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全文: "Unilateral spatial neglect"
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  • 保健医療学雑誌
    2017年 8 巻 1 号 89
    発行日: 2017/04/01
    公開日: 2017/04/03
    ジャーナル フリー
  • Toshikatsu Fujii, Atsushi Yamadori, Reiko Fukatsu, Kyoko Suzuki
    The Tohoku Journal of Experimental Medicine
    1996年 180 巻 1 号 73-81
    発行日: 1996年
    公開日: 2006/05/02
    ジャーナル フリー
    It was originally claimed that left hand use on line bisection tasks reduced the extent of left neglect by Halligan and Marshall. However, in a following study, the same research group failed to reproduce this left hand amelioration effect if the left hand was initially placed on the right side, and they claimed that spatio-motor cueing was more important in reducing unilateral neglect than the hand used. The present study concerns with the validity of these two theoretical views on modification of unilateral neglect, i.e., hemispheric activation and spatio-motor cueing. A patient with left unilateral neglect and a slight left hemiparesis participated in three experiments. Under conventional testing condition, line bisection performed with the right hand showed more severe left neglect than when performed with the left hand. These hand effects were modified by changing a starting position of the patient's hand when bisecting horizontal lines. However, under body-fixed condition, effects of hand-used as well as starting position were again significant. The results suggest that not only spatio-motor cueing but also differential hemispheric activation can exert a profound effect on unilateral neglect.
  • Watanabe Satoru, Amimoto Kazu, Yonezawa Ryusuke
    理学療法学Supplement
    2015年 2014 巻 O-0466
    発行日: 2015年
    公開日: 2015/04/30
    会議録・要旨集 フリー
    【Purpose】The ability to recognize the whole target body is necessary for patients with unilateral spatial neglect(USN)to acquire motor skills by observing actions. Therefore, we studied how patients with USN perceive observed body image using biological motion(BM).【Methods】Patients with stroke with 10 and without 3 USN were studied. The patients with USN patients had different types of lesions, with differing severities of neglect. Frontal views of 2 different left-right asymmetric movements and of 3 different symmetric movements, generated by points of light denoting the major joints of an individual's body were used as BM stimuli. We asked subjects to watch each stimulus displayed on a screen carefully and record their interpretation of what the stimulus looked like. In addition, we had them performed upper limb motor learning tasks by mimicking the actions observed in the BM stimuli. We compared the results of motor learning with the corresponding BM perception.【Results】The results showed that 5 patients with USN could not identify asymmetric stimuli. Two of them could not identify symmetric biological motion or acquire motor skill by action observation. These 2 patients showed moderate neglect and hemianopia and had lesions in the posterior parietal lobe. The remaining 3 patients with USN could acquire motor skill by observing actions, showed moderate or mild neglect without hemianopia and had lesions in the frontal lobe or thalamus. The patients without USN could perceive the BM stimuli.【Discussion】We hypothesize that the USN patients with hemianopia or parietal lobe damage have difficulty learning motor skills by observing actions because they cannot perceive the whole target body. Other patients with USN might engage different attention systems depending on their environment rather than estimating the whole body based on a perception of only half of it.
  • Iwatsuki Hiroyasu, Echigo Ayumi, Sakamoto Mayu
    理学療法学Supplement
    2015年 2014 巻 O-0013
    発行日: 2015年
    公開日: 2015/04/30
    会議録・要旨集 フリー
    【Purpose】Unilateral spatial neglect is a behavioral syndrome occurring after a right-hemisphere stroke. Treatment for spatial neglect focuses on cognitive rehabilitation that uses prism adaptation therapy as one approach. However, this therapy has limitations both in terms of its narrowness of focus and duration of the beneficial effects. This study was carried out to evaluate the effects of pointing practice on walking performance looking through a right-left reversing prism.【Methods】The participants were twelve right-handed healthy persons with a mean(SD)of 25.5(6.7)years. They put on prism glasses causing right-left reversal of the visual field, and were asked 30 times to point to targets placed 3m in front using a laser pointer once daily, five days a week. Timed up and go(TUG)test and walking around the edge of a 3m square(SW)were used to measure walking performance and were evaluated 3 times(before, immediately after and 5 mins after the pointing practice)daily for 5 days.【Results】From 3 day to 5 days, the required times, both TUG and SW, recorded immediately after and 5 mins after the pointing practice were significantly shorter than that of before. In particular, the deviations from the walking path in SW showed significant differences between the values recorded immediately after and 5 mins after the pointing practice and that of before.【Discussion】Improvement of walking performance with a prism after the pointing practice might have facilitated adaptation between mediated proprioceptive perceptions and visual information.The efficacy of single-session prism adaptation suggests general improvement of daily activities in patients with unilateral spatial neglect.
