经颅磁刺激对卒中后患者视觉空间忽略作用机制的研究进展

视觉空间忽略（visual spatial neglect,VSN）是指卒中后对来自病灶对侧空间的刺激不能正确注意、搜索、反应、定位或报告,患者不能注意到来自患侧的视觉、听觉或触觉等刺激。VSN是一种神经性功能障碍综合症,多发生在右侧大脑半球受损后,因为右侧大脑半球对注意的支配起主要作用,其主要发病机制一般认为是由于半球间竞争导致的,当一侧大脑半球受损后,患侧半球失去了对健侧半球的抑制作用,导致健侧大脑半球出现病理性过度兴奋。     

卒中患者听觉忽略的研究进展

单侧忽略（unilateral neglect）是卒中患者常见的一种行为综合征，表现为患者不能对病灶对侧躯体或空间出现的刺激（视觉、躯体感觉、听觉以及运动觉刺激）作出反应。单侧忽略的病灶常位于右侧大脑外侧裂周围，典型的行为表现是患者似乎感觉不到病灶对侧的空间。在右侧大脑半球卒中患者的急性期中，单侧忽略的发病率高达82％，直接影响了患者偏瘫康复的效果。以往的大多数研究主要集中在卒中患者视觉忽略方面，但越来越多的证据表明，卒中患者的单侧忽略可以表现为听觉忽略、触觉忽略或者多种感觉忽略并存。作者就听觉单侧忽略的研究进展综述如下。     

半侧空间忽略研究概况

半侧空间忽略是指对病灶半球对侧空间的刺激失去反应、应答及定向能力的功能障碍。由其引起的多种行为偏侧表现称为半侧空间忽略综合征。分感觉性忽略与运动性忽略两种,多与右半球顶叶及额叶病变有关。有关的机制为方向特异性注意系统的破坏、运动性迟缓以及半球内部说明系统的削弱。     

经颅磁刺激对卒中患者单侧空间忽略和运动功能康复的作用

目的探讨经颅磁刺激对卒中患者单侧空间忽略和运动功能康复的影响。方法将30例卒中后伴有单侧空间忽略的患者按随机数字表分为重复经颅磁刺激(rTMS)组15例和对照组15例,对rTMS组患者采用行为学训练方法 (包括视觉扫描训练、躯干旋转训练、交叉促进训练,15 min/次,2次/d;常规训练30 min/次,2次/d)和rTMS治疗(刺激频率为0.5 Hz、强度为静息运动阈值的90%,治疗15 min/次,2次/d),均为期2周。对照组患者只接受行为学训练治疗。治疗前后两组患者分别进行直线二等分试验、线段划消试验、画钟试验、简式Fugl-Meyer运动功能评定、改良Barthel指数评定。结果①治疗后,rTMS组与对照组直线二等分试验评分中位数(M,范围)分别为8.17(0～48.31)、31.75(0～86.96);两组线段划消试验评分M分别为0.005(0～0.333)、1.333(0～5.667);两组画钟试验评分M分别为0(0～1)、1(0～2)。差异均有统计学意义,均P<0.05。②治疗后rTMS组与对照组简式Fugl-Meyer运动功能评分M分别为36(24～94)、21(6～63),两组各指标评分比较差异有统计学意义;两组治疗后改良Barthel指数评分M分别为45(30～65)、40(10～60),差异均有统计学意义。均P<0.001。结论经颅磁刺激对卒中患者单侧空间忽略治疗有显著作用,卒中后患侧单侧空间忽略的恢复有助于患者运动功能的康复。     

半侧空间忽略研究概况

半侧空间忽略是指对病灶半球对侧空间的刺激失去反应,应答及定向能力的功能障碍。由其引起的多种行为偏侧表现称为半侧空间忽略综合征。分感觉性忽略与运动性忽略两种,多与右半球顶叶及额叶病变有关。有关的机制为方向特异性注意系统的破坏,运动性迟缓以及半球内部说明系统的削弱。     

生物反馈疗法配合作业治疗改善老年脑卒中患者单侧空间忽略症

单侧空间忽略症(unilateral spatial neglect,USN)是脑损伤造成的损伤半球对侧空间未知或有意义的刺激不能反应或定向.本文回顾性分析20例脑卒中后USN患者采用肌电生物反馈疗法配合作业治疗的临床效果.     

