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Week 1 Articles Flashcards

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1
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Aim + who affected most

Introduction

A

Aim: help individuals regain function
Occurs in those with acquired brian injury (30%) and traumatic brain injury (20-40%)

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2
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Restorative training

Introduction

A

Restorative training: targets damaged brain areas via repetitive exercises (mixed success)

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3
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Compensatory strategies

Introduction

A

Compensatory strategies: targets intact cognitive functions to bypass impairment (more successful for daily life adaptation)
Ex: alternative sensory strategies or environmental adaptations.

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4
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Visual agnosia

Introduction

Definition, prevalence, types (prosopagnosia, object agnosia, topographical agnosia, pure alexia)

A

The inability to recognise objects, faces, letters, or places using vision, despite normal eyesight.
1-3% of ABI patients
Types:
1. Prosopagnosia = inability to recognises faces
2. Object agnosia = inability to identify objects
3. Topographical agnosia = difficulty in navigating environments
4. Letter agnosia (pure alexia) = inability to recognise letters and words.

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5
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Balint’s Syndrome

Introduction

Definition, cause, symptoms (simultagnosia, optic ataxia, ocular apraxia)

A

Severe impairment in spatial awareness and visual attention
Cause: bilateral parietal lobe damage
Symptoms:
* Simultanagnosia = inability to perceive multiple objects at once.
* Optic ataxia = impaired hand-eye coordination
* Ocular apraxia = difficulty in shifting gaze to visual stimuli

Severe cases may appear functionally blind due to these deficits.

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6
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Groups

Method

A
  1. Balint’s Syndrome rehab
  2. Prosopagnosia and object agnosia rehab
  3. Topographical agnosia rehab
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7
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Rehab of Balint’s Syndrome

Results

A
  • Compensatory strategies = most effective
  • Restorative training = mixed results
  • Psychoeducation and functional adaptation = crucial for patient improvement
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8
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Rehab of prosopagnosia and object agnosia

Results

A
  • Restorative training had limited success
  • Compensatory approaches = most effective
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9
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Rehab of topographical agnosia

Results

A
  • Navigating training improved independence
  • Both studies showed functional improvements
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10
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Challenges in rehab

Conclusion

A
  1. patients struggle with frustration and acceptance
  2. limited transferability of lab-based training to real-life situations
  3. need for individualised rehab approaches
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11
Q

Heutink (rehab of visual agnosia and balint’s syndrome)

Final take on rehab strategies?

Conclusion

A
  • Compensatory strategies provide the best functional outcomes.
  • Restorative training may work in some cases but its time-intensive with limited benefits
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12
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Visual neglect and its impact

Introduction

Cause, prevalence (left and right), course,

A
  • Cause: consequence of right hemisphere damage, affecting attention to the left side of space.
  • 80% of right-hemisphere stroke patients experience neglect in the acute phase.
  • left hemipshere neglect (from left hemisphere damage) is rare, less severe, and recovers more quickly
  • 50% of patients continue to exhibit neglect one year post-stroke.
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13
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Neural mechanisms of neglect

Introduction

A
  • Impaired integratio of attention-related processes within the right hemisphere is a key factor
  • Disconnection between hemispheres contributes to persistent neglect
  • Posterior callosal dysfunction may prevent the left hemisphere from compensating for right hemisphere deficits
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14
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Prism Adaptation (PA) as a rehab tool

Introduction

Definition, how it works, challenges

A

PA = non-invasive technique used to treat neglect
How it works:
* Prismatic goggles shift the visual field rightward, causing a righward bias
* Patients compensate by adjusting their movements leftward over time.
* After removing the prisms, a leftward shift remains, reducing neglect symptoms

Challenges with PA
* Not all patients benefit from PA
* Unclear why PA fails in some patients = possible structural differences in the brain

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15
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Aim + hypothesis

A

Aim: identify anatomical predictors of PA effectiveness using MRI and diffusion imaging
Hypotheses:
* PA may improve neglecct by recruiting compensatory mechanisms in the left hemisphere.
* Structural brain differences (cortical thickness, white matter integrity) may predict PA success

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16
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Participants

Methods

A

Participants: 14 with chronic left visual neglect (from right-hemisphere strokes, at least 3 months post-stroke)
* 10 control healthy group.

