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Development of a Visual Cueing System Using Immersive Virtual Reality for Object-Centered Neglect in Stroke Patients

  • June 2018
DOI:10.1109/SMC.2018.00182
  • Conference: Proceeding of The 2018 IEEE International Conference on Systems, Man, and Cybernetics (SMC2018)
Authors:
Akinori Hagiwara
Akinori Hagiwara
Akinori Hagiwara
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Kazuhiro Yasuda at Waseda University
Kazuhiro Yasuda
Kenta Saichi
Kenta Saichi
Kenta Saichi
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Daisuke Muroi at Kameda Medical Center
Daisuke Muroi
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Abstract and Figures

Unilateral spatial neglect (USN) is defined as failure to report, respond, or adjust to novel or meaningful stimuli presented to the side opposite a brain lesion. This symptom deteriorates the rehabilitation efficiency and hinders activities of daily living. USN is classified into 2 sub-categories: body-centered neglect and object-centered neglect. No optimal intervention has been proposed for treating object-centered neglect. Thus, we developed a visual cueing system using immersive virtual reality to improve object-centered neglect. A feasibility study showed 2 typical measurements for object-centered neglect tended to improve the symptom, these results provide preliminary evidence for designing successful rehabilitation programs using a visual cueing system in patients with object-centered neglect.
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Development of a visual cueing system using
immersive virtual reality for object-centered neglect
in stroke patients
Akinori Hagiwara
Graduate School of Creative
Science and Engineering
Waseda University
Tokyo, Japan
akinori-
hagiwara@iwata.mech.waseda.ac
.jp
Kazuhiro Yasuda
Research Institute for Science
and Engineering
Waseda University
Tokyo, Japan
kazuhiro-yasuda@aoni.waseda.jp
Kenta Saichi
Graduate School of Creative
Science and Engineering
Waseda University
Tokyo, Japan
k.saichi27@gmail.com
Daisuke Muroi
Department of Rehabilitaion
Kameda Medical Center
Chiba, Japan
mutyon88@hotmail.com
Shuntarou Kawaguchi
Department of Rehabilitaion
Sonoda Rehabilitation Hospital
Tokyo, Japan
taro_0128_0112@yahoo.co.jp
Masahiro Ohira
Department of Rehabilitation
Yokohama Shinmidori General
Hospital
Midori-ku Yokohamashi, Japan
theijapan@yahoo.co.jp
Tadamitsu Matsuda
Department of Physical Therapy,
Facluty of Social Work Studies
Josai International University
Chiba, Japan
funwavesurfgogo@yahoo.co.jp
Hiroyasu Iwata
Faculuty of Science and
Engineering
Waseda University
Tokyo, Japan
jubi@waseda.ac.jp
Abstract—Unilateral spatial neglect (USN) is defined as
failure to report, respond, or adjust to novel or meaningful
stimuli presented to the side opposite a brain lesion. This
symptom deteriorates the rehabilitation efficiency and hinders
activities of daily living. USN is classified into 2 sub-categories:
body-centered neglect and object-centered neglect. No optimal
intervention has been proposed for treating object-centered
neglect. Thus, we developed a visual cueing system using
immersive virtual reality to improve object-centered neglect. A
feasibility study showed 2 typical measurements for object-
centered neglect tended to improve the symptom, these results
provide preliminary evidence for designing successful
rehabilitation programs using a visual cueing system in patients
with object-centered neglect.
Keywords—Unilateral Spatial Neglect, Object-centered Neglect,
Visualized Cueing
I. INTRODUCTION
Unilateral spatial neglect (USN) is commonly defined as a
failure to report, respond, or adjust to stimuli that are presented
contralateral to a brain lesion [1]. Approximately 50% of
stroke patients suffer from USN, which impedes the activities
of daily living [2][3][4]. For example, individuals with USN
leave food on the neglected side of their plate and fail to look
to the opposite side of the street when crossing. These
symptoms strongly interfere with these patients’ ability to live
independent lives [5]. Thus, optimal intervention for USN is
crucial for stroke rehabilitation [6].
USN is classified into 2 sub-categories: body-centered
neglect and object-centered neglect [7][8]. In body-centered
neglect, the neglected side (mainly the left side) may refer to
the left of the body midline, whereas object-centered neglect is
defined as an omission or inattention to the contralesional side
of an individual object [9]. It is well known that damage to the
frontal-parietal lobe network causes body-centered neglect, and
the temporal-parietal lobe network corresponds to object-
centered neglect [9][10].
