidedneglectwillexhibitarightwarddeviationoftheline'struemidpoint.[6] Anotherwidelyusedtestisthelinecancellationtest.Here,apatientispresentedwithapieceofpaperthathasvariouslinesscatteredacrossitandisaskedtomarkeachofthelines.Patientswhoexhibitleft-sidedneglectwillcompletelyignorealllinesontheleftsideofthepaper.[6] Visualneglectcanalsobeassessedbyhavingthepatientdrawacopyofapicturewithwhichtheyarepresented.Ifthepatientisaskedtodrawacomplexpicturetheymayneglecttheentirecontralesionalsideofthepicture.Ifaskedtodrawanindividualobject,thepatientwillnotdrawthecontralesionalsideofthatobject.[12] Apatientmayalsobeaskedtoreadapageoutofabook.Thepatientwillbeunabletoorienttheireyestotheleftmarginandwillbeginreadingthepagefromthecenter.Presentingasinglewordtoapatientwillresultinthepatienteitherreadingonlytheipsilesionalpartofthewordorreplacingtheparttheycannotseewithalogicalsubstitute.Forexample,iftheyarepresentedwiththeword"peanut",theymayread"nut"orsay"walnut".[12] Varieties[edit] Neglectisaheterogenousdisorderthatmanifestsitselfradicallydifferentlyindifferentpatients.Nosinglemechanismcanaccountforthesedifferentmanifestations.[11]Avastarrayofimpairedmechanismsarefoundinneglect.Thesemechanismsalonewouldnotcauseneglect.[12]Thecomplexityofattentionalone—justoneofseveralmechanismsthatmayinteract—hasgeneratedmultiplecompetinghypotheticalexplanationsofneglect.Soitisnotsurprisingthatithasprovendifficulttoassignparticularpresentationsofneglecttospecificneuroanatomicalloci.Despitesuchlimitations,wemaylooselydescribeunilateralneglectwithfouroverlappingvariables:type,range,axis,andorientation.[citationneeded] Type[edit] Typesofhemispatialneglectarebroadlydividedintodisordersofinputanddisordersofoutput.Theneglectofinput,or"inattention",includesignoringcontralesionalsights,sounds,smells,ortactilestimuli.Surprisingly,thisinattentioncanevenapplytoimaginedstimuli.Inwhat'stermed"representationalneglect",patientsmayignoretheleftsideofmemories,dreams,andhallucinations. Outputneglectincludesmotorandpre-motordeficits.Apatientwithmotorneglectdoesnotuseacontralesionallimbdespitetheneuromuscularabilitytodoso.Onewithpre-motorneglect,ordirectionalhypokinesia,canmoveunaffectedlimbsablyinipsilateralspacebuthavedifficultydirectingthemintocontralesionalspace.Thusapatientwithpre-motorneglectmaystruggletograspanobjectontheleftsideevenwhenusingtheunaffectedrightarm.[citationneeded] Range[edit] Hemispatialneglectcanhaveawiderangeintermsofwhatthepatientneglects.Thefirstrangeofneglect,commonlyreferredtoas"egocentric"neglect,isfoundinpatientswhoneglecttheirownbodyorpersonalspace.[17]Thesepatientstendtoneglecttheoppositesideoftheirlesion,basedonthemidlineofthebody,head,orretina.[18]Forexample,inagapdetectiontest,subjectswithegocentrichemispatialneglectontherightsideoftenmakeerrorsonthefarrightsideofthepage,astheyareneglectingthespaceintheirrightvisualfield.[19] Thenextrangeofneglectis"allocentric"neglect,whereindividualsneglecteithertheirperi-personalorextrapersonalspace.Peri-personalspacereferstothespacewithinthepatient'snormalreach,whereasextrapersonalspacereferstotheobjects/environmentbeyondthebody'scurrentcontactorreachingability.