Serino Andrea, Angeli Valentina, Frassinetti Francesca, Làdavas Elisabetta
Dipartimento di Psicologia, Università di Bologna, Italy.
Neuropsychologia. 2006;44(7):1068-78. doi: 10.1016/j.neuropsychologia.2005.10.024. Epub 2005 Dec 5.
Prism adaptation (PA) has been demonstrated to be effective in improving hemispatial neglect. However not all patients seem to benefit from this procedure. Thus, the objective of the present work is to provide behavioural and neuroanatomical predictors of recovery by exploring the reorganization of low-order visuo-motor behaviour and high-order visuo-spatial representation induced by PA. To this end, 16 neglect patients (experimental group) were submitted to a PA treatment for 10 daily sessions. Neglect and oculo-motor responses were assessed before the treatment, 1 week, 1 and 3 months after the treatment. Eight control patients, who received general cognitive stimulation, were submitted to the same tests at the same time interval. The results showed that experimental patients obtained, as a consequence of PA, a long lasting neglect recovery, a reorganization of low-order visuo-motor behaviour during and after prism exposure (error reduction and after-effect, respectively) and a leftward deviation of oculo-motor responses. Importantly, the level of error reduction obtained in the first week of treatment was predictive of neglect recovery and the amelioration of oculo-motor responses, and the degree of eye movement deviation was positively related to neglect amelioration. Finally, the study of patients' neuroanatomical data showed that severe occipital lesions were associated with a lack of error reduction, poor neglect recovery and reduced oculo-motor system amelioration. In conclusion, the present results suggest that low-order visuo-motor reorganization induced by PA promotes a resetting of the oculo-motor system leading to an improvement in high-order visuo-spatial representation able to ameliorate neglect.
棱镜适应（PA）已被证明在改善半侧空间忽视方面是有效的。然而，并非所有患者似乎都能从该治疗中获益。因此，本研究的目的是通过探索PA诱导的低阶视觉运动行为和高阶视觉空间表征的重组，来提供恢复的行为和神经解剖学预测指标。为此，16名忽视患者（实验组）接受了为期10天的PA治疗。在治疗前、治疗后1周、1个月和3个月评估忽视和眼动反应。8名接受一般认知刺激的对照患者在相同的时间间隔接受相同的测试。结果表明，由于PA，实验组患者获得了持久的忽视恢复、在棱镜暴露期间和之后低阶视觉运动行为的重组（分别为误差减少和后效）以及眼动反应的向左偏移。重要的是，治疗第一周获得的误差减少水平可预测忽视恢复和眼动反应的改善，并且眼动偏差程度与忽视改善呈正相关。最后，对患者神经解剖学数据的研究表明，严重的枕叶病变与误差减少不足、忽视恢复不佳和眼动系统改善减少有关。总之，目前的结果表明，PA诱导的低阶视觉运动重组促进了眼动系统的重置，从而导致能够改善忽视的高阶视觉空间表征的改善。