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17
Q

Lunven (predictors of successful prism adaptation in visual neglect)

PA Procedure

Methods

A

PA procedure:
* Patients with prismatic goggles shifting the visual field 10 degrees rightward.
* 100 rapid pointing movements toward left/right targets were performed.
* Before and after PA, patients performed straight-ahead pointing tasks with blindfolds.
* Neglect severity assessed via 6 tests.

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18
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Response classification

Methods

Study These Flashcards
A

High-responders = ≥20% improvement in neglect severity score
Low-responders = <20% improvement

19
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Imaging data acquisition

Methods

Study These Flashcards
A

MRI and diffusion imaging:
* Structural MRI for cortical thickness measurement
* Diffusion MRI (DTI) for white matter integrity
Grey matter and white matter

20
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Analysis

Methods

Study These Flashcards
A

Comparisons between high-responders and low-responders for:
* Cortical thickness
* White matter integrity (FA)
* Lesion volume

21
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Behavioural results

Results

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A
  • All patients showed adaptations to prisms (initial rightward error corrected after trials)
  • High-responders had significantly greater improvement in neglect symptoms than low-responders
  • Time since stroke was significantly shorter in high-responders (341 days) vs low responders (816 days)
22
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Lesion analysis

Results

Study These Flashcards
A

Lesion overlap was centered in the right fronto-parietal white matter
Low responders had additional damage:
* Inferior parietal lobule
* Precentral gyrus and superior frontal lobe

23
Q

Lunven (predictors of successful prism adaptation in visual neglect)

Cortical thickness findings

Results

Study These Flashcards
A

Higher cortical thickness in left hemisphere correlated with better PA response
High responders had thicker cortex in:
* Inferior parietal lobule
* Superior temporal sulcus
* Inferior temporal gyrus

24
Q

Lunven (predictors of successful prism adaptation in visual neglect)

White matter findigns

Results

Study These Flashcards
A

High responders = greater white matter integrity (FA) in corpus callosum:
* Body of the corpus callosum (sensorimotor connectivity)
* Genu of the corpus callosum (PFC connectivity)