Various rehabilitation interventions have been explored for
USN treatment. Proposals for the treatment of body-centered
neglect include visual search task, prism adaptation, limb
activation, and optokinetic stimulation [11][12]. Further, we
recently developed a first-person view in an immersive VR
environment with a head-mounted display (HMD) to develop a
tractable USN rehabilitation system that allows training in 3D
virtual environments in both near and far space [13]. However,
these interventions are not intended to treat object-centered
neglect [14]. Thus, we proposed a visual cueing system using
immersive virtual reality for object-centered neglect in stroke
patients to explore its applicability for future clinical use.
Moreover, we examined the validity and feasibility of the
proposed device through a case series of stroke patients with
object-centered neglect.
II. SYSTEM OVERVIEW
Our system consists of an HMD (Oculus Rift CV1, Oculus
VR., Inc.) and a personal computer as shown in Fig. 1. We
1022
2018 IEEE International Conference on Systems, Man, and Cybernetics
2577-1655/18/$31.00 ©2018 IEEE
DOI 10.1109/SMC.2018.00182
developed a VR environment using Unity software (Unity
Technologies). In this system, a tracking sensor acquires
information on the patient’s head position and the head
rotation is reflected in the VR environment. Patients with
object-centered neglect are not able to recognize the
contralesional side of an individual object [9].
Figure 1. System overview
Thus, this system displays clue stimulation in the VR
environment to guide the patient’s attention to the neglected
side of the target object. In this way, the patient is able to
recognize the neglected side of the target object. Furthermore,
this system shuts down the surrounding stimuli (i.e., other
stimulus around the target) through blackout in the VR
environment.
A. Visual cueing system
The VR system displays clue stimulation to guide the
patient’s attention to the neglected side and shuts down (i.e.,
blackout) the visual stimuli around the target object to induce
passive (inactive) attention as shown in Fig. 2. It has been
reported that damage to the ventral posterior temporal lobe,
which is the ventral pathway of visual information processing,
causes object-centered neglect [15]. In general, the ventral
stream is responsible for passive attention [15]. Accordingly,
we used red color clues and flashes to induce passive attention.
Moreover, the blackout prevented the patient from removing
attention from the clue.
In the VR intervention, the therapist operates the system with
a series of 4 actions, which are as follows: 1) display the clue
stimulation, 2) blackout the surrounding environment, 3)
move the clue stimulation, and 4) remove the blackout (Fig.
2). With these 4 actions, the system draws the patient’s
attention to the neglected side of the object (green panel).
After the 4 actions, the therapist asks the patient to read the 4-
digit number on the green panel.
Figure 2. Visual cueing in immersive VR
III. THE
CLINICAL
TRIAL
The clinical trial (case series with 4 patients) was
performed to examine the validity and feasibility of the system.
The Waseda University Ethics Committee approved all the
procedures in this study.
A. Target
Four patients with stroke (mean age: 64.0 ± 11.2 years)
were included in the study. Patients had to satisfy the following
criteria: a) a symptom of object-centered neglect, b) the ability
to communicate well and sufficiently understand instructions
provided by the researcher, and c) no other medical conditions
that could interfere with the performance on tests for visual
neglect and trial design.
B. Research design
The entire procedure was conducted at a
rehabilitation center using a pre-post design. Prior to the
intervention, patients underwent specific tests for neglect. In
the VR intervention, patients wore the HMD while in the
sitting position, and the clue stimulation was used to direct the
patient’s attention to the neglected side of the target object
(i.e., 4 actions with the VR system described in the visual
cueing system). Patients repeated the 4 actions a total of 10
times. After the intervention, patients performed the specific
test for neglect that was identical to the pre-test.
C. Evaluation and variable
Variables: The following conventional variables were used
to describe the patient’s degree of neglect: a) the Apples Test
[16], which is a cancellation task, in which outline drawings of
150 apples are shown pseudorandomly scattered over an A4
paper sheet presented in landscape orientation, wherein one-
1023
third of the apples are full (targets) and two-thirds are open on
either the left or the right side (Fig. 3); b) the Line Bisection
Test of the Behavioral Inattention Test (BIT) [17][18], in
which patients are asked to mark the center of 3 horizontal
lines placed on the right, center, and left of an A4 sheet and
deviation from the true center is measured (Fig. 4). In general,
tests a and b were used to evaluate object-centered neglect.