  • MASAAKI NAGAFUCHI
    The Tohoku Journal of Experimental Medicine
    1990年 161 巻 Supplement 号 131-138
    発行日: 1990年
    公開日: 2011/03/14
    ジャーナル フリー
    Right unilateral spatial neglect (USN) was investigated on three left brain-damaged patients suffering from the right homonymous hemianopsia and hemiplegia. A test battery consisted of visuo-constructive praxis; 1) putting blocks into a box, 2) bisecting a horizontal line, 3) figure drawing, 4) drawing of a dial plate and 5) copying drawing. The investigation revealed that USN of left brain-damaged patients resulted from 1) generally impaired mental function, 2) right unilateral sensory deprivation and 3) right hemiplegia. It was guessed that, as for a patient with right homonymous hemianopsia and hemiplegia, his attention would be attracted toward the left hand, and then he would be apt to neglect the right side. Right USN was not so prominent compared with the left one of right hemispheric lesion. However, it is suggested that if clinicians examine carefully the visuo-constructive function in addition to aphasia on left brain-damaged patients, right USN appears greater in some cases.
  • Chikako Yoneda, Eiichi Saitoh, Megumi Suzuki, Masayuki Yamada
    Japanese Journal of Comprehensive Rehabilitation Science
    2011年 2 巻 1-4
    発行日: 2011年
    公開日: 2012/03/05
    ジャーナル フリー
    Yoneda C, Saitoh E, Suzuki M, Yamada M. Effects of prism directionality and active movement adaptation on the symptoms of unilateral spatial neglect. Jpn J Compr Rehabil Sci 2011; 2: 1-4.
    Objective: Prism adaptation therapy is one of the treatment methods for unilateral spatial neglect (USN). In this study, we examined the influence of prism deviations toward the right and toward the left. We also studied the additional effects of hand movements as performance adaptation to prisms.
    Methods: Patients with left USN caused by stroke were split into 2 groups on the basis of whether or not they performed adaptation movements. In all the patients, prisms deviating the visual field 10° to the right and to the left were used, and the adaptation task consisted of right index finger movements to reach 3 targets on a desk, 50 times each. During the movements, hand trajectories were visible. In the group in which adaptation movements were not performed, the participants wore the prisms for 20 minutes. A line bisection test using a 50-cm tape was used to evaluate the USN before and after treatment.
    Results: The use of left-deviating prisms resulted in worsening of the USN in the group in which adaptation movements were performed (p=0.01). In this group, the point of bisection showed a tendency to move toward the left (p=0.29) when right-deviating prisms were used.
    Conclusions: The results indicated that adaptation treatment using right-deviating prisms might be effective for USN, even when the trajectory of the movements is visible.