[17]Patientswithallocentricneglecttendtoneglectthecontralesionalsideofindividualitems,regardlessofwheretheyappearwithrespecttotheviewer.[18]Forexample,Inthesamegapdetectiontestmentionedabove,subjectswithallocentrichemispatialneglectontherightsidewillmakeerrorsonallareasofthepage,specificallyneglectingtherightsideofeachindividualitem.[19] Thisdifferentiationissignificantbecausethemajorityofassessmentmeasurestestonlyforneglectwithinthereaching,orperi-personal,range.Butapatientwhopassesastandardpaper-and-penciltestofneglectmaynonethelessignorealeftarmornotnoticedistantobjectsontheleftsideoftheroom. Incasesofsomatoparaphrenia,whichmaybecausedbypersonalneglect,patientsdenyownershipofcontralesionallimbs.Sacks(1985)describedapatientwhofelloutofbedafterpushingoutwhatheperceivedtobetheseveredlegofacadaverthatthestaffhadhiddenunderhisblanket.Patientsmaysaythingslike,"Idon'tknowwhosehandthatis,butthey'dbettergetmyringoff!"or,"Thisisafakearmsomeoneputonme.Isentmydaughtertofindmyrealone." Axis[edit] Mosttestsforneglectlookforrightwardorleftwarderrors.Butpatientsmayalsoneglectstimuliononesideofahorizontalorradialaxis.Forexample,whenaskedtocircleallthestarsonaprintedpage,theymaylocatetargetsonboththeleftandrightsidesofthepagewhileignoringthoseacrossthetoporbottom.[citationneeded] Inarecentstudy,researchersaskedpatientswithleftneglecttoprojecttheirmidlinewithaneonbulbandfoundthattheytendedtopointitstraightaheadbutpositionitrightwardoftheirtruemidline.Thisshiftmayaccountforthesuccessoftherapeuticprismglasses,whichshiftleftvisualspacetowardtheright.Byshiftingvisualinput,theyseemtocorrectthemind'ssenseofmidline.Theresultisnotonlytheameliorationofvisualneglect,butalsooftactile,motor,andevenrepresentationalneglect. Orientation[edit] Animportantquestioninstudiesofneglecthasbeen:"leftofwhat?"Thatistosay,whatframeofreferencedoesasubjectadoptwhenneglectingthelefthalfofhisorhervisual,auditory,ortactilefield?Theanswerhasprovencomplex.Itturnsoutthatsubjectsmayneglectobjectstotheleftoftheirownmidline(egocentricneglect)ormayinsteadseealltheobjectsinaroombutneglectthelefthalfofeachindividualobject(allocentricneglect).[20] Thesetwobroadcategoriesmaybefurthersubdivided.Patientswithegocentricneglectmayignorethestimulileftwardoftheirtrunks,theirheads,ortheirretinae.[20]Thosewithallocentricneglectmayneglectthetrueleftofapresentedobject,ormayfirstcorrectintheirmind'seyeaslantedorinvertedobjectandthenneglectthesidetheninterpretedasbeingontheleft.[21]So,forexample,ifpatientsarepresentedwithanupside-downphotographofaface,theymaymentallyfliptheobjectrightsideupandthenneglecttheleftsideoftheadjustedimage.Inanotherexample,ifpatientsarepresentedwithabarbell,patientswillmoresignificantlyneglecttheleftsideofthebarbell,asexpectedwithrighttemporallobelesion.Ifthebarbellisrotatedsuchthattheleftsideisnowontherightside,patientswillmoresignificantlyneglecttheleftsideoftheobject,eventhoughitisnowontherightsideofspace.