Meal preparation abilities after left or right hemisphere stroke

Poole JL, Sadek J, Haaland KY. Meal preparation abilities after left or right hemisphere stroke.

Objective

To examine meal preparation ability after right or left hemisphere damage (RHD, LHD) caused by stroke and whether cognitive (spatial abilities, aphasia, limb apraxia) and motor deficits are differentially associated with meal preparation.

Design

Observational cohort design.

Setting

Primary care Veterans Affair Medical Center and private medical center.

Participants

Volunteer right-handed sample of adults with LHD (n=30) or RHD (n=16) caused by stroke and healthy demographically matched adults (n=63) (N=109).

Interventions

Not applicable.

Main Outcome Measures

Total completion time, number and type of errors, and level of independence for a meal preparation task consisting of making a hot beverage and toast, eating part of the meal, and clean-up.

Results

Both stroke groups took significantly more time to complete the meal preparation task than the control group. Total errors and level of independence were worse in the group with LHD than other groups, but individual errors did not significantly differ between the 2 stroke groups. While correlations should be interpreted cautiously, especially in the relatively small RHD group, poorer ipsilesional motor performance was associated with longer completion time in the RHD group, and poorer contralesional motor performance and greater aphasia were associated with less independence in the LHD group.

Conclusions

These findings demonstrate impaired meal preparation after LHD or RHD but greater impairment after LHD. Poorer meal preparation is associated with different cognitive and motor deficits in the 2 stroke groups.     

伴有右侧偏瘫的脑卒中病人的功能康复：与单侧忽略的关系

目的：研究右侧偏瘫脑卒中病人的认知交际能力的康复与单侧空间忽略的关系。 设计：在入院、出院和 3个月的随访期后,对病人的认知交际能力进行评估。 环境：城市急性康复中心。 病人： CT证实为右侧偏瘫的 52例右利手病人。 主要的结果测量：芝加哥功能评定量表康复研究所的各项测量。包括：仪器（商标为 FIM）、阅读理解能力和书面表达能力。 结果：病人在入院到出院期功能有明显的改善,从出院到随访期 FIM表现出明显的改善。忽略的严重程度与入院、出院和随访期的 FIM运动分数, FIM认知分数和 FIM整体分数密切相关。伴有…     

Recovery of functional status after right hemisphere stroke: relationship with unilateral neglect

OBJECTIVE: To evaluate relationships between unilateral spatial neglect and both overall and cognitive-communicative functional outcomes in patients with right hemisphere stroke. DESIGN: Assessment of overall and cognitive-communicative function was conducted on admission to acute rehabilitation, at discharge, and at 3-month follow-up. SETTING: Urban, acute inpatient rehabilitation facility. PATIENTS: Fifty-two consecutive admissions of adult right-handed patients with a single, right hemispheric stroke, confirmed by computed tomography scan. MAIN OUTCOME MEASURES: The FIM instrument and reading comprehension and written expression items of the Rehabilitation Institute of Chicago Functional Assessment Scale(R). RESULTS: Patients made significant functional gains between admission and discharge, and between discharge and follow-up on the FIM. Severity of neglect was correlated with total, motor, and cognitive FIM scores at admission, discharge, and follow-up. Subjects with neglect had significantly more days from onset to admission and a longer length of rehabilitation stay than subjects without neglect. FIM outcomes were significantly different for subject groups with more severe neglect. Both the presence of neglect and its severity were significantly related to functional outcomes for reading and writing. CONCLUSIONS: Patients with neglect show reduced overall and cognitive-communicative functional performance and outcome than patients without neglect. Further studies are needed to explore causal relationships between these factors.     

Active treatments for aprosodia secondary to right hemisphere stroke

This study investigates the effects of two mechanism-based treatments for expressive aprosodia. Three participants, two women and one man, had a right hemisphere cerebral infarction resulting in affective aprosodia with greater expressive than receptive deficits. Trained raters determined presence of aprosodia by judging participants' performance on two emotional communication batteries. A single-subject design with replication across three participants was employed. Sentence production with the use of treated and nontreated emotions was measured during baseline and treatment phases. Sentences were scored for accuracy by a trained rater blind to time of testing and analyzed visually and statistically. Effect sizes calculated on the resulting data for each participant and treatment confirmed modest to substantial treatment effects for both treatments in all three participants. Because of a relative paucity of treatment studies investigating expressive aprosodia, these data are among the first to suggest that aprosodia may be amenable to behavioral treatments.     