  • Giuseppe Vallar
    認知神経科学
    2009年 11 巻 3+4 号 171-180
    発行日: 2009年
    公開日: 2011/06/30
    ジャーナル フリー
      Abstract:Unilateral cerebral lesions may bring about a multifaceted pattern of impairment of spatial cognition, termed “unilateral spatial neglect”. The deficit is more frequent and severe after lesions involving the right cerebral hemisphere, and concerns the left side of space, contralateral to the side of the lesion (contralesional). The main feature of spatial neglect is a disordered perceptual awareness of sensory events, taking place in the contralesional side of space, and of the body. A deficit of the planning of intentional movements towards the neglected side of space may also occur, suggesting that perceptual and action systems, though closely linked, are discrete processes. Unilateral spatial neglect may be characterized as a disorder of conscious spatial representations. A great deal of evidence suggests that “neglected” events are nevertheless adequately processed by the brain, up to the extraction of their meaning, and even with a preserved representation of the metric of space, provided their aware spatial localization or detection is not required. Awareness of events around us appears to involve spatial reference frames, which also contribute to cognitive processes, such as numerical cognition. The wealth of selective patterns of impairment shown by neglect patients (e.g., “personal” vs. “extra-personal”, “perceptual” vs. “premotor” neglect) indicates that manifold spatial representations exist, notwithstanding our largely unitary phenomenal experience of space. The main neural networks supporting spatial representation and awareness include the posterior-inferior parietal regions, the temporo-parietal junction, the premotor cortex, and the fronto-parietal connections, as well as subcortical grey nuclei. The neural correlates of spatial neglect do not comprise the primary motor and sensory cortices, suggesting a higher-order, cognitive, deficit of perceptual and action spatial processes. Spatial representations provide a basic reference frame also to elementary sensorimotor loops. This is suggested both by the higher incidence of left-sided sensorimotor hemi-syndromes after right hemispheric damage, and by their amenability to physiological maneuvers (vestibular stimulation, prism adaptation, etc.), which affect spatial representations, and a number of manifestations of the neglect syndrome. Finally, spatial representations are involved in some function monitoring processes and belief systems. This is suggested by the syndrome of unawareness of motor and sensory deficits (anosognosia), and by the productive delusional beliefs concerning one side of the body (the somatoparaphrenic symptom-complex), and, less frequently, extra-personal events. Seen through the neuropsychological perspective provided by patients with spatial neglect, spatial awareness is a multi-component process, pervading many areas of cognition.
  • Toshiaki TANAKA, Yasuhiro NAKAJIMA, Hidefumi Matsushita, Shunichi SUGIHARA, Takashi IZUMI, Norio KATO, Tomoya MIYASAKA
    会議録・要旨集 認証あり
  • Takamura Yusaku, Imanishi Maho, Osaka Madoka, Ohmatsu Satoko, Tominaga Takanori, Morioka Shu, Kawashima Noritaka
    理学療法学Supplement
    2015年 2014 巻 O-0467
    発行日: 2015年
    公開日: 2015/04/30
    会議録・要旨集 フリー
    【Purpose】While symptom of unilateral spatial neglect(USN)gradually improve with time in many cases, most of therapists empirically know once a patient recognizes own neglect behavior, they intentionally tend to pay attention toward the neglect space. In this study, we aimed to characterize visual attention capacity in patients with right hemisphere lesion based on eye tracker-based behavioral and EEG data.【Methods】41 patients with right hemisphere lesion participated in this study. The patients were divided into three subgroups based on the score of the behavioral inattention test(BIT):USN(n=12), USN improved(IMP, n=10), and non- USN right hemisphere damage group(CONT, n=19). Participants seated at the chair in front of eye tracker mounted PC display(Tobii TX60 Tobii inc., Sweden)and asked to perform eye pursuit-driven choice reaction task. The task consists of 25 trials of eye pursuit motion toward a one of five randomly flashed circular objects those are horizontally located on the display. The onset and velocity of eye movement were calculated. We additionally conducted EEG measurement during the task to discuss cortical mechanism underlying behavioral result(n=9).【Results】Onset of eye movement in USN group was significantly delayed specifically in the left target. While the onset and velocity of eye movement in IMP group was similar to those in CONT group, the gaze distribution before the onset of eye movement in IMP group showed leftward-shift as compared to CONT group(p<0.01). The result of EEG measurement revealed that theta band power at Fz was significantly larger in IMP group than CONT group, suggesting that those patients requires an attentional demand for the task.【Discussion】The present results suggest that the patients who recognize the presence of USN intentionally pay attention to neglected space as a compensatory strategy.