[21]Thisalsooccurswithslantedormirror-imagepresentations.ApatientlookingatamirrorimageofamapoftheWorldmayneglecttoseetheWesternHemispheredespitetheirinvertedplacementontotherightsideofthemap. Variousneuropsychologicalresearchstudieshaveconsideredtheroleofframeofreferenceinhemispatialneglect,offeringnewevidencetosupportbothallocentricandegocentricneglect.Tobegin,onestudyconductedbyDongyunLi,Hans-OttoKarnath,andChristopherRordenexaminedwhetherallocentricneglectvarieswithegocentricposition.Thisexperimentaldesignconsistedoftestingelevenrighthemisphericstrokepatients.Fiveofthesepatientsshowedspatialneglectontheircontralesionalside,whiletheremainingsixpatientsshowednospatialneglect.[22]Duringthestudy,thepatientswerepresentedwithtwoarraysofseventriangles.Thefirstarrayranfromsouthwesttonortheast(SW-NE)andthesecondarrayranfromsoutheasttonorthwest(SE-NW).Inaportionoftheexperimentaltrials,themiddletriangleinthearraycontainedagapalongoneside.Participantsweretestedontheirabilitytoperceivethepresenceofthisgap,andwereinstructedtopressoneresponsebuttonifthegapwaspresentandasecondresponsebuttonifthegapwasabsent.[22] Totesttheneglectframeofreference,thetwodifferentarrayswerecarefullysituatedsothatgapinthetrianglefellonoppositesidesoftheallocentricfield.IntheSW-NEarray,thegapinthetrianglefellontheallocentricrightoftheobject-centeredaxisalongwhichthetrianglepointed.IntheSE-NWconfiguration,thegapinthetrianglefellontheallocentricleftoftheobject-centeredaxis.[22]Furthermore,varyingthepositionofthearrayswithrespecttotheparticipant'strunkmidlinewasusedtotestegocentricneglect.Thearrayswerethereforepresentedat0°(i.e.inlinewiththeparticipant'strunkmidline),at−40°left,andat+40°right.[22]Ultimately,varyingthepositionofthearraywithinthetestingvisualfieldallowedforthesimultaneousmeasurementofegocentricneglectandallocentricneglect.Theresultsofthisexperimentaldesignshowedthatthespatialneglectpatientsperformedmorepoorlyfortheallocentricleftsideofthetriangle,aswellasforobjectspresentedontheegocentricleftsideofthebody.[22]Furthermore,thepooraccuracyfordetectingfeaturesoftheobjectontheleftsideoftheobject'saxiswasmoreseverewhentheobjectswerepresentedonthecontralesionalsideofthebody.Thus,thesefindingsillustratethatbothallocentricandegocentricbiasesarepresentsimultaneously,andthategocentricinformationcaninfluencetheseverityofallocentricneglect.[22] Asecondstudy,conductedbyMoscovitchandBehrmann,investigatedthereferenceframeofneglectwithrespecttothesomatosensorysystem.Elevenpatientswithparietallobelesionsandsubsequenthemispatialneglectwereanalyzedduringthisexperiment.[23]Adoublesimultaneousstimulationprocedurewasutilized,duringwhichthepatientsweretouchedlightlyandsimultaneouslyontheleftandrightsideofthewristofonehand.Thepatientsweretestedbothwiththeirpalmsfacingdownandwiththeirpalmsfacingup.[23]Thisexperimentalconditionallowedthescientiststodeterminewhetherneglectinthesomatosensorysystemoccurswithrespecttothesensoryreceptorsurface(egocentric)orwithrespecttoahigher-orderspatialframeofreference(allocentric).Theresultsofthisexperimentshowedthehemispatialneglectpatientsneglectedsomatosensorystimulionthecontralesionalsideofspace,regardlessofhandorientation.[23]Thesefindingssuggestthat,withinthesomatosensorysystem,stimuliareneglectedwithrespecttotheallocentric,spatialframeofreference,inadditiontoanegocentric,sensoryframeofreference.