Goedert Kelly M, Chen Peii, Boston Raymond C, Foundas Anne L, Barrett A M
Seton Hall University, South Orange, NJ, USA
Kessler Foundation, West Orange, NJ, USA Rutgers New Jersey Medical School, Newark, NJ, USA.
Neurorehabil Neural Repair. 2014 Jun;28(5):483-93. doi: 10.1177/1545968313516872. Epub 2013 Dec 27.
Background Spatial neglect is a debilitating disorder for which there is no agreed on course of rehabilitation. The lack of consensus on treatment may result from systematic differences in the syndrome's characteristics, with spatial cognitive deficits potentially affecting perceptual-attentional "Where" or motor-intentional "Aiming" spatial processing. Heterogeneity of response to treatment might be explained by different treatment impacts on these dissociated deficits: prism adaptation, for example, might reduce Aiming deficits without affecting Where spatial deficits.
Here, we tested the hypothesis that classifying patients by their profile of Where-versus-Aiming spatial deficit would predict response to prism adaptation and specifically that patients with Aiming bias would have better recovery than those with isolated Where bias. Methods We classified the spatial errors of 24 subacute right stroke survivors with left spatial neglect as (1) isolated Where bias, (2) isolated Aiming bias, or (3) both. Participants then completed 2 weeks of prism adaptation treatment. They also completed the Behavioral Inattention Test and Catherine Bergego Scale (CBS) tests of neglect recovery weekly for 6 weeks. Results As hypothesized, participants with only Aiming deficits improved on the CBS, whereas those with only Where deficits did not improve. Participants with both deficits demonstrated intermediate improvement. Conclusion These results support behavioral classification of spatial neglect patients as a potential valuable tool for assigning targeted, effective early rehabilitation.
背景：空间忽视是一种使人衰弱的疾病，目前尚无公认的康复方案。治疗缺乏共识可能是由于该综合征特征存在系统差异，空间认知缺陷可能会影响感知-注意的“哪里”或运动-意图的“瞄准”空间处理。对治疗反应的异质性可能是由不同治疗对这些分离缺陷的不同影响所解释的：例如，棱镜适应可能会减少瞄准缺陷而不影响“哪里”空间缺陷。
在此，我们检验了以下假设：根据患者的“哪里”与“瞄准”空间缺陷特征进行分类，可以预测对棱镜适应的反应，特别是有瞄准偏差的患者比仅有“哪里”偏差的患者恢复得更好。方法：我们将24名患有左侧空间忽视的亚急性右脑卒中幸存者的空间误差分类为：（1）仅有“哪里”偏差，（2）仅有瞄准偏差，或（3）两者皆有。参与者随后完成了为期2周的棱镜适应治疗。他们还在6周内每周完成行为疏忽测试和凯瑟琳·贝热戈量表（CBS）疏忽恢复测试。结果：正如假设的那样，仅有瞄准缺陷的参与者在CBS上有所改善，而仅有“哪里”缺陷的参与者则没有改善。两种缺陷都有的参与者表现出中等程度的改善。结论：这些结果支持将空间忽视患者进行行为分类，作为分配有针对性、有效早期康复的潜在有价值工具。