  • 前島 伸一郎
    高次脳機能研究 (旧 失語症研究)
    2006年 26 巻 3 号 235-244
    発行日: 2006年
    公開日: 2007/10/05
    ジャーナル フリー
    ある基準によって区分された各項をさらに細かく分けることを下位分類という。半側無視を下位分類することは,局在診断の手段としての重要性のみならず,日常生活場面での問題点や対処法を明確にしていく必要性の上に成り立ち,完治とはいかないまでも,何らかの改善方策を見出す可能性へとつながるものである。本稿では半側無視の発現機序の解明や治療法の確立を期待して,いくつかの基準に基づいた分類を行った。すなわち,原因疾患からみた分類,半球優位性からみた分類,重症度の分類,病巣の違いによる分類,無視空間の違いによる分類,無視する感覚様式の違いによる分類,認知·遂行過程による分類,発現機序からみた分類などを行い,それらについて解説を加えた。
  • Shunichi Sugihara, Toshiaki Tanaka, Tomoya Miyasaka, Takashi Izumi, Koichi Shimizu
    Journal of Physical Therapy Science
    2016年 28 巻 2 号 332-338
    発行日: 2016年
    公開日: 2016/02/29
    ジャーナル フリー
    [Purpose] The purpose of this study was the development of a method for presenting diverse visual information and assessing visual space recognition using a new head mounted display (HMD) system. [Subjects] Eight patients: four with unilateral spatial neglect (USN) and four with visual field defects (VFD). [Methods] A test sheet was placed on a desk, and its image was projected on the display of the HMD. Then, space recognition assessment was conducted using a cancellation test and motion analysis of the eyeballs and head under four conditions with images reduced in size and shifted. [Results] Leftward visual search was dominant in VFD patients, while rightward visual search was dominant in USN patients. The angular velocity of leftward eye movement during visual search of the right sheet decreased in both patient types. Motion analysis revealed a tendency of VFD patients to rotate the head in the affected direction under the left reduction condition, whereas USN patients rotated it in the opposite direction of the neglect. [Conclusion] A new HMD system was developed for presenting diverse visual information and assessing visual space recognition which identified the differences in the disturbance of visual space recognition of VFD and USN patients were indicated.
  • Shu Morioka, Atsushi Matsuo, Midori Abe, Shozo Miyamoto, Fumio Yagi
    Journal of Physical Therapy Science
    2005年 17 巻 1 号 39-42
    発行日: 2005年
    公開日: 2005/07/16
    ジャーナル フリー
    The left side neglect tendency was examined by the ability to draw self-portraits in six unilateral spatial neglect (USN) patients with the patients' eyes open and closed. With the eyes open, all the six patients were able to draw their self-portraits. All of those self-portraits were their own visual images, in which clear defects were observed on the left side of the body. With their eyes closed, however, three of them managed to draw their self-portraits but the other three failed to do so. The self-portraits drawn by the three patients with eyes closed had more defective parts than those drawn with eyes open. These results indicate that USN patients have difficulty not only in memorizing the visual scene but also in recalling their body image. Furthermore, it is also interesting to observe the left-right inversion in the self-portrait drawing.
  • Satoru Watanabe, Kazu Amimoto
    Journal of Physical Therapy Science
    2007年 19 巻 1 号 73-76
    発行日: 2007年
    公開日: 2007/03/23
    ジャーナル フリー
    "Mirror Agnosia" is characterized by searching for the mirror image and showing difficulty of modifying behavior even after the object is presented in real space (Ramachandran, 1997). The possibility of therapeutic intervention of using a mirror for unilateral spatial neglect (USN) with mirror agnosia was suggested, but few researches on mirror agnosia and mirror approach for USN have been reported. The purpose of this study was to confirm the influence of the use of a mirror for USN with mirror agnosia. Two patients with left hemiparesis with USN were evaluated. We propped a mirror on the right side of the patient parallel to the sagittal plane and presented a ball apart from it. We asked the patient to grasp it with looking into the mirror. If they could not reach the actual ball, we shifted the ball closer to the mirror and tried again. When two patients grasped the ball, we asked them to reach it repeatedly. Albert test was executed before and after the session. Both patients could not reach the ball initially, but were able to grasp it when it was closer to the mirror. They showed an improvement in the Albert test after this approach. This method might be useful therapeutic intervention for USN with mirror agnosia.