[23]Ultimately,thediscoveriesmadebytheseexperimentsindicatethathemispatialneglectoccurswithrespecttomultiple,simultaneouslyderivedframesofreference,whichdictatethenatureandextentofneglectwithinthevisual,auditory,andtactilefields. Treatment[edit] Treatmentconsistsoffindingwaystobringthepatient'sattentiontowardtheleft,usuallydoneincrementally,bygoingjustafewdegreespastmidline,andprogressingfromthere.Rehabilitationofneglectisoftencarriedoutbyneuropsychologists,occupationaltherapists, speech-languagepathologists,neurologicmusictherapists,physicaltherapists,optometrists,andorthoptists. Formsoftreatmentthathavebeentestedwithvariablereportsofsuccessincludeprismaticadaptation,whereaprismlensisworntopullthevisionofthepatienttowardstheleft,constrainedmovementtherapywherethe"good"limbisconstrainedinaslingtoencourageuseofthecontralesionallimb.Eye-patchinghassimilarlybeenused,placingapatchoverthe"good"eye.Pharmaceuticaltreatmentshavemostlyfocusedondopaminergictherapiessuchasbromocriptine,levodopa,andamphetamines,thoughthesetestshavehadmixedresults,helpinginsomecasesandaccentuatinghemispatialneglectinothers.Caloricvestibularstimulation(CVS)hasbeenshowntobringaboutabriefremissioninsomecases.[24]howeverthistechniquehasbeenknowntoelicitunpleasantside-effectssuchasnystagmus,vertigoandvomiting.[25] AstudydonebySchindlerandcolleaguesexaminedtheuseofneckmusclevibrationonthecontralesionalposteriorneckmusclestoinducediversionofgazefromthesubjectivestraightahead.Subjectsreceived15consecutivetreatmentsessionsandwereevaluatedondifferentaspectsoftheneglectdisorderincludingperceptionofmidline,andscanningdeficits.Thestudyfoundthatthereisevidencethatneckmusclestimulationmaywork,especiallyifcombinedwithvisualscanningtechniques.Theimprovementwasevident2monthsafterthecompletionoftreatment.[26] Otherareasofemergingtreatmentoptionsincludetheuseofprisms,visualscanningtraining,mentalimagerytraining,videofeedbacktraining,trunkrotation,galvanicvestibularstimulation(GVS),transcranialmagneticstimulation(TMS)andtranscranialdirect-currentstimulation(tDCS).Oftheseemergingtreatmentoptions,themoststudiedinterventionisprismadaptationandthereisevidenceofrelativelylong-termfunctionalgainsfromcomparativelyshort-termusage.However,allofthesetreatmentinterventions(particularlythestimulationtechniques)arerelativelynewandrandomised,controlledtrialevidenceisstilllimited.Furtherresearchismandatoryinthisfieldofresearchinordertoprovidemoresupportinevidence-basedpractice.[27] InareviewarticlebyPierce&Buxbaum(2002),theyconcludedthattheevidenceforHemisphericActivationApproaches,whichfocusesonmovingthelimbonthesideoftheneglect,hasconflictingevidenceintheliterature.