脑卒中后的半侧空间忽略

目的 对脑卒中后的半侧空间忽略现象进行评价，探讨忽略的表现及与病灶的部位、范围的关系。方法采用忽略组合试验对30例脑卒中病人进行研究。结果30例脑卒中病人中，17例存在半侧空间忽略。其中，右侧病灶12例，左侧病灶5例。对侧忽略11例，同侧忽略6例。同CTMRI检查显示伴有忽略的病人其病灶涉及许多脑区，以顶叶受累最为常见。结论脑卒中后部分病人可出现半侧空间忽略。左右半球病灶均可出现忽略。在伴有忽略表现病人的病灶中，顶叶是较常见的受累部位。     

作业疗法治疗脑卒中后单侧空间忽略患者的康复疗效

<正>单侧空间忽略(USN)是脑卒中后患者最常见的认知功能障碍之一,右侧半球脑卒中患者发病率高达82%〔1〕。患者虽然不存在视觉、躯体感觉及意识障碍,但对病灶对侧(常是左侧)的刺激不能注意,对患者认知功能及日常生活能力(ADL)的康复存在长期的负面影响〔2,3〕。本研究观察作业疗法对脑卒中后USN患者的疗效。1资料与方法1.1一般资料2009年6月1日至2011年9月30日本院神     

半侧空间忽略研究进展

半侧空间忽略是指对病灶半球对侧空间刺激失去反应、应答及定向能力的功能障碍。多种因素可改变和影响空间忽略的程度 ,如体位的变化、刺激物的复杂性、暗示的影响、眼动刺激的作用、前庭刺激以及颈肌震动等。研究表明 ,自我为中心矢状纵轴、环境地心引力以及刺激本身等均可作为空间忽略的参照物。     

半侧空间忽略研究进展

半侧空间忽略是指对病灶半球对侧空间刺激失去反应、应答及定向能力的功能障碍。多种因素可改变和影响空间忽略的程度，如体位的变化，刺激物的复杂性，暗示的影响，眼动刺激的作用，前庭刺激以及颈肌震动等。研究表明，自我为中心矢状纵轴，环境地心引力以及刺激本身等均可作为空间忽略的参照物。     

健侧半球间歇θ脉冲刺激和低频重复经颅磁刺激治疗卒中后视空间忽略的效果比较

目的 对比间歇θ脉冲刺激(iTBS)刺激健侧半球前额叶背外侧(DLPFC)与1 Hz重复经颅磁刺激(rTMS)刺激健侧半球顶后皮质(PPC)治疗卒中后视空间忽略的疗效.方法 前瞻性连续纳入2019年4月至2021年3月入诊首都医科大学宣武医院康复医学科的33例卒中后视空间忽略患者,采用随机信封法将所有患者随机分为3组[...     

Phonological decisions require both the left and right supramarginal gyri

Recent functional imaging studies demonstrated that both the left and right supramarginal gyri (SMG) are activated when healthy right-handed subjects make phonological word decisions. However, lesion studies typically report difficulties with phonological processing after left rather than right hemisphere damage. Here, we used a unique dual-site transcranial magnetic stimulation (TMS) approach to test whether the SMG in the right hemisphere contributes to modality-independent (i.e., auditory and visual) phonological decisions. To test task-specificity, we compared the effect of real or sham TMS during phonological, semantic, and perceptual decisions. To test laterality and anatomical specificity, we compared the effect of TMS over the left, right, or bilateral SMG and angular gyri. The accuracy and reaction times of phonological decisions were selectively disrupted relative to semantic and perceptual decisions when real TMS was applied over the left, right, or bilateral SMG. These effects were not observed for TMS over the angular gyri. A follow-up experiment indicated that the threshold-intensity for inducing a disruptive effect on phonological decisions was identical for unilateral TMS over the right or left SMG. Taken together, these findings provide converging evidence that the right SMG contributes to accurate and efficient phonological decisions in the healthy brain, with no evidence that the left and right SMG can compensate for one another during TMS. Our findings motivate detailed studies of phonological processing in patients with acute or long-term damage of the right SMG.     