  • 平林 一, 稲木 康一郎, 平林 順子, 伊沢 真
    失語症研究
    1999年 19 巻 3 号 218-224
    発行日: 1999年
    公開日: 2006/04/25
    ジャーナル フリー
    本研究では,外的に確認を誘導した場合に,左半側空間無視の検査成績に改善がみられるか否かを検討した。Behavioural inattention test に含まれる Conventional sub-tests を左半側空間無視患者 21名に施行し,それぞれの下位検査を遂行し終えたたびごとに赤ペンを手渡し,もう一度見直しをして,訂正があればそれで記入するようにと教示した。その結果,線分二等分検査や模写のような単一対象の左側にみられる無視については,見直しの効果は明らかではなかったが,文字ならびに星の抹消課題では,見直しを促した後に抹消数が増加する症例が有意に多く,広い範囲の空間探索を必要とする課題においては,再度の見直し,すなわち「確認」が無視の軽減を導く可能性が考えられた。左半側空間無視のリハビリテーションにおいては,確認行動の補強が,無視を軽減させる1つの手段になりうる可能性を示唆した。
  • Japanese Psychological Research
    1988年 30 巻 1 号 48
    発行日: 1988年
    公開日: 2009/02/24
    ジャーナル フリー
  • Takaaki Fujita, Atsushi Sato, Yuichi Yamamoto, Koji Otsuki, Kazuaki Iokawa, Toshimasa Sone, Manabu Midorikawa, Kenji Tsuchiya, Lee Bumsuk, Fusae Tozato
    Journal of Physical Therapy Science
    2016年 28 巻 6 号 1883-1887
    発行日: 2016年
    公開日: 2016/06/24
    ジャーナル フリー
    [Purpose] Dressing is an activity of daily living for which stroke patients often show discrepancies between capacity and actual performance. The aim of this study was to elucidate the physical function and unilateral spatial neglect in stroke patients that reduce their level of actual performance despite having the capacity for dressing independently. [Subjects and Methods] This retrospective study included 60 first-time stroke patients judged by occupational therapists as able to dress independently. The patients were divided into two groups according to their FIM® instrument scores for dressing the upper and lower body: an independent group with both scores ≥6 and an assistance group with one or both scores ≤5. After adjusting for confounding factors through propensity score matching, the groups were compared by using Stroke Impairment Assessment Set items, the Simple Test for Evaluating Hand Function of both upper limbs, and the Berg balance scale. [Results] The assistance group had a significantly lower score for the Berg balance scale than the independent dressing group (31.0 ± 12.3 vs. 47.8 ± 7.4). [Conclusion] The results of the present study suggested that the balance function has an effect on the discrepancy between dressing capacity and performance.
  • Atsushi Manji, Tadamitsu Matsuda, Kazu Amimoto
    理学療法学Supplement
    2017年 2016 巻 O-NV-05-1
    発行日: 2017年
    公開日: 2017/04/24
    会議録・要旨集 フリー

    【Purpose】Many studies of tDCS have indicated the effect on the recovery of upper limb function, unilateral spatial neglect and aphasia in the stroke rehabilitation. Although walking ability is important in stroke patients to maintain daily life, there was a little study as to treat walking ability on stroke patients.It previously reported that the SMA potentially plays an important role in balance recovery after stroke. We aimed to investigate the effect of combined therapy BWSTT and tDCS on gait function recovery of stroke patients.

    【Methods】Eighteen stroke patients(mean age:61.8±11.8 y/o, days from onset:133.9±59.0 days, mean FIM score:106.1±10.4)participated in this study. The two BWSTT periods of 1 weeks each, with real tDCS(anode:front of Cz, cathode:inion, 1mA, 20minutes)on supplementary motor area(SMA)and sham stimulation were randomized in a double-blind cross-over design. We measured time required of 10m walk test(10MWT)and timed up and go test(TUG)at the before and after each periods. Saitama Misato rehabilitation hospital ethics committee approved this study. All participants gave their written informed consent.

    【Results】We found the real tDCS with BWSTT improved gait speed(10MWT)and applicative walking ability(TUG)significantly(p<0.05)compared with BWSTT+sham stimulation period.

    【Discussion】Our findings demonstrated the feasibility and efficacy of tDCS in the gait training after stroke. It is possible that the facilitative effects of tDCS on SMA resulted in improvement of postural control during BWSTT. The results indicated implications for the use of tDCS in balance and gait training rehabilitation after stroke.