Patients performed these 2 tests in far space to examine the
neglect symptoms in far spaceFrom ecological perspective,
we were interested in testing any change in test performance
related to far space (i.e., no paper and pencil test). In the Far
Space Test, the measurement test was projected on the wall,
and patients used a pointer to check the stimuli in the test [13].
Figure 3. Apples test
Figure 4. Line Bisection task
Analysis: To examine the difference between the pre- and
post-test, we calculated the ratios from the values of each
measurement at the pre- and post-test including: a). X1 is the
number of checked apples those has no clack. X2 is the number
of checked apples those has a clack on the neglect side. neglect
severity on the Apples Test as the error ratio is E, which is
calculated by
Ε=Χ2/(Χ1+Χ2) ίίί(1)
; b) neglect severity on the Line Bisection Test as the
percent deviation by the ratio of the length between the
checked position and the neglect end of the line to the length of
the line.
D. Results
The calculated ratios of each test are shown in Fig. 5 and 6. As
shown in Fig. 5, 3 of 4 patients showed reduced error ratio on
the Apples Test. The percent deviation in the Line Bisection
Test for all of the patients tended to be reduced (Fig. 6).
Figure 5. Error ratio on the Apples Test
Figure 6. Percent deviation on the Line Bisection Test
IV. DISCUSSIO N
Following the intervention, the error ratio decreased in 3 of
4 patients on the Apples Test, and there was a tendency for the
check position to be moved to the neglected side in all 4
patients. Given that these 2 typical measurements for object-
centered neglect tended to improve the symptom, these results
provide preliminary evidence for designing successful
rehabilitation programs using a visual cueing system in
patients with object-centered neglect. Although the underlying
mechanisms are still unknown, the activation of passive
attention (ventral pathway) using optimal visual stimuli in the
1024
immersive VR environment may be involved.
This feasibility study was conducted using only 4 stroke
patients. Furthermore, we only investigated the immediate
effect of the visual cueing system. Thus, long-term intervention
studies including larger samples are required to further
examine the therapeutic efficacy of this proposed system in
stroke patients.
V. CONCLUSION
We introduced a visual cueing system using immersive VR
to direct the patient’s attention to the neglected side of the
target object. Our feasibility study revealed that object-
centered neglect tended to improve immediately following the
intervention; thus, these results provide preliminary
knowledge for designing successful rehabilitation programs
for patients with object-centered neglect.
ACKNOWLEDGMENT
This work was supported by the Grant-in-Aid for Junior
Researchers, Research Institute for Science and Engineering,
Waseda University [Technological Research Section: 17C13]
and Global Robot Academia Institute, Waseda University
[FY2017]. The authors are grateful to the patient in our
experiment.
NOTE
Akinori Hagiwara and Kazuhiro Yasuda contributed
equally to this paper.
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... A previous study reported that the existing therapeutic modalities were ineffective in treating allocentric neglect [21]. Therefore, some therapeutic approaches for allocentric neglect have been attempted: repetitive transcranial magnetic stimulation (rTMS) [22], visual cueing using immersive virtual-reality [23], training using a computer during transcranial direct current stimulation (tDCS) [24]. ...
... However, most studies only conducted studies on the effect of intervention without discriminating the type of neglect. By contrast, there are only a few studies on DTX after the differential diagnosis essential for a selective approach according to the type of neglect [23,24,30,33,36]. This review examined DTx for egocentric and allocentric neglect in patients with brain injury. ...
... Hagiwara et al. [23] reported the effects of the training to provide visual cues using virtual reality (VR) for treating allocentric neglect in four stroke patients. The visual cues were provided using a head-mount display (HMD) type VR, Oculus Rift (Oculus VR., Inc.). ...
Digital Therapeutics for the Egocentric and Allocentric Neglects in Patients With Brain Injury: A Mini Review
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  • Jun 2023
Various therapeutic approaches have been developed for neglect. Many studies have demonstrated the effect of Digital therapeutics(DTx) on neglect. By contrast, only a few studies have reported on the effects of DTx on egocentric and allocentric neglect. In this article, seven studies on DTx of egocentric and allocentric neglect were reviewed. DTx, which was employed in these studies, could be classified as follows: 1) software adaptation in traditional treatment, 2) VR game using the head-mount display as treatment, and 3) development of new digital program like ReMoVES. In addition, more studies and effective results were reported on egocentric neglect than allocentric neglect. In future studies, each effect on egocentric and allocentric neglect should be identified in detail through the appropriate use of differential evaluation and long-term application of independent digital therapeutics.