Application of digital practice to improve head movement,visual perception and activities of daily living for subacute stroke patients with unilateral spatial neglect: Preliminary results of a single-blinded,randomized controlled trial

Background:Virtual reality (VR) based digital practice is an attractive way to provide a patient engagement, motivation and adaptable environment for stroke rehabilitation. However, clinical evidence of efficacy with VR-based digital practice is very limited. In this study, we investigated the effects of VR-based digital practice program on unilateral spatial neglect (USN) rehabilitation in patients with subacute stroke.Methods:Twenty-four subacute stroke patients with USN were enrolled and randomly assigned to digital practice group (n = 12) and control group (n = 12). Patients in digital practice group received training programs with VR-based applications with leap motion environment. Control group received conventional USN specific training programs. All patients were underwent 4 week practice program (3 sessions/week, a half-hour/session). We analyzed training effects before and after training by assessing the line bisection test, Catherine Bergego Scale, modified Barthel index, Motor-Free Visual Perception Test Vertical Version (MVPT-V), and horizontal head movements (rotation degree and velocity during the VR-based applications), and compared the results between the two groups.Results:Compared to control group, digital practice group showed significantly greater improvements in the line bisection test (P = .020), and visual perceptual tasks (MVPT-V, responded more on left visual task, P = .024; correctly respond more on both left and right visual tasks, P = .024 and P = .014, respectively; and faster response time, P = .014). Additionally, horizontal head movement of rotation degree and velocity during the VR based practice in the digital practice group were significantly increased more than control group (P = .007 and P = .001, respectively).Conclusions:VR-based digital practice program might be an affordable approach for visual perception and head movement recovery for subacute stroke patients with USN.     

Touch perception reveals the dominance of spatial over digital representation of numbers

We learn counting on our fingers, and the digital representation of numbers we develop is still present in adulthood [Andres M, et al. (2007) J Cognit Neurosci 19:563-576]. Such an anatomy-magnitude association establishes tight functional correspondences between fingers and numbers [Di Luca S, et al. (2006) Q J Exp Psychol 59:1648-1663]. However, it has long been known that small-to-large magnitude information is arranged left-to-right along a mental number line [Dehaene S, et al. (1993) J Exp Psychol Genet 122:371-396]. Here, we investigated touch perception to disambiguate whether number representation is embodied on the hand ("1" = thumb; "5" = little finger) or disembodied in the extrapersonal space ("1" = left; "5" = right). We directly contrasted these number representations in two experiments using a single centrally located effector (the foot) and a simple postural manipulation of the hand (palm-up vs. palm-down). We show that visual presentation of a number ("1" or "5") shifts attention cross-modally, modulating the detection of tactile stimuli delivered on the little finger or thumb. With the hand resting palm-down, subjects perform better when reporting tactile stimuli delivered to the little finger after presentation of number "5" than number "1." Crucially, this pattern reverses (better performance after number "1" than "5") when the hand is in a palm-up posture, in which the position of the fingers in external space, but not their relative anatomical position, is reversed. The human brain can thus use either space- or body-based representation of numbers, but in case of competition, the former dominates the latter, showing the stronger role played by the mental number line organization.     

棱镜适应治疗单侧空间忽视

单侧窄间忽视足影响脑损伤尤其是卒中后患者功能康复的重要因素,寻求有效的康复治疗措施对于提高患者生活质量具有重要意义.棱镜适应是目前使用最广泛并且研究最深入的忽视症治疗方法,但国内研究较少.文章对单侧空间忽视棱镜适应的治疗机制、在卒中后单侧空间忽视中的应用以及疗效等方面的研究进展进行综述.     

经颅直流电刺激联合高压氧疗治疗脑卒中后单侧空间忽略患者的临床效果研究

背景 研究表明,经颅直流电刺激能有效改善单侧空间忽略患者的运动功能和认知功能,但临床上对经颅直流电刺激联合高压氧疗治疗脑卒中后单侧空间忽略患者的临床效果尚不明确.目的 观察经颅直流电刺激联合高压氧疗治疗脑卒中后单侧空间忽略患者的临床效果.方法 选取2015年9月至2021年2月南京医科大学附属淮安第一医院收治的82例脑...     