[28]Theauthorsnotethatapossiblelimitationinthisapproachistherequirementforthepatientstoactivelymovetheneglectedlimb,whichmaynotbepossibleformanypatients.Constraint-InducedTherapy(CIT),appearstobeaneffective,long-termtreatmentforimprovingneglectinvariousstudies.However,theuseofCITislimitedtopatientswhohaveactivecontrolofwristandhandextension.PrismGlasses,HemispatialGlasses,andEye-Patchinghaveallappeartobeeffectiveinimprovingperformanceonneglecttests.CaloricStimulationtreatmentappearstobeeffectiveinimprovingneglect;however,theeffectsaregenerallyshort-term.ThereviewalsosuggeststhatOptokineticStimulationiseffectiveinimprovingpositionsense,motorskills,bodyorientation,andperceptualneglectonashort-termbasis.AswithCaloricStimulationtreatment,long-termstudieswillbenecessarytoshowitseffectiveness.AfewTrunkRotationTherapystudiessuggestitseffectivenessinimprovingperformanceonneglecttestsaswellastheFunctionalIndependenceMeasure(FIM).SomelessstudiedtreatmentpossibilitiesincludetreatmentsthattargetDorsalStreamofvisualprocessing,MentalImageryTraining,andNeckVibrationTherapy.[28]Trunkrotationtherapiesaimedatimprovingposturaldisordersandbalancedeficitsinpatientswithunilateralneglect,havedemonstratedoptimisticresultsinregainingvoluntarytrunkcontrolwhenusingspecificposturalrehabilitativedevices.OnesuchdeviceistheBonSaintCômeapparatus,whichusesspatialexploratorytasksincombinationwithauditoryandvisualfeedbackmechanismstodeveloptrunkcontrol.TheBonSaintCômedevicehasbeenshowntobeeffectivewithhemiplegicsubjectsduetothecombinationoftrunkstabilityexercises,alongwiththecognitiverequirementsneededtoperformtheposturaltasks.[29] Seealso[edit] Agnosia(particularlymirroragnosia) Allochiria Anosognosia Blindsight Braindamage Crossmodalattention Delusion Hemimotorneglect Monothematicdelusion References[edit] ^abcdUnsworth,C.A.(2007).CognitiveandPerceptualDysfunction.InT.J.Schmitz&S.B.O'Sullivan(Eds.),PhysicalRehabilitation(pp.1149-1185).Philadelphia,F.A:DavisCompany. ^"One-SidedNeglect". ^Kim,M;Na,DL;Kim,GM;Adair,JC;Lee,KH;Heilman,KM(1999)."Ipsilesionalneglect:behaviouralandanatomicalfeatures".JournalofNeurology,Neurosurgery&Psychiatry.67(1):35–38.doi:10.1136/jnnp.67.1.35.PMC 1736416.PMID 10369819. ^Li,Korina;PareshA.Malhotra(2015)."Review:Spatialneglect".PracticalNeurology.15(5):333–339.doi:10.1136/practneurol-2015-001115.PMC 4602245.PMID 26023203. ^Giuseppe,VallarM.(2015)."SpatialNeglect".JournalofNeurology,Neurosurgery&Psychiatry.86(9):e3.4–e3.doi:10.1136/jnnp-2015-311750.12.S2CID 23426250. ^abcdeFarah,MarthaJ.(2004).Thecognitiveneuroscienceofvision(Repr. ed.).Malden,Mass.:Blackwell.p. 208.ISBN 978-0631214038. ^Vallar,Giusepppe(March1998)."Spatialhemineglectinhumans".TrendsinCognitiveSciences.2(3):87–95.doi:10.1016/s1364-6613(98)01145-0.PMID 21227084.S2CID 15366153. ^Kleinman,Jonathan;Newhart,Melissa;Davis,Cameron;Heidler-Gary,Jeniffer;Gottesman,Rebecca;Hillis,Argyie(2007)."RightHemispatialNeglect:FrequencyandCharacterizationFollowingAcuteLeftHemisphereStroke".BrainandCognition.64(1):50–59.doi:10.1016/j.bandc.2006.10.005.PMC 1949495.PMID 17174459. ^Iachini,Tina;Ruggiero,Gennaro;Conson,Massimiliano;Trojano,Luigi(2009)."Lateralizationofegocentricandallocentricspatialprocessingafterparietalbrainlesions".BrainandCognition.69(3):514–20.doi:10.1016/j.bandc.2008.11.001.PMID 19070951.S2CID 22773671. ^Bradshaw,JohnL.;Mattingley,JasonB.(1995).Clinicalneuropsychology :behavioralandbrainscience.SanDiego,Calif.:AcademicPress.pp. 125–174.ISBN 978-0121245450. ^abcdD'Esposito,Mark,ed.