ObjectiveSpatial Neglect is prevalent among stroke survivors, yet few treatments have evidence supporting efficacy. This study examines the feasibility of Prism Adaptation Treatment (PAT) within an inpatient rehabilitation facility and... more
ObjectiveSpatial Neglect is prevalent among stroke survivors, yet few treatments have evidence supporting efficacy. This study examines the feasibility of Prism Adaptation Treatment (PAT) within an inpatient rehabilitation facility and the degree by which PAT improves symptoms of spatial neglect and functional independence among sub-acute survivors of right hemispheric stroke.DesignIn this retrospective cohort study, 37 right hemispheric stroke patients were identified as having received at least 4 PAT sessions during their inpatient stay. Spatial neglect and functional independence levels of patients in the PAT cohort were compared to a matched active control group comprised of rehabilitation patients receiving alternative therapies to address neglect admitted during the same time period.ResultsMost patients received the full recommended 10 sessions of PAT (average sessions completed = 8.6). A higher percentage of severe neglect patients receiving PAT (69%) displayed clinically sig...
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Spatial neglect (SN) constitutes a substantial barrier to functional recovery after acquired brain injury. However, because of its multimodal nature, no single test can capture all the signs of SN. To provide a clinically feasible... more
Spatial neglect (SN) constitutes a substantial barrier to functional recovery after acquired brain injury. However, because of its multimodal nature, no single test can capture all the signs of SN. To provide a clinically feasible solution, we used conventional neuropsychological tests as well as the Catherine Bergego Scale (CBS) via the Kessler Foundation Neglect Assessment Process (KF-NAP). The goal was to add evidence that a global approach should detect better even subtle signs of SN. Fourteen individuals with lesions located in the right cerebral hemisphere participated in the study. Participants were assessed with a comprehensive battery of neuropsychological tests, comprising a set of visuospatial tests to evaluate several spatial domains. In addition, patients underwent functional assessment with the Barthel Index, the Functional Independence Measure (FIM), and the CBS via KF-NAP. The CBS via KF-NAP was associated with the visuospatial paper-based tests (p = .004) as well as...
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To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Inception cohort SETTING: Inpatient rehabilitation facility (IRF) PARTICIPANTS: 108 individuals with... more
To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Inception cohort SETTING: Inpatient rehabilitation facility (IRF) PARTICIPANTS: 108 individuals with unilateral brain damage after their first stroke were assessed at the times of IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect, as measured with the Kessler Foundation Neglect Assessment Process (KF-NAP™). Usual and standard IRF care. Functional Independence Measure (FIM™), Conley Scale, number of falls, length of stay (LOS), and discharge disposition. The greater severity of spatial neglect (higher KF-NAP scores) at IRF admission, the lower FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and slower FIM improvement rate. The presence of spatial neglect (KF-NAP > 0), but not Conley Scale scores, predicted falls such that participants with spatial...
Research Interests: Psychology, Rehabilitation, Medicine, Stroke, Humans, and 15 moreFemale, Male, Two Stroke Engine, Length of Stay, Clinical Sciences, Aged, Middle Aged, Neglect, Rehabilitation Centers, Hemispatial Neglect, Socioeconomic Factors, Brain injuries, Severity of Illness Index, Disability Evaluation, and Patient discharge
VALID RESEARCH ON NEGLECT REHABILITATION DEMANDS A STATISTICAL APPROACH COMMENSURATE WITH THE CHARACTERISTICS OF NEGLECT REHABILITATION DATA: neglect arises from impairment in distinct brain networks leading to large between-subject... more
VALID RESEARCH ON NEGLECT REHABILITATION DEMANDS A STATISTICAL APPROACH COMMENSURATE WITH THE CHARACTERISTICS OF NEGLECT REHABILITATION DATA: neglect arises from impairment in distinct brain networks leading to large between-subject variability in baseline symptoms and recovery trajectories. Studies enrolling medically ill, disabled patients, may suffer from missing, unbalanced data, and small sample sizes. Finally, assessment of rehabilitation requires a description of continuous recovery trajectories. Unfortunately, the statistical method currently employed in most studies of neglect treatment [repeated measures analysis of variance (ANOVA), rANOVA] does not well-address these issues. Here we review an alternative, mixed linear modeling (MLM), that is more appropriate for assessing change over time. MLM better accounts for between-subject heterogeneity in baseline neglect severity and in recovery trajectory. MLM does not require complete or balanced data, nor does it make strict a...
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Background and Purpose— Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke.... more
Background and Purpose— Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke. Methods— We performed a case–control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups. Results— Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95...
