Psych 403 9

neglect refers to

when a patient does not notice or respond to stimuli contralateral to the side of brain injury

names that mean neglecgt

neglect, unilateral spatial neglect, heminegelect, semi innatention

hemineglect is most commonly caused by

stroke

broad symptoms that may be present with hemineglect

egocentric neglect, allocentric neglect, peripersonal space neglect, anosagnosia

egocentric neglect

objects or people relative to the patients perspective are neglects

allocentric neglect

neglecting part of an object regardless of which side of visual field it falls on

peripersonal space neglect/ extrapersonal neglect

neglect or things within personal space

anosagnosia

when the patient is unaware of neglect

strokes resulting in neglect often affect the

middle cerebral artery

neglect is characterized by

a reduction in awareness of the contra lesional space

true/false ego and allo centric neglect may both occur in a person based on task demands

true

severe stroke patients with neglect may also have BLANK during the acute stage

ipsilesional deviation of their heads and eyes

when might someone’s neglect be less evident

when they are more aroused

true/false neglect may be due to sensory or motor impairments

false

prompt: watch a video on somatoparaphrenia

\-

neglect is NOT

modality specific, due to defective sensation, due to defective memory

why is neglect NOT modality specific

there is normally no variation in degree of neglect across different sensory modalities

neglect is modified by

attention and motivation

neglect is dependent on

interpretation

impairments in motor or sensory aspects do not cause neglect, but they might BLANK

worsen outcome or complicate

neglect is best explained by BLANK theories

attentional

what happened in the Milan experiment

subjects were asked to recall buildings in a famous plaza in Milan that they were familiar with

results of the Milan experiment

subjects with left side contralateral neglect were able to recall more landmarks on the right side when asked to imagine themselves facing the cathedral, recalled fewer on the left side. When imagining on the steps of the cathedral remembered less on the left that they could previously remember and more on the right.

what does the milan experiment suggest

issues with recall are not due to faulty memory, due to attention

some common tasks to measure neglect

block pattern arranging, line bisection task, cancellation tasks

personal neglect can be measured by

asking a person to groom

extrapersonal neglect can be measured by

asking them to name objects in the room they are in

extent of neglect varies with

type of task used

problem with measuring neglect

no test best describes neglect which leads to variations in estimates across studies

what is the most common site of injury resulting in neglect

right parietal lobe, specifically the supra marginal gyrus

white matter connections especially the BLANK are implicated in neglect

superior longitudinal fasiculus tracts linking the frontal and parietal regions, fronto-occipital fasiculus

aside from the supra marginal gyrus, what are some common sites of injury where neglect occurs

frontal lobes, striatum , subcortical structures, interhemispheric activitiy differences

generally, neglect results from

dysfunction of widespread brain networks

what is a brain sign of good recovery from spatial neglect

increased connectivity between implicated regions and ability to be activated by relevant tasks

some initial spikes in neglect are related to

edema and diaschisis

recovery from neglect is greatest in the first few BLANK after stroke

weeks

network dysfunction in BLANK seems to be most critical to neglect symptoms

white matter pathways in the right hemisphere

why are right hemisphere lesions more likely to result in contralateral neglect

right hemisphere attends to both visual fields whereas left attends to only one

neglect occurs in about BLANK % of stroke patients

25

patients most often recover from neglect in the first BLANK

month

recovery for neglect is slowest for

neglect of peripersonal space

allochiria

a person starts to respond to stimuli on the neglected side as if it was on the good side

sensory extinction

a person responds correctly UNLESS a similar stimulus is presented bilaterally

which hemisphere lesion is likely to have a longer recovery time for neglect

right

people with BLANK damage have a limited potential for recovery from negelct

callosal

consequences of neglect

ignoring one side of the body

attending to only one side

bumping into objects and getting into accidents

difficulty finding objects, doing hobbies

lack of insight or awareness

people with neglect generally need more rehab and have the following outcomes

longer hospital stays, slower recovery rates, require more post rehab assistance, less likely to go home

true/false neglect can impair reading

true

paolucci and colleagues studied neglect with a BLANK approach

matched comparison

neglect negatively impacts BLANK

rehab

findings of paulucci and colleagues

neglect negatively impacts rehab, unilateral spatial neglect did worse, length of stay was higher