Depressed mood and intra-hemispheric location of lesion in right hemisphere stroke patients

42 stroke patients with verified right hemisphere lesions were studied. Depressed mood was measured by means of a global rating scale, and an inventory administered as a structured interview. As measured by the global ratings and one of the inventory subscales, patients with deep, retrorolandic lesions showed significantly more depressed mood than other patients. The findings are discussed in the light of current relevant research, and implications for management of depressed mood in stroke patients are suggested.     

Brief cognitive screening of right hemisphere stroke: relation to functional outcome.

OBJECTIVES: Traditional mental status screens have limited sensitivity in detection of focal brain damage and are particularly insensitive to right hemisphere stroke (RHS). Addition of a simple measure of constructional ability, clock drawing, should enhance the sensitivity of the Modified Mini-Mental State Exam (3MS) in RHS. The relation between the 3MS-clock drawing screen and functional outcome in RHS was also examined. DESIGN: Logistic regression analysis (Study 1) with cross validation on an independent sample (Study 2). SETTING: Inpatient medical rehabilitation. PATIENTS: Study 1: 32 acute RHS patients (mean age 75.2yrs) and 35 age- and education-matched healthy controls. Study 2 (cross-validation): 32 acute RHS patients (mean age 72.8yrs) and 36 matched healthy controls. OUTCOME MEASURES: 3MS, clock drawing, and Functional Independence Measure scores. RESULTS: The 3MS-clock screen accurately distinguished RHS patients from controls. The clock drawing was a valuable and unique addition to the 3MS. RHS patients who were impaired on the 3MS-clock drawing screen had significantly worse FIM scores at discharge than RHS patients who were not impaired on the cognitive screen. CONCLUSION: Clinicians can enhance the sensitivity of their brief mental status examination of RHS patients, in addition to obtaining useful prognostic information, by including a clock drawing task in their screen.     

Organizational strategy influence on visual memory performance after stroke: cortical/subcortical and left/right hemisphere contrasts

OBJECTIVE: To examine how organizational strategy at encoding influences visual memory performance in stroke patients. DESIGN: Case control study. SETTING: Postacute rehabilitation hospital. PARTICIPANTS: Stroke patients with right hemisphere damage (n = 20) versus left hemisphere damage (n = 15), and stroke patients with cortical damage (n = 11) versus subcortical damage (n = 19). MAIN OUTCOME MEASURES: Organizational strategy scores, recall performance on the Rey-Osterrieth Complex Figure (ROCF). RESULTS: Results demonstrated significantly greater organizational impairment and less accurate copy performance (i.e., encoding of visuospatial information on the ROCF) in the right compared to the left hemisphere group, and in the cortical relative to the subcortical group. Organizational strategy and copy accuracy scores were significantly related to each other. The absolute amount of immediate and delayed recall was significantly associated with poor organizational strategy scores. However, relative to the amount of visual information originally encoded, memory performances did not differ between groups. CONCLUSIONS: These findings suggest that visual memory impairments after stroke may be caused by a lack of organizational strategy affecting information encoding, rather than an impairment in memory storage or retrieval.     

Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke

OBJECTIVE: To examine the relation between left unilateral spatial neglect (USN) and rehabilitation outcomes in patients with right hemisphere stroke. DESIGN: A retrospective analysis of a database of right hemisphere stroke patients. SETTING: Acute inpatient rehabilitation hospital. PARTICIPANTS: Patients (N=175) with a diagnosis of right hemisphere stroke who had undergone a neuropsychologic screening including assessment of USN and depressive symptoms at time of admission to an inpatient rehabilitation program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional status was evaluated with the FIM instrument at admission and discharge. The relationship between USN, depressive symptoms, cognitive functioning, length of stay (LOS), and rate of progress in rehabilitation was examined via univariate (correlational) and multivariate (Cox regression) analyses. RESULTS: Patients with USN had longer LOS and progressed more slowly compared with those without USN. When matched against patients with equally poor functional status at admission, USN patients still had longer admissions and progressed more slowly. CONCLUSIONS: USN is a unique predictor of rehabilitation outcomes in patients with right hemisphere stroke. Identification of those specific functional skill areas most affected by USN may make possible the development of targeted interventions aimed at these key areas.     

基于眼动技术的VR认知训练在卒中后右脑半球损伤注意障碍患者中的康复应用

目的:评价基于眼动技术的VR认知训练在卒中后右脑半球损伤注意障碍患者康复中的疗效。方法:将40例右脑半球损伤脑卒中后注意障碍的患者随机分成2组,2组均进行常规治疗,观察组在其基础上进行眼动技术的VR认知康复训练替代常规治疗中认知功能训练。治疗前后分别采用MoCA评分,数字广度测试,字母删除测验,凝视时间评估。结果:治疗6周后,2组患者MoCA评分,数字广度测试,凝视时间均明显提高(P<0.05),而2组字母删除测验中错误删除数、总治疗时长治疗前后和组间无明显变化;治疗后观察组MoCA评分、字母删除测验中正确删除数、数字广度测试顺背数字和倒背数字、凝视时间指标改善程度优于对照组(P<0.05)。结论:基于眼动技术的VR认知康复训练可以有效改善卒中后右脑半球损伤注意障碍患者的注意功能。     

Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with Unilateral Spatial Neglect

Purpose.?The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training.