Research Interests: Geriatrics, Quality of life, Risk, Medicine, Comorbidity, and 15 morePhysical Therapy, Activities of Daily Living, Urinary incontinence, Stroke, Humans, Retirement, Female, Male, Social Environment, Clinical Sciences, Aged, Neurosciences, Case Control Studies, Cohort Studies, and Cardiovascular medicine and haematology
ObjectiveTo examine whether stroke survivors with more severe spatial neglect during their acute inpatient rehabilitation had poorer mobility after returning to their communities.DesignA prospective observational study.SettingAcute... more
ObjectiveTo examine whether stroke survivors with more severe spatial neglect during their acute inpatient rehabilitation had poorer mobility after returning to their communities.DesignA prospective observational study.SettingAcute inpatient rehabilitation and follow‐up in the community.ParticipantsThirty‐one consecutive stroke survivors with right‐brain damage (women, n = 15 [48.4%]), with the mean (standard deviation) age of 60 ± 11.5 years, were included in the study if they demonstrated spatial neglect within 2 months after stroke.MethodsSpatial neglect was assessed with the Behavioral Inattention Test (BIT) (range, 0‐146 [a lower score indicates more severity]) and the Catherine Bergego Scale (range, 0‐30 [a higher score indicates more severity]). A score of the Behavioral Inattention Test <129 or of the Catherine Bergego Scale >0 defined the presence of spatial neglect.Main Outcome MeasurementsThe outcome measure is community mobility, defined by the extent and frequency...
Research Interests: Adolescent, Medicine, Physical Therapy, Activities of Daily Living, Humans, and 15 moreFemale, Male, Clinical Sciences, Aged, Middle Aged, Neglect, Adult, Prognosis, Inpatients, Observational Study, Predictive value of tests, Confidence Interval, Neuropsychological Tests, Disability Evaluation, and Functional independence measure
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Better understanding of cerebral blood flow (CBF) perfusion in stroke recovery can help inform decisions about optimal timing and targets of restorative treatments. In this study, we examined the relationship between cerebral perfusion... more
Better understanding of cerebral blood flow (CBF) perfusion in stroke recovery can help inform decisions about optimal timing and targets of restorative treatments. In this study, we examined the relationship between cerebral perfusion and recovery from stroke‐induced reading deficits. Left stroke patients were tested with a noninvasive CBF measure (arterial spin labeling) <5 weeks post‐stroke, and a subset had follow up testing >3 months post‐stroke. We measured blood flow perfusion within the left and right sides of the brain, in areas surrounding the lesion, and areas belonging to the reading network. Two hypotheses were tested. The first was that recovery of reading function depends on increased perfusion around the stroke lesion. This hypothesis was not supported by our findings. The second hypothesis was that increased perfusion of intact areas within the reading circuit is tightly coupled with recovery. Our findings are consistent with this hypothesis. Specifically, hig...
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Research Interests: Psychology, Neuropsychology, Neurology, Agnosia, Medicine, and 15 moreProblem Solving, Humans, Anomia, Female, Male, Differential Diagnosis, Aged, Middle Aged, Adult, Parietal Lobe, Agraphia, Alzheimer Disease, Neuropsychological Tests, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Psychology, Cognitive Psychology, Perception, Spatial cognition, Attention, and 15 moreMedicine, Space perception, Humans, Spatial ability, Female, Male, Spatial Behavior, Adult, Bias (Epidemiology), Copying, COgnitive and Behavioral Neurology Neuropsychology, Bisection method, Psychomotor Performance, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Attention, Medicine, Movement disorders, Dopamine, and 15 moreBrain, Humans, Male, Clinical Sciences, Middle Aged, Neglect, Public health systems and services research, Videotape Recording, Bromocriptine, Cerebral Infarction, Motor Skills, Agonist, Neuropsychological Tests, dopaminergic, and Adverse effect
Skilled learned purposive movement (praxis) is mediated by a left hemisphere modular (parietal–premotor) network in right-handed people.1 The most sensitive method of screening subjects with neurologic conditions for limb apraxia is to... more
Skilled learned purposive movement (praxis) is mediated by a left hemisphere modular (parietal–premotor) network in right-handed people.1 The most sensitive method of screening subjects with neurologic conditions for limb apraxia is to ask them to produce transitive pantomimes to command (in which tools act on an object, e.g., “show me how you would use a screwdriver to put a screw in the wall”). Subjects with neurologic conditions, such as strokes or neurodegenerative disease, may make a number of qualitatively different errors when attempting to pantomime. For example , they may make content errors (pantomiming the use of a hammer instead of a screwdriver) or they may make movement errors such as incorrect joint coordination (e.g., pantomiming the use of a screwdriver by rotating at the wrist rather than the elbow).2 When testing subjects with apraxia, clinicians have casually observed that, unlike normal subjects, these patients often verbally describe a movement while attempting to pantomime (“Well, I would put my hand on the screwdriver and lift it up, then I would turn it”). Their difficulty cannot be attributed to inadequate understanding of the task, and the inappropriate speech can persist despite explicit instruction to respond with gestures alone. In this pilot investigation, we wished to learn …