View
... A previous study reported that the existing therapeutic modalities were ineffective in treating allocentric neglect [21]. Therefore, some therapeutic approaches for allocentric neglect have been attempted as follows: repetitive transcranial magnetic stimulation (rTMS) [22], visual cueing using immersive virtual reality [23], and computer-based training during transcranial direct current stimulation (tDCS) [24]. ...
... However, most of the studies only investigated the effects of the intervention without differentiating the types of neglect. In contrast, there are few studies on DTX after differential diagnosis that are essential for a selective approach according to the type of neglect [23,24,[32][33][34]. This review examined DTx for egocentric and allocentric neglect in patients with brain injury. ...
... Five studies were in medical journals, four of which were research studies [32][33][34][35], and one was a case study [24]. Two studies were in non-medical journals, both of which were conference papers [23,36] (Table 2). between egocentric and allocentric neglect and studies that investigated the effects of DTx according to the type of neglect involved. ...
Digital Therapeutics for the Egocentric and Allocentric Neglects in Patients with Brain Injury: A Mini Review
Article
Full-text available
Various therapeutic approaches have been developed for neglect. Many studies have demonstrated the effect of digital therapeutics (DTx) on neglect. However, few studies have reported the effects of DTx on egocentric and allocentric neglect. The differentiation of types of neglect and separate interventions is crucial in the rehabilitation process. In this article, seven studies on DTx on egocentric and allocentric neglect were reviewed. DTx, which was employed in these studies, could be classified as follows: (1) software adaptation in traditional treatment, (2) VR game using the head-mount display as treatment, and (3) the development of a new digital program like ReMoVES. In addition, more studies and more effective results were reported for egocentric neglect than for allocentric neglect. In future studies, each effect on egocentric and allocentric neglect should be identified in detail with the appropriate use of differential evaluation and long-term application of independent DTx.
View
... A total of 33 full-text articles were examined. As 23 studies were excluded during full-text check, 10 articles [20,[24][25][26][27][28][29][30][31][32] were considered eligible for the systematic review. Flow-chart of studies screening is available in Figure 1. ...
... Two studies used a virtual version of the line bisection test as intervention protocol [27,28]. In six studies, the intervention protocol was composed of more than one task/action [25,26,28,29,31,32]. Three studies made use of an IVR program [20,24,30]. ...
... These exercises aim to guide the patient's attention to the neglected side of the target object. The different systems turn off the surrounding stimuli (i.e., other stimuli around the target) through the blackout in the VR environment, as shown in the study by Hagiwara et al. [29]. Session frequency and duration were different in almost all of the studies; only two studies [24,32] had the same duration of the session (one hour), but their protocols were different. ...
Exploring the Potential of Immersive Virtual Reality in the Treatment of Unilateral Spatial Neglect Due to Stroke: A Comprehensive Systematic Review
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The present review aims to explore the use of Immersive Virtual Reality (IVR) in the treatment of visual perception in Unilateral Spatial Neglect (USN) after a stroke. PubMed, Scopus, Embase and Pedro databases were searched, from inception to 1 February 2022. All studies that investigated the effect of IVR on USN, such as outcome in the stroke population, have been included. The current comprehensive systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in the PROSPERO database [CRD42022311284]. Methodological quality was assessed through JBI critical appraisal tool. A total of 436 articles were identified through the database searches. A total of 10 articles, with a heterogeneous study design, which involved 77 patients with USN with low-to-moderate methodological quality, have been selected. Five out the included studies tested usability of IVR for assessed or treated visual perception deficits in USN, comparing the results with 134 healthy subjects. In the rest of studies that tested IVR such as treatment, three showed statistical positive results (p < 0.05) in visual perception outcome. To date, the literature has suggested the potential benefits in the use of IVR for the treatment of visual perception disorders in USN. Interestingly, IVR motivates patients during the rehabilitation process improving compliance and interest. The heterogeneity in the studies' design and in IVR treatments indicate the need of future investigations in the consideration of potentiality and low-cost of this technology.