Long-term prognosis of unilateral spatial neglect--dissociation between conventional tests and behavioral observation

The long-term prognosis of unilateral spatial neglect (USN) in three elderly patients with stroke was investigated. Case 1 was a 62-year-old man who had suffered from right putaminal hemorrhage three years ago. Obvious right USN was found soon after the onset. After 6 months of rehabilitation he recovered and became independent in ADL without USN signs in daily circumstances. However, left USN signs appeared in some stressful situations such as traditional poetry-based competition or driving an electrical wheelchair on crowded roads. Case 2 was a 62-year-old man who had suffered from cerebral hemorrhage in the right putamen 6 years ago. He showed left USN soon after the onset, but it disappeared gradually. Cerebral infarction in the left basal ganglia occurred 6 years after the first attack. He showed decline of general attention accompanying left USN. Case 3 was a 70-year-old man who had showed left USN signs 7 years previously. He became independent and disappeared USN signs. However his activities of daily living declined gradually, and mental status became worse. Left USN signs were observed again on USN tests. Left USN was observed in three cases soon after the onset of the first stroke and then disappeared. However, USN signs became obvious in some specific situations. The appearance or disappearance of USN seemed to depend on the relationship among severity of USN, physical and mental functions, and circumstances in which USN was evaluated.     

Clock drawing in acute stroke

We studied 118 elderly subjects with first-ever stroke free of severe cognitive impairment and able to write. Within 14 days of stroke we measured clock drawing, ability to copy drawings of dual pentagons and a house, line bisection, Mini-Mental State score, homonymous hemianopia and visual and tactile extinction. Thirty subjects had impaired clock drawing. When compared with the remaining 88 subjects with normal clock drawing the impaired group had similar pre-stroke characteristics but had significantly more severe stroke deficits. Hospital stay was significantly longer in the impaired group and a much greater proportion of subjects were discharged to long-term hospitals rather than home. Barthel ADL scores at days 7, 30, 60 and maximal recovery were significantly lower. Using a multivariate generalized linear model, clock drawing was a significant independent predictor of maximal Barthel ADL after accounting for other significant predictors such as Barthel score at day 7, limb power, visual extinction, line bisection error and Mini-Mental State score. Impaired clock drawing can reflect either cognitive impairment or spatial neglect.     

Twitch airway pressure elicited by magnetic phrenic nerve stimulation in anesthetized healthy children

Children with diaphragm dysfunction may be unable to maintain adequate ventilation. Accurate diagnosis is important, but can only be achieved using an appropriate test and reference range. The aim of this study, therefore, was to measure diaphragm contractility and examine the influence of age and maturation, using magnetic phrenic nerve stimulation in healthy children. Anterolateral magnetic stimulation (MS) of the phrenic nerves was performed using a 43-mm figure-eight coil in 23 children (14 male; mean age, 7.8 years; range, 1.8-15.7) anesthetized for minor surgery with sevoflurane gas. The airway was maintained with a cuffed laryngeal mask airway (LMA) which was briefly occluded during MS. Diaphragm contractility was assessed by measuring the airway pressure (TwPaw) elicited by MS. TwPaw responses were obtained in all subjects, with mean (SD) TwPaw 18.2 (6.8) cm H2O bilateral, 7.3 (3.2) cm H2O left unilateral, and 8.6 (3.1) cm H2O right unilateral. Subgroup analysis was performed in 17 of the children who were prepubertal. Their mean (SD) TwPaw was 17.3 (6.8) cm H2O bilateral, 7.1 (3.7) cm H2O left unilateral, and 8.3 (3.3) right unilateral. The mean (SD) intrapatient coefficients of variation for bilateral and left and right unilateral TwPaw were 8.4% (5.2), 6.7% (3.5), and 11.7% (10.3), respectively. Bilateral and left and right unilateral TwPaw were significantly related to age (P < 0.05). In healthy prepubertal children, diaphragm contractility is primarily influenced by age.