(2003).Neurologicalfoundationsofcognitiveneuroscience([Online-Ausg.] ed.).Cambridge,Mass.:MIT.pp. 1–19.ISBN 978-0262042093. ^abcdeMesulam,[ed.by]M.-Marsel(2000).Principlesofbehavioralandcognitiveneurology(2. ed.).Oxford[u.a.]:OxfordUniv.Press.pp. 174–239.ISBN 978-0195134759. ^abBrandt,Thomas;Dieterich,Marianne;Strupp,Michael;Glasauer,Stefan(2012)."ModelApproachtoNeurologicalVariantsofVisuo-spatialNeglect".BiologicalCybernetics.106(11–12):681–90.doi:10.1007/s00422-012-0517-3.PMID 22941239.S2CID 17077259. ^abcdBisiach,Edoardo(1996)."UnilateralNeglectandtheStructureofSpaceRepresentation".CurrentDirectionsinPsychologicalScience.5(2):62–65.doi:10.1111/1467-8721.ep10772737.S2CID 7971943. ^RodeG.,CottonF.,Jacquin-CourtoisS.,RossettiY.,BartolomeoP.(2010)."Representationanddisconnectioninimaginalneglect".Neuropsychologia.48(10):2903–2911.doi:10.1016/j.neuropsychologia.2010.05.032.PMID 20621588.S2CID 25650432.{{citejournal}}:CS1maint:multiplenames:authorslist(link) ^Doricchi,F.;Iaria,G.;Silvetti,M.;Figliozzi,F.;Siegler,I.(2007)."The"ways"welookatdreams:evidencefromunilateralspatialneglect(withanevolutionaryaccountofdreambizarreness".ExperimentalBrainResearch:450-461. ^abVaishnavi,Sandeep;JesseCalhoun;AnjanChatterjee(February2001)."BindingPersonalandPeripersonalSpace:EvidencefromTactileExtinction"(PDF).JournalofCognitiveNeuroscience.13(2):181–189.CiteSeerX 10.1.1.483.6296.doi:10.1162/089892901564243.PMID 11244544.S2CID 9438503.Archivedfromtheoriginal(PDF)on14June2010.Retrieved6May2012. ^abKleinman,Jonathan;MelissaNewhart;CameronDavis;JenniferHeidler-Gary;RebeccaGottesman;ArgyeHillis(2007)."Righthemispatialneglect:Frequencyandcharacterizationfollowingacutelefthemispherestroke"(PDF).BrainandCognition.64(1):50–59.doi:10.1016/j.bandc.2006.10.005.PMC 1949495.PMID 17174459.Retrieved8May2012. ^abKleinman,Jonathan;MelissaNewhart;CameronDavis;JenniferHeidler-Gary;RebeccaGottesman;ArgyeHillis(2007)."Righthemispatialneglect:Frequencyandcharacterizationfollowingacutelefthemispherestroke(Fig.2)".BrainandCognition.64(1):50–59.doi:10.1016/j.bandc.2006.10.005.PMC 1949495.PMID 17174459. ^abBeschin,N;Cubelli,R;Sala,S.D.;Spinazzola,L(1997)."LeftofWhat?Theroleofegocentriccoordinatesinneglect".JournalofNeurology,Neurosurgery&Psychiatry.63(4):483–489.doi:10.1136/jnnp.63.4.483.PMC 2169750.PMID 9343128. ^abTipper,S.P.;Behrmann,M.(1996)."Object-centerednotscene-basedvisualneglect".JournalofExperimentalPsychology:HumanPerceptionandPerformance.22(5):1261–1278.doi:10.1037/0096-1523.22.5.1261.PMID 8865621. ^abcdefLi,D;Karnath,H;Rorden,C(2014)."Egocentricrepresentationsofspaceco-existwithallocentricrepresentations:Evidencefromspatialneglect".Cortex.58:161–169.doi:10.1016/j.cortex.2014.06.012.PMC 4130897.PMID 25038308. ^abcdMoscovitch,M;Behrmann,M(1994)."Codingofspatialinformationintehsomatosensorysystem:evidencefrompatientswithneglectfollowingparietallobedamage".JournalofCognitiveNeuroscience.6(2):151–155.doi:10.1162/jocn.1994.6.2.151.PMID 23962367.S2CID 26156232. ^Gainotti,Guido(1993)."TheRoleofSpontaneousEyeMovementsinOrientingAttentionandinUlinateralNeglect".InRobertson,IanH.;Marshall,JohnC.