why is rehab hard to provide specifically for neglect

there is a lack of insight into the problem

goals of neglect therapy

forced awareness of neglected space, fixing body orientation and position sense

some examples of neglect therapies

visual scanning, prisms, NIBS, motor and sensory activation, feedback training, eyepatches, caloric stimulation, TENS, neck stimulation, drug treatments

paradigm for neglect therapy

remind the patient of neglected space, do exercise to encourage attending to neglected area, reinforce good searching behaviours

overall, is there good evidence for neglect therapy

some evidence for improving negative symptoms, not convincing overall

does neglect therapy work?

we dont know yet

prompt: why is neglect more common after right than left hemisphere injury?

\-

prompt: discuss the evidence that negelct is not due to sensory loss or a general memory impairment

\-

Prompt: what is the most common and best supported treatment for neglect? Are you confident in findings?

\-

Prompt: John insists that his left arm does not belong to him, what is the name for this specific symptom and the disorder it is part of?

\-

results of the cochrane review on neglect therapy

non pharmacological interventions have yet to be proven to improve outcomes

cognitive impact of stroke

anosognosia, attention, apraxia, concentration difficulties, memory impairment, executive dysdunction, vascular cognitive impairment

what is another term for vascular cognitive impairment

dementia

BLANK % of th population will have vascular cognitive impairment

5

VCI

vascular cognitive impairment

true/false stroke increases the risk of dementia in those with mild cognitive impairment

true

common signs of concentration problems

cannot filter out what is going on around you, cannot stay focused on a single taks, cannot move from one task to another easily, cannot do more than one thing at nce, cannot processes things quickly

areas assesed in cognitive rehab

attention, executive function, learning and memory, global cognition, visuospatial perception and orientation, amusia, activities of daily living

what is visuospatial perception and orientation

the ability to correctly process and mentally manipulate visuospatial information

amusia

the inability to perceive or recognize music

example test to assess attention

colour trails test

prompt: watch a video on Colour trails test

\-

example learning and memory test

corsi block tapping test (forward) and digit span test (forward)

prompt: watch videos of corsi block tapping test and digit span test

\-

global cognition tests

WAIS, MOCA

MOCA =

Montreal Cognitive Assessment

what percentage of ischemic patients will experience executive dysfunction

40

BLANK independently predicts poor ADL function, lower quality of life, less community participation, and lower independence

executive dysfunction

why does cognitive impairment affect participation in rehab

impairment requires more therapy

executive dysfunction results from BLANK injury and associated connections in the BLANK lobe

prefrontal cortex, parietal

true/false executive dysfunction is not replicated in rodent or primate studies

false

VLPFC injury affects

short term memory

the RPFC is involved in BLANK, probably processing

multitasking, long term memory and what others are thinking about

the DLPFC is involved in BLANK

planning, manipulating stored memories

Medial PFC is involved in

selecting among conflicting behaviours

besides the PFC, what other regions are implicated in executive dysfunction because of network connections

default mode network, salience network, attention networks, and frontoparietal networks

true/false lesion location and size predict executive dysfunction

false

true/false general scales of stroke severity such as mRS are good predictors of executive dysfunction

false

true/false structural and functional connectivity are better measures of executive function

true

integrety of the BLANK, BLANK predicts executive dysfunction vell

superior longitudintal fasiculus, fronto-parietal connection

SLF

superior longitudinal fasciculus

additional BLANK such as atrophy and small lesions in addition to stroke

cerebrovascular burden

BLANK network connectivity is related to good recovery whereas BLANK network connectivity is linked to poorer executive function

within, between

behaviour recovery following stroke is predicted by

recovery of network modularity

modularity measures

the density of links inside connections compared to links between connections

prompt: watch a video on modularity

\-

what domains show recovery with increased modularity, what do not

higher demand cognitive tasks do, motor and visual domains do not,

modularity is decreased in acute patients but returns near control levels at BLANK and BLANK times

3 month, 1 year

decline in modularity reflects less BLANK within a system and less BLANK between systems

integration, separation