Marshall Randolph S
The Neurological Institute of New York, Columbia University Medical Center, New York, 10032, USA.
Neurologist. 2009 Jul;15(4):185-92. doi: 10.1097/NRL.0b013e3181942894.
Hemineglect is a difficult neurologic condition to rehabilitate. It arises predominantly from right brain injury, and manifests heterogeneously in clinical deficits such as poor visual exploration to the left, inaccurate assessment of the midpoint of a line, left limb hypokinesis, and anosognosia. Most of the cognitive dysfunction produced by hemineglect is because of an asymmetric distribution of attention, either with respect to extrapersonal space or to an object being viewed. Many treatments draw on hemineglect theory to attempt to mediate the basic asymmetry of attention.
Treatment approaches can be divided into 2 main categories. Extrinsic or "top-down" approaches require active participation of the patient under the guidance of a therapist. The most common approach of this type is visual scanning therapy in which the patient is continually instructed to move the gaze leftward into the neglected space. Intrinsic or "bottom-up" approaches manipulate stimulus characteristics, sensory input, or the brain directly in an attempt to alter the interhemispheral attentional imbalance. Examples of this approach include vestibular stimulation of the left side, sensory activation of the left limb, and transcranial magnetic stimulation of the overactive left hemisphere. Combined approaches such as prism adaptation have also shown good results.
Hemineglect is a complicated disorder that poses challenges to treatment. A paucity of clinical trial evidence limits our ability to extrapolate experimental mediation of hemineglect to globally improved functioning. Nonetheless, many treatment approaches appear promising. Underlying neuroscience may help guide future treatment approaches.
偏侧空间忽视是一种难以康复的神经病症。它主要由右脑损伤引起，在临床缺陷中表现各异，如向左视觉探索不佳、对线中点评估不准确、左肢运动减少和疾病感缺失。偏侧空间忽视产生的大多数认知功能障碍是由于注意力的不对称分布，无论是关于个人空间外的空间还是被观察的物体。许多治疗方法借鉴偏侧空间忽视理论来试图调节注意力的基本不对称性。
治疗方法可分为两大类。外在或“自上而下”的方法需要患者在治疗师的指导下积极参与。这类方法中最常见的是视觉扫描疗法，即不断指导患者将目光向左移入被忽视的空间。内在或“自下而上”的方法直接操纵刺激特征、感觉输入或大脑，试图改变半球间的注意力不平衡。这种方法的例子包括左侧前庭刺激、左肢感觉激活以及对过度活跃的左半球进行经颅磁刺激。诸如棱镜适应等联合方法也显示出良好效果。
偏侧空间忽视是一种复杂的病症，对治疗构成挑战。临床试验证据的匮乏限制了我们将偏侧空间忽视的实验性调节推广至整体功能改善的能力。尽管如此，许多治疗方法似乎很有前景。基础神经科学可能有助于指导未来的治疗方法。