(eds.).Unilateralneglect:clinicalandexperimentalstudies.pp. 107–22.ISBN 978-0-86377-208-5. ^MillerS.M.;Ngo.T.T.(2007)."Studiesofcaloricvestibularstimulation:implicationsforthecognitiveneurosciences,theclinicalneurosciencesandneurophilosophy".ActaNeuropsychiatrica.19(3):183–203.doi:10.1111/j.1601-5215.2007.00208.x.PMID 26952856.S2CID 26119745. ^SchindlerI,KerkhoffG,KarnathHO,KellerI,GoldenbergG(2002)."Neckmusclevibrationinduceslastingrecoveryinspatialneglect".JournalofNeurology,Neurosurgery&Psychiatry.73(4):412–9.doi:10.1136/jnnp.73.4.412.PMC 1738082.PMID 12235310. ^LuauteJ,HalliganP,RodeG,Jacquin-CourtoisS,BoissonD(2006)."Prismadaptationfirstamongequalsinalleviatingleftneglect:Areview".RestorativeNeurologyandNeuroscience.24(4–6):409–418. ^abPierceS.R.;BuxbaumL.J.(2002)."Treatmentsofunilateralneglect:Areview".ArchivesofPhysicalMedicineandRehabilitation.83(2):256–268.doi:10.1053/apmr.2002.27333.PMID 11833032. ^deSezeM.;WiartL.;Bon-Saint-ComeA.;DebelleixX.;deSezeM.;JosephP.;et al.(2001)."Rehabilitationofposturaldisturbancesofhemiplegicpatientsbyusingtrunkcontrolretrainingduringexploratoryexercises".ArchivesofPhysicalMedicineandRehabilitation.82(6):793–800.doi:10.1053/apmr.2001.0820793.PMID 11387585.Archivedfromtheoriginalon2011-11-05.Retrieved2011-05-13. Notes Hans-OttoKarnath;A.DavidMilner;GiuseppeVallar(2002).Thecognitiveandneuralbasesofspatialneglect.Oxford[Oxfordshire]:OxfordUniversityPress.ISBN 978-0-19-850833-5. Robertson,I.H.,&Halligan,P.W.(1999).Spatialneglect:Aclinicalhandbookfordiagnosisandtreatment.Hove,EastSussex:Erlbaum. Heilman,K.MandValenstein,E.(2003)ClinicalNeuropsychology:FourthEdition Husain,Masud;Rorden,Chris(2003)."Non-spatiallylateralizedmechanismsinhemispatialneglect".NatureReviewsNeuroscience.4(1):26–36.doi:10.1038/nrn1005.PMID 12511859.S2CID 11450338. Furtherreading[edit] Bartolomeo,Paolo(2014).Attentiondisordersafterrightbraindamage:Livinginhalvedworlds[permanentdeadlink]London :Springer,2014.(thecontentisremovedfromthelink.) Bartolomeo,Paolo(2007)."Visualneglect"(PDF).CurrentOpinioninNeurology.20(4):381–6.doi:10.1097/WCO.0b013e32816aa3a3.PMID 17620870.S2CID 18332604. ThomasHoffman,Themanwhosebrainignoreshalfofhislife,TheGuardian.Friday23November201208.27EST HusainMasud(2008)."PDF".Scholarpedia.3(2):3681.doi:10.4249/scholarpedia.3681. RobinWalkerUnilateralNeglect:ClinicalandExperimentalStudiesdetailedbookreviewatMonashUniversityandUniversityofDurham Schindler,l;KerkhoffG;KarnathHO;KellerI;GoldenbergG.(2002)."Neckmusclevibrationinduceslastingrecoveryinspatialneglect".JournalofNeurology,Neurosurgery&Psychiatry.73(4):412–9.doi:10.1136/jnnp.73.4.412.PMC 1738082.PMID 12235310. Vaishnavi,Sandeep;JesseCalhoun;AnjanChatterjee(February2001)."BindingPersonalandPeripersonalSpace:EvidencefromTactileExtinction"(PDF).JournalofCognitiveNeuroscience.13(2):181–189.CiteSeerX 10.1.1.483.6296.doi:10.1162/089892901564243.PMID 11244544.S2CID 9438503.Archivedfromtheoriginal(PDF)on14June2010.Retrieved6May2012. Kleinman,Jonathan;MelissaNewhart;CameronDavis;JenniferHeidler-Gary;RebeccaGottesman;ArgyeHillis(2007)."Righthemispatialneglect:Frequencyandcharacterizationfollowingacutelefthemispherestroke"(PDF).BrainandCognition.64(1):50–59.doi:10.1016/j.bandc.2006.10.005.PMC 