Method.?Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention.

Results.?The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing.

Conclusions.?Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.     

Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with unilateral spatial neglect

Purpose. The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training.

Method. Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention.

Results. The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing.

Conclusions. Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.     

Ego-syntonic alien hand syndrome after right posterior cerebral artery stroke

The alien hand syndrome classically consists of involuntary movements accompanied by a feeling of foreignness and personification of the affected limb. Autocriticism, in which patients criticize and express astonished frustration with the behavior of the autonomous limb, is a commonly noted feature. Most cases of alien hand are associated with lesions of the supplementary motor areas of the frontal lobes, the corpus callosum, or both. The authors report on a 79-year-old man who sustained a right posterior cerebral artery distribution infarction and developed alien hand syndrome in the absence of callosal involvement. Also unique is that the patient perceived the alien hand as acceptable and positive, not hostile and repugnant. This case suggests not only that the neuroanatomic regions responsible for alien hand syndrome may require re-examination, but also that its definition may need expansion.     

右大脑半球卒中与汉语语法障碍

目的研究右半球是否参与汉语语法的加工以及病变时语法障碍的特点。方法用《汉语语法量表》对30例右半球卒中患者及30例正常人进行汉语语法测验。结果右半球卒中组与正常对照组在“比”字结构句和句子-图画匹配测试中存在的差异具有显著性意义(P<0.05),右半球卒中患者对复杂语法句的理解较简单语法句理解困难(P<0.05),其余测试成绩的差异未见显著性意义。结论右大脑半球参与汉语语法加工,右半球卒中对词法理解影响不大,主要导致句法理解障碍。     

Functional recovery of gait and joint kinematics after right hemispheric stroke

OBJECTIVE: To gain insight into the relation between changes in gait patterns over time and functional recovery of walking ability in stroke patients. DESIGN: Cohort study. SETTING: Inpatient rehabilitation center of a university hospital in the Netherlands. PARTICIPANTS: Thirteen stroke patients admitted, or awaiting admission, for inpatient rehabilitation 3 weeks poststroke, and 16 healthy control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: At 3, 6, 12, 24, and 48 weeks poststroke, functional recovery of walking ability was assessed with the Rivermead Mobility Index (RMI) and the Functional Ambulation Categories (FAC). When possible, kinematics of the knee, hip, and pelvis were assessed through gait analysis in an 8 x 4 m gait laboratory. Minimal scores of 8 on the RMI and 4 on the FAC were necessary before patients were classified as functionally recovered. RESULTS: Patients whose joint kinematics during ambulation had recovered to within the range of the control group showed functional recovery of walking ability. However, some patients whose kinematics had developed toward an abnormal pattern also showed functional recovery. CONCLUSIONS: Recovery of joint kinematics toward a normal pattern is not required for functional recovery of walking ability. Early recognition of compensatory walking patterns that facilitate functional recovery may have implications for rehabilitation programs.     

White matter integrity in right hemisphere predicts pitch-related grammar learning

White matter plays an important role in various domains of cognitive function. While disruptions in white matter are known to affect many domains of behavior and cognition, the ability to acquire grammatical regularities has been mostly linked to the left hemisphere, perhaps due to its dependence on linguistic stimuli. The role of white matter in the right hemisphere in grammar acquisition is yet unknown. Here we show for the first time that in the domain of pitch, intact white matter connectivity in right-hemisphere analogs of language areas is important for grammar learning. A pitch-based artificial grammar learning task was conducted on subjects who also underwent diffusion tensor imaging. Probabilistic tractography using seed regions of interest in the right inferior frontal gyrus and right middle temporal gyrus showed positive correlations between tract volume and learning performance. Furthermore, significant correlations were observed between learning performance and FA in white matter underlying the supramarginal gyrus, corresponding to the right temporal-parietal junction of the arcuate fasciculus. The control task of recognition did not correlate with tract volume or FA, and control tracts in the left hemisphere did not correlate with behavioral performance. Results show that the right ventral arcuate fasciculus is important in pitch-based artificial grammar learning, and that brain structures subserving learning may be tied to the hemisphere that processes the stimulus more generally.