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Development of the 3D Evaluation System for Unilateral Spatial Neglect Using Immersive Virtual Reality没入型仮想現実による半側空間無視の評価システム: -An Explorative Study to Detect the Area of Neglect in Near and Far Space--近位・遠位空間無視に着目した無視領域定量化の試み-
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  • Jun 2019
USN is one of the sequelae of stroke, and it is the failure to response or report to meaningful stimuli which are presented on the opposite side to a cerebral hemisphere lesion. These symptoms can exist for near and far spaces combined or independently, and it is important to provide evaluation system for near and far space neglect. Therefore, we developed the system which enable evaluate both near and far space neglect with immersive virtual reality (iVR), and we performed a validation study in USN patients. As a result, we realized to describe the aspect of USN in both near and far space. In this report, the applicability of an evaluation system using iVR is shown; however, the reliability and validity must be confirmed for groups, and proof of clinical usefulness must be established.
View
The allocentric neglect due to injury of the inferior fronto-occipital fasciculus in a stroke patient: A case report
Article
Full-text available
  • Jan 2018
Rationale: We report on a patient who developed allocentric neglect due to injury of the inferior fronto-occipital fasciculus (IFOF) following intracranial hemorrhage, diagnosed using diffusion tensor tractography (DTT). Patient concerns: Her cognition seemed normal (A 17-year-old, right-handed female patient). However, in spite of a normal visual field, her perception was missing on the left side, and she had no awareness of her deficit. She was unable to perceive the left side in each of 2 objects, regardless of position of the 2 objects, and failed at detail exploration of the left side of 1 object. In addition, the line bisection test, the most representative neglect test, did not reveal any abnormality. Diagnoses: She was diagnosed with an intracerebral hemorrhage (right thalamus), intraventricular hemorrhage, and subarachnoid hemorrhage due to arteriovenous malformation in the right thalamus. Interventions: Seven weeks after onset, she began rehabilitation. Consequently, the apple cancellation test to discriminate between allocentric and egocentric neglect was performed, with the result of severe allocentric neglect. Outcomes: The right superior longitudinal fasciculus and inferior longitudinal fasciculus were well-reconstructed without definite injury compared with those of the left side. However, the right IFOF was discontinued in the anterior portion around the frontal lobe. Lessons: Allocentric neglect due to injury of IFOF was demonstrated in a stroke patient using DTT. It appears that DTT would be helpful in demonstrating the neglect type and pathway in patients with neglect.
View
Validation of an immersive virtual reality system for training near and far space neglect in individuals with stroke: A pilot study
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Spatial neglect
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The syndrome of visuospatial neglect is a common consequence of unilateral brain injury. It is most often associated with stroke and is more severe and persistent following right hemisphere damage, with reported frequencies in the acute stage of up to 80%. Neglect is primarily a disorder of attention whereby patients characteristically fail to orientate, to report or to respond to stimuli located on the contralesional side. Neglect is usually caused by large strokes in the middle cerebral artery territory and is heterogeneous, such that most patients do not manifest every feature of the syndrome. A number of treatments may improve neglect, but there is no widely accepted universal approach to therapy. Although most patients recover spontaneously, the evidence suggests that they continue to have significant cognitive impairments, particularly relating to attention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Lesion Sites Associated with Allocentric and Egocentric Visuospatial Neglect in Acute Stroke
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Visuospatial neglect is a disorder that can often result from stroke and is characterized by an inability to attend to contralesional stimuli. Two common subtypes include allocentric (object-centered) neglect and egocentric (viewer-centered) neglect. In allocentric neglect, spatial inattention is localized to the contralesional side of an object regardless of its relative position to the observer. In egocentric neglect, spatial inattention is localized to the contralesional side of the individual's midline. The neuroanatomical correlates of each subtype is unknown. However, recent work has suggested that damage to temporal, inferior parietal and occipital areas may result in allocentric neglect and that damage to fronto-parietal areas may result in egocentric neglect. We used voxel-based lesion symptom mapping (VLSM) to compare lesion location to behavioural performance on the conventional six subtests of the Behavioural Inattention Test (BIT) in 62 subjects with acute right hemisphere ischemic stroke. Our results identified an anatomical dissociation in lesion location between subjects with neglect based on poor performance on allocentric tests (line bisection, copying and drawing tasks), and on egocentric tests (star, letter and line cancellation). VLSM analyses revealed that poor performance on the allocentric tasks was associated with lesions to the superior and inferior parietal cortex, and the superior and middle temporal gyri. In contrast, poor performance on the egocentric tasks was associated with lesions in the pre-central gyrus, middle frontal gyrus, insula and putamen. Interestingly, the letter cancellation task and average performance on egocentric tests were associated with frontal and parietal lesions. Some of these parietal lesion locations overlapped with lesion locations associated with allocentric neglect. These findings are consistent with suggestions that damage to temporal and parietal areas are more associated with allocentric neglect and damage to frontal lobe areas are more associated with egocentric neglect.
