Riestra Alonso R, Barrett A M
Hospital Ángeles Lomas and Centro de Neuro-rehabilitación Ángeles, Huixquilucan, Mexico.
Handb Clin Neurol. 2013;110:347-55. doi: 10.1016/B978-0-444-52901-5.00029-0.
Spatial neglect is a frequent cause of disability associated with high costs and duration of hospital stay, increased family burden, and requirements for skilled chronic care. This condition is disproportionately more frequent with right than left hemispheric injury and it is characterized by perceptual, representational, and behavioral deficits involving or directed towards the left hemispace or the left hemibody. Spatial dysfunction is conceptualized into two major components: the perceptual/representational "where" component that results mainly from injury to posterior brain regions and the premotor/intentional "aiming" component that results mostly from damage to anterior brain regions. Additionally, deficits in arousal, vigilance, affective symptoms, and disorders of emotional communication may compound the clinical manifestations of spatial neglect. Evidence-based sources that evaluate the effectiveness of rehabilitation treatments for neglect are, unfortunately, unable to provide a unified consensus for the efficacy of a given treatment approach. The reasons for this failure are related to internal inconsistencies defining appropriate criteria for treatment success and lack of characterization of neglect mechanisms and considerations of patient characteristics related to treatment failure. In this chapter we advocate the use of visual scanning, limb activation therapy, and "general treatment" because we believe that they are appropriately supported by different sources and they may be useful for experimental trials and standardized clinical care. We advocate an integrative approach that takes advantage of the same rehabilitation strategy or task to treat different perceptual, representational, and premotor components of neglect. A variety of therapies that may be familiar to the rehabilitation team may be useful as long as they are applied in a systematized program and are based on good clinical judgment. Information regarding adjuvant pharmacological therapy is sparse but different agents with aminergic and cholinergic activity may be useful. Medication with sedative, antidopaminergic or anticholinergic properties may interfere with the rehabilitation process and should be avoided.
空间忽视是导致残疾的常见原因，与高昂的费用、较长的住院时间、加重的家庭负担以及对专业长期护理的需求相关。这种情况在右半球损伤时比左半球损伤更为常见，其特征是涉及或指向左半空间或左半侧身体的感知、表征和行为缺陷。空间功能障碍被概念化为两个主要组成部分：主要由后脑区域损伤导致的感知/表征“空间定位”部分，以及主要由前脑区域损伤导致的运动前/意向性“指向”部分。此外，觉醒、警觉、情感症状以及情感交流障碍可能会使空间忽视的临床表现更加复杂。遗憾的是，评估忽视康复治疗效果的循证资源无法就特定治疗方法的疗效达成统一共识。这种失败的原因与定义治疗成功的适当标准时存在的内部不一致、忽视机制缺乏特征描述以及与治疗失败相关的患者特征考虑不足有关。在本章中，我们提倡使用视觉扫描、肢体激活疗法和“综合治疗”，因为我们认为它们得到了不同资源的适当支持，并且可能对实验性试验和标准化临床护理有用。我们提倡一种综合方法，利用相同的康复策略或任务来治疗忽视的不同感知、表征和运动前组成部分。只要康复团队熟悉的各种疗法以系统化的方案应用并基于良好的临床判断，就可能有用。关于辅助药物治疗的信息很少，但具有胺能和胆碱能活性的不同药物可能有用。具有镇静、抗多巴胺能或抗胆碱能特性的药物可能会干扰康复过程，应避免使用。