1949495.PMID 17174459.Retrieved8May2012. Kleinman,Jonathan;MelissaNewhart;CameronDavis;JenniferHeidler-Gary;RebeccaGottesman;ArgyeHillis(2007)."Righthemispatialneglect:Frequencyandcharacterizationfollowingacutelefthemispherestroke(Fig.2)".BrainandCognition.64(1):50–59.doi:10.1016/j.bandc.2006.10.005.PMC 1949495.PMID 17174459. vteSignsandsymptomsrelatingtomovementandgaitGait Gaitabnormality CNS Scissorgait Cerebellarataxia Festinatinggait Marcheàpetitpas Propulsivegait Stompinggait Spasticgait Magneticgait Truncalataxia Muscular Myopathicgait Trendelenburggait Pigeongait Steppagegait Antalgicgait Coordination Ataxia Cerebellarataxia Dysmetria Dysdiadochokinesia Pronatordrift Dyssynergia Sensoryataxia Asterixis Abnormalmovement Athetosis Tremor Fasciculation Fibrillation Posturing Abnormalposturing Opisthotonus Spasm Trismus Cramp Tetany Myokymia Jointlocking Paralysis Flaccidparalysis Spasticparaplegia Spasticdiplegia Spasticparaplegia Syndromes Monoplegia Diplegia/Paraplegia Hemiplegia Triplegia Tetraplegia/Quadruplegia Generalcauses Uppermotorneuronlesion Lowermotorneuronlesion Weakness Hemiparesis Other Rachiticrosary Hyperreflexia Clasp-kniferesponse vteSignsandsymptoms,andsyndromesassociatedwithlesionsofthebrainandbrainstemCerebralcortex ACAsyndrome MCAsyndrome PCAsyndrome Aphasia Frontallobe Expressiveaphasia Abulia Parietallobe Receptiveaphasia Hemispatialneglect Gerstmannsyndrome Astereognosis Occipitallobe Bálint'ssyndrome Corticalblindness Purealexia Temporallobe Corticaldeafness Prosopagnosia Subcortex Basalganglia Chorea Dystonia Parkinson'sdisease Thalamicsyndrome Cerebellum Lateral Dysmetria Dysdiadochokinesia Intentiontremor Medial Cerebellarataxia BrainstemMedulla Lateralmedullarysyndrome/Wallenberg PICA Medialmedullarysyndrome/Dejerine ASA Pons Upperdorsalpontinesyndrome/Raymond–Céstansyndrome Lateralpontinesyndrome(AICA)(lateral) Medialpontinesyndrome/Millard–Gublersyndrome/Foville'ssyndrome(basilar) Locked-insyndrome Internuclearophthalmoplegia Oneandahalfsyndrome Midbrain Weber'ssyndrome ventralpeduncle,PCA Benediktsyndrome ventraltegmentum,PCA Parinaud'ssyndrome dorsal,tumor Claude'ssyndrome Other Alternatinghemiplegia Other Uppermotorneuronlesion ClassificationDICD-9-CM:781.8ExternalresourceseMedicine:neuro/719 Authoritycontrol:Nationallibraries Israel UnitedStates Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Hemispatial_neglect&oldid=1085014661" Categories:Symptomsandsigns:NervoussystemSyndromesHiddencategories:CS1maint:multiplenames:authorslistArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromDecember2020ArticleswithunsourcedstatementsfromAugust2021AllarticleswithdeadexternallinksArticleswithdeadexternallinksfromApril2022ArticleswithpermanentlydeadexternallinksArticleswithJ9UidentifiersArticleswithLCCNidentifiers Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages العربيةCatalàČeštinaDanskDeutschEspañolفارسیFrançaisՀայերենÍslenskaItalianoעבריתMagyarNederlands日本語NorskbokmålPolskiPortuguêsRipoarischРусскийSarduSuomiSvenskaไทยTürkçe中文 Editlinks