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We compared, for the first time, the overall and differential effects of three of the most widely used left neglect (LN) treatments: visual scanning training (VST), limb activation treatment (LAT), and prism adaptation (PA).Thirty-three LN patients were assigned in quasi-random order to the three groups (VST, LAT, or PA). Each patient received only one type of treatment. LN patients' performance on everyday life tasks was assessed four times (over a period of 6 weeks): A1 and A2 (i.e., the two pre-treatment assessments); A3 and A4 (i.e., the two post-treatment assessments). LN patients in each of the three treatment conditions were treated for the same number of sessions (i.e., 20). The results showed that improvements were present in the majority of the tests assessing the peripersonal space in everyday life activities. Our findings were independent of unspecific factors and lasted for at least 2 weeks following the end of the treatments. There were no interactions, however, between LN treatments and assessments. We suggest that all three treatments can be considered as valid rehabilitation interventions for LN and could be employed for ameliorating LN signs.
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Prism Adaptation Improves Ego-Centered but Not Allocentric Neglect in Early Rehabilitation Patients
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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.
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Separating Forms of Neglect Using the Apples Test: Validation and Functional Prediction in Chronic and Acute Stroke
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  • May 2011
We report data on the validation and functional correlates of Apples Test, which attempts to differentiate between different forms of unilateral neglect. Study 1 presents data from 25 participants with chronic brain lesions who completed the Apples Test and another standard measure of neglect (Star Cancellation). The patients' performance relative to 86 controls was assessed and their relative performance across the two tests compared. Study 2 recruited 115 acute hospital stroke patients who completed the Apples Test as part of the Birmingham University Cognitive Screen procedure. We assessed the relations between the different forms of neglect. Study 3 examined neglect type (as measured by the Apples Test) among the acute stroke group in relation to their activities of daily living abilities and affect. In Study 1 Apples Test scores correlated with Star Cancellation performance, while also differentiating between neglect across the page and neglect of parts of objects. Study 2 confirmed the dissociation from Study 1. "Pure" forms of each type of neglect were equally prevalent after right and left hemisphere lesions, while the presence of both deficits was associated with right hemisphere damage. Study 3 showed that each form of neglect also correlated with other measures of cognition. When compared with pure page-based neglect, object-centered neglect was associated with a lower Barthel score (p < .001), while patients with both forms of neglect had higher level of depression (p < .001) than those with the pure forms. We conclude that the Apples test provides a clinically applicable measure of different forms of neglect. In addition it is a useful predictor of functional outcome. We discuss the nature of the two forms of neglect diagnosed by the test and the functional implications.
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Study on the Occurrence and Neural Bases of Hemispatial Neglect With Different Reference Frames
Article
  • Jan 2012
To study the distributions and the neural correlates of left hemispatial neglect with different reference frames. Data were collected from patients with right brain injury who participated in a case series. Hospital departments of rehabilitation and neurology. Right brain-damaged patients (N=110). Not applicable. The frequency of left hemispatial neglect with different reference frames was investigated, and the respective brain lesions were displayed and analyzed. Not all subjects finished predesigned neglect tests because of their condition: 8 of the 55 neglect patients were unable to complete the test for classification. Thirty (63.83%) of 47 subjects with neglect displayed both allocentric and egocentric neglect, while 17 subjects showed pure egocentric neglect. The lesions in the inferior frontal gyrus, precentral gyrus, postcentral gyrus, superior temporal gyrus (STG), middle temporal gyrus (MTG), insula, and surrounding white matters were more frequent in the neglect group than in the control group. Compared with the egocentric neglect group, the lesions in the right STG, MTG, lenticular nucleus, and the surrounding white matter were damaged more frequently in the group displaying both allocentric and egocentric neglect. More than half of the subjects with left neglect after right brain injury have both egocentric and allocentric neglect. The right inferior frontal gyrus, precentral gyrus, postcentral gyrus, STG, MTG, insula, and the surrounding white matter are associated with left hemispatial neglect. Left allocentric neglect is associated with the right STG, MTG, and lenticular nucleus.
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