  • Numao Taku, Amimoto Kazu
    理学療法学Supplement
    2015年 2014 巻 P3-0800
    発行日: 2015年
    公開日: 2015/04/30
    会議録・要旨集 フリー
    【Purpose】Patients with left-sided unilateral spatial neglect(USN)tend to have a right-facing trunk and/or head. Training these patients to rotate their trunk to the left is said to be an effective way to reduce this tendency. We believe that the leftward trunk rotation range increases if training is conducted after putting on a neck collar to fix the head and body. This is because when the patient turns his trunk to the left, the visual field is also unavoidably turned in the same direction. As a pilot study, we investigated the effect of leftward trunk rotation training with/without a neck collar on healthy subjects.【Methods】A total of 16 healthy subjects(mean age 22.6±3.8 years)were recruited and randomly allocated into two groups(A and B). Group A performed leftward head and trunk rotation 20 times after putting on a Philadelphia collar and group B underwent the same procedure without the collar. We measured the head and trunk rotation angle and the center of pressure(COP)displacements in both groups with and without the collar, both before and after training.【Results】The subjects in group B showed a significant increase in the leftward rotation of the trunk angle and in the leftward COP displacements compared to the subjects in group A. The group A subjects who decreased the leftward weight shift showed improvement in the rightward head rotation angle.【Discussion】Among healthy subjects, it seems that a neck collar interfered with learning leftward trunk rotation. It is said that head rotation and trunk rotation are kinetically linked. It is possible that when the head rotation was blocked by the neck collar, the trunk rotation was also inhibited due to the resulting chain reaction.
  • Amimoto Kazu, Fujino Yuji, Manji Atsushi, Watanabe Satoru, Matsuda Tadamitsu
    理学療法学Supplement
    2015年 2014 巻 O-0469
    発行日: 2015年
    公開日: 2015/04/30
    会議録・要旨集 フリー
    【Purpose】In stroke physical therapy, it has been reported that Pusher behavior was negative factor to maintain their upright posture and balance. Relationships of visual and postural verticality and this symptom were discussed in recent studies. However there have been no study to clarify the relationship Pusher and USN as to verticality.The purpose of present study was to investigate the subjective postural verticality(SPV)in patients with Pusher behavior in relation to USN.【Methods】A total of 56 stroke patients(mean age of 65.8 years, 51.9 days from onset), and 13 normal adults(61.8 years old)were enrolled in this study. Scale for contraversive pushing(SCP)was adopted as criteria for presence(more than 1.75 point)of Pusher behavior. Our originally developed vertical board(VB)was used in measurement of SPV. After subjects seated on the VB and eyes closed, we rotated the VB in 1.5 degree per second from 15 degrees tilted to the right or left position. When a subject judged their body was upright, we recorded the angle deviation of the VB by electric angle monitor. Plus value of angle means deviation to the non-hemiparetic side, minus value to the hemiparetic side.【Results】Pusher with USN(n=12)patients showed -0.4 degree, USN without Pusher patients(n=12)-1.5 degree, Pusher without USN(n=4)+0.6 degree, and no Pusher and no USN(n=28)indicated -0.2 degree in directional error(constant error). Absolute error in patients were 5.05, 5.43, 3.69, 2.74, showed significantly larger than that of normal subjects 1.91(p<.05)【Discussion】Results of this study suggest that SPV in Pusher would be modulated by presence of USN. If neglect is associated with Pusher, the direction of SPV would be changed to hemiparetic side.
  • 太田 久晶
    臨床神経学
    2013年 53 巻 11 号 1270-1272
    発行日: 2013/11/01
    公開日: 2013/11/29
    ジャーナル フリー
    半側空間無視は,病巣対側空間に注意を向けることが困難となる現象であり,日常生活場面において大きな影響をおよぼす.これまでに報告されてきた本症状に対する治療介入方法の中でも,プリズム順応課題は,もっともすぐれた介入方法であると考えられる.この方法は,介入効果の般化と持続性にすぐれ,また,発症からの経過日数を問わず,慢性期の患者に対しても介入効果がみとめられることが大きな特徴である.ただし,この介入効果がえられない症例も報告されている.プリズム順応効果の期待ができる症状特性を明らかにすることと,より多くの患者に効果が期待できる順応課題の実施方法を明らかにすることが今後の検討課題であると考えられる.
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