25
# Lunven (predictors of successful prism adaptation in visual neglect) Key findings | Discussion
* High cortical thickness in left temporo-parietal and prefrontal regions predicted PA success * Better corpus callosum integrity supported interhemispheric compensation * Shorter time post-stroke increased likelihood of PA success
26
# Lunven (predictors of successful prism adaptation in visual neglect) Implications for rehab | Discussion
* PA may work best when applied early after stroke. * Left hemisphere structured play a key role in neglect recovery * PA modules interhemispheric communication via the corpus callosum
27
# Lunven (predictors of successful prism adaptation in visual neglect) Conclusion | Conclusion
* PA success depends on left hemisphere structural integrity and interhemispheric connectivity * Applying PA early post-stroke may maximise recovery potential * Future research should explore long-term PA effects and brain plasticity mechanisms
28
# Park (Apraxia review and update) Apraxia | Introduction ## Footnote Praxis, definition, common causes, impact
Praxis: the ability to perform skilled or learned movements essential for daily living. Apraxia: the inability to perform purposeful movements, despite normal strength, coordination, and comprehension. Common causes: * Neurological disorders (stroke, dementia, parkinson's disease) * Lesions in the motor, premotor, temporal and parietal cortices. Impact: * affects quality of life, making daily tasks (dressing, eating, grooming) difficult. * recognition and treatment are critical to improve independence.
29
# Park (Apraxia review and update) Historical background | Introduction ## Footnote Huge Liepmann, Norman Geschwind, Modern understanding
Hugo Liepmann: * first described apraxia in stroke patients * proposed that motor planning occurs in the left hemisphere * suggested that movements require information flow from the parietal and occipital lobes to the motor cortex Normal Geschwind: * Suggested that apraxia results from disconnection between the premotor cortex and Wernicke's area via the superior longitudinal fasciculus. Modern understanding: * apraxia is not a single disorder but a network dysfunction involving the frontal, parietal, and temporal cortices
30
# Park (Apraxia review and update) Ideomotor apraxia | Classification of Apraxia ## Footnote Cause and symptoms
Cause: disruption in the left parietal lobe, premotor cortex, or corpus callosum Symptoms: * Cannot perform gestures on command but can do them spontaneously. * Ex: cannot mime using a screwdriver but can use one automatically
31
# Park (Apraxia review and update) Ideational apraxia | Classification of Apraxia ## Footnote Cause and symptoms
Cause: lesions in the left premotor, prefrontal, middle temporal, and parietal areas Symptom: * Cannot conceptualise multi-step tasks. * Ex: caannot demonstrate how to mail a letter even if they recognise an envelope and a stamp.
32
# Park (Apraxia review and update) Limb-Kinetic apraxia | Classification of Apraxia ## Footnote Cause and symptoms
Cause: damage to the contralateral premotor motor Symptoms: * Loss of fine motor coordination * Ex: clumsy, imprecise movements, difficulty buttoning a shirt.
33
# Park (Apraxia review and update) Task specific apraxias | Classification of Apraxia ## Footnote Cause and Types/symptoms
Cause: Lesions vary depending on the type Types/symptoms: * Dressing apraxia = cannot dress indpendently * Gait apraxia = cannot initiate walking * Eyelid opening apraxia = cannot voluntarily open eyes but can do so reflexively.
34
# Park (Apraxia review and update) Neurological disorders associated with apraxia | Evaluation of apraxia ## Footnote Stroke, AD, PD, CBS
Stroke = common in left hemisphere strokes (33%) Neurodegenerative diseases: * Alzheimer's = praxis deficits linked to semantic memory loss. * Parkinson's disease = limb-kinetic apraxia affects dexterity rather than strength * corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP) = severe ideomotor apraxia and limb-kinetic apraxia
35
# Park (Apraxia review and update) Clinical tests for apraxia: key observations in testing | Evaluation of apraxia
Patients with left hemisphere stroke = struggle more with pantomine and transitive movements Patients with AD = intact tool use but deficits in function and gesture knowledge
36
# Park (Apraxia review and update) Functional brain areas involved: left premotor cortex | Neurophysiological of apraxia ## Footnote Function + involvement
* Function = motor planning and retrieval of tool-related knowledge * Involvement = damage leads to ideomotor apraxia
37
# Park (Apraxia review and update) Functional brain areas involved: Left inferior parietal lobule | Neurophysiological of apraxia ## Footnote Function + involvement
* Function = integration of spatial and temporal aspects of movements * Involvement = damage causes grasping errors, difficulty in pantomiming tool use
38
# Park (Apraxia review and update) Functional brain areas involved: Left middle temporal gyrus | Neurophysiological of apraxia ## Footnote Function + involvement
* Function = storage of semantic knowledge for tools and gestures * Involvement = damage results in conceptual errors in object use
39
# Park (Apraxia review and update) Functional brain areas involved: corpus callosum | Neurophysiological of apraxia ## Footnote Function + involvement
* Function = transfers movement commands between hemispheres * Involvement = disruption leads to left-hand apraxia in callosal lesions
40
# Park (Apraxia review and update) Imaging and stimulation studies | Neurophysiological of apraxia ## Footnote fMRI, EEG, TMS
fMRI: * Shows left hemisphere dominance in tool-use pantomine * The parietal cortex is key for movement sequencing EEG: * Indicate pre-movement activity in the parietal and sensorimotor areas Transcranial magnetic stimulation (TMS): * shows category-specific effects * inferior parietal lobule stimulation = deficits in tool use * anterior temporal stimulation = deficits in general semantic memory
41
# Park (Apraxia review and update) Non-invasive brain stimulation | Neurophysiological of apraxia
42
# Park (Apraxia review and update) Treatment of Apraxia | Treatment ## Footnote Rehab strategies and methods
* Apraxia-specific training improves activities of daily living * Training with tool-use gestures helps recover function * Patients with stroke and apraxia benefit more from targeted praxis rehab than aphasia therapy Rehab methods: * Gesture training = patients practice meaningful and meaningless gestures - improves praxis and functional independence * Errorless learning = patients repeat actions without errors to reinforce correct movements - effective for AD and stroke * Compensatory strategies = patients use verbal instructions or visual cues to guide movements - helps maintain function in severe cases
43
# Park (Apraxia review and update) Conclusion | Conclusion
* Apraxia is a disorder of sensorimotor integration, seen in stroke and neurodegenerative diseases * Multiple brain regions (left parietal, temporal, premotor, and motor cortices) are involved. * Effctive rehab includes gesture training, compensatory strategies and possibly brain stimulation

NeuroPsychology (4 decks)

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