(USN) is a neurological condition caused by damage to either the right or left hemisphere of the brain, resulting in the of stimuli presented on the opposite side. Patients with USN experience challenges in performing activities of daily living, and they may require prolonged hospital stay. Currently, evidence-based training options for recovery are limited due to lesion size and area variations, which cause different symptoms. To develop effective rehabilitation strategies, animal models that can control lesion size and area must be developed. The rodent models of USN, which were developed in the late 1900s, have identified the key brain regions affecting attentional functions. These regions include the medial agranular cortex and posterior parietal cortex. The network involving the superior colliculus, striatum, hypothalamus, and thalamus is also essential for attention and direction selection. Different behavioral tasks and optogenetics have identified detailed brain region functions in USN, and advancements in treatment exploration have been made using rodent models. This review introduced the existing rodent models of USN, focused on the neurological mechanisms responsible for USN, and discussed the potential application of validated treatment methods from rodent models to humans.

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Right-sided (USN) of patients with left hemisphere stroke disappears within a few months from the onset. Also, it has been reported that right-sided USN of bilateral hemisphere lesions patients persists even after 6 months from the onset. Herein, we present the case of a left middle cerebral artery stroke patient with persistent right-sided USN. The patient was right-handed female in her eighties. She was diagnosed with myelodysplastic syndrome 12 years before and then had severe anemia. She suffered from stroke and was hospitalized. She complained of severe right-sided hemiparesis, sensory disturbance, USN, and aphasia. During hospitalization, the laboratory tests revealed a hemoglobin level of 6.0 – 10.2 g/dL and hematocrit level of 18.3–31.8 %. She underwent rehabilitation for fatigue from the anemia. However, her right-sided hemiparesis and USN persisted, and on day 174 post onset she needed support for activities of daily living. Studies have reported that the persistence of the right-sided USN with left hemisphere lesions have a strong relationship with hypoperfusion in the left hemisphere and right parietal regions, even if the right hemisphere has no lesion at all. The decrease in the bilateral hemisphere function is known to hinder the improvement of right-sided USN. Severe anemia (hematocrit level 21.0 %) has also been reported to decrease the oxygen metabolism of whole brain cortex. From these studies severe anemia was thought to hinder the improvement of right-sided USN.

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It was originally claimed that left hand use on line bisection tasks reduced the extent of left 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 than the hand used. The present study concerns with the validity of these two theoretical views on modification of , i.e., hemispheric activation and spatio-motor cueing. A patient with left and a slight left hemiparesis participated in three experiments. Under conventional testing condition, line bisection performed with the right hand showed more severe left 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 .

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半側空間無視（USN）に対する1 Hz反復経頭蓋磁気刺激（rTMS）の効果や，局所脳血流量（rCBF）の変化を調べてUSNの回復過程に関わる脳内機構について検討した．対象は，右大脳半球の血管障害 例（脳梗塞19 例，脳出血3 例）で，発症からrTMS開始までが70～220 日（平均128.3 日）であった．rTMSは，左頭頂後部（P5）を運動閾値の90％の強度で，1 Hz，500発刺激を隔日で計7セッション施行した（2 例で2 クール施行）．評価は，Behavioural inattention test（BIT）や視覚的探索課題-反応時間，Xe-CT（cold法）などを用いて行った．結果では，抹消試験や模写試験，視覚探索反応時間は，rTMS施行1 週～2 週後から改善を認め，その効果は終了2 週後も持続していた．rCBFでは，rTMS施行後に右小脳半球で有意の増加を認めた．以上より，健側半球への低頻度rTMSはUSNに対して有効と思われ，USNの回復には小脳を含む脳内機構の改善が重要と考えられた．

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Purpose: To determine if functional connectivity measured with resting-state functional MRI could be used as a tool to assess

during stroke recovery.

Methods: Resting-state functional MRI was performed on 13 stroke patients with lesions in the right cerebral hemisphere and 31 healthy subjects. The functional connectivity score was defined as a correlation of a target region with the right inferior parietal lobule.

was measured with a behavioral inattention test.

Results: First, the functional connectivity scores between the right inferior parietal lobule and right inferior frontal gyrus, including the opercular and triangular parts, were significantly decreased in stroke patients with

compared with patients without and were significantly correlated with the behavioral inattention test score. Second, the functional connectivity scores between the bilateral inferior parietal lobules were also significantly decreased in patients with compared with patients without and were significantly correlated with the behavioral inattention test score. Third, negative functional connectivity scores between the right inferior parietal lobule and bilateral medial orbitofrontal cortexes, which are related to the default mode network, were detected in patients without in contrast to a reduction of this negative tendency in patients with . The functional connectivity scores between these regions were significantly different between patients with and without and were negatively correlated with the behavioral inattention test score.

Conclusion: Though still in the pilot research stage and using a small number of cases, our findings are consistent with the hypothesis that functional connectivity maps generated with resting-state functional MRI may be used as a tool to evaluate

during stroke recovery.

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[Purpose] This study aims to investigate the effects of mental practice on in patients with chronic stroke. [Subjects] The subjects of this study included 30 patients with chronic . [Methods] The subjects were randomly divided into either the experimental group (EG) or control group (CG). All subjects received a standard rehabilitation program. In addition to the standard rehabilitation, the EG subjects received mental practice (5 days a week for 4 weeks) for 10 minutes. To compare two groups, line bisection test (LBT) and star cancellation test (SCT) were conducted. [Results] Both groups showed significant improvement in the LBT and SCT. There were statistically significant differences in the changes in LBT, but there were no significant differences in the changes in the SCT between both groups. [Conclusion] This study demonstrated that mental practice may be a valuable additional rehabilitation method in the chronic stage of .

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半側空間無視に対して理学療法的視点から概説する。特性ではタイプや重症度により反応が異なることや，半盲などの合併症が症状を複雑化させることを説明する。評価では机上検査は数種類実施し比較すること，基本動作における無視の影響を観察すること，ADLは家族の精神状態を把握することが重要であることを指摘する。治療アプローチでは，治療対象と特性を考慮して方法を選択する必要があり，従来の治療法に加えプリズム順応や側方ミラーアプローチといった感覚運動可塑性刺激を中心とした方法など最近のトピックスを交えて紹介する。

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[Purpose] This study aimed to clarify the immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the left

model. [Participants and Methods] We included 64 healthy participants to create left models and divided them into four subgroups. Each subgroup received opposite lateral weight-shifting training with or without mirror visual feedback. We then evaluated the static and dynamic standing balance by measuring the center of pressure point alterations in the medial-lateral and anterior-posterior planes. We further evaluated the center of pressure length and bilateral load ratio. [Results] The center of pressure was significantly stable upon performing the eyes-open static standing balance test in the left weight-shifting training subgroup with mirror visual feedback. When participants performed the left dynamic standing balance test, the center of pressure moved significantly rightward and became significantly stable in the right weight-shifting training subgroup with mirror visual feedback. The left load ratio significantly decreased in the right weight-shifting training of subgroups that either did or did not receive mirror visual feedback upon performing the left dynamic standing balance test. [Conclusion] We concluded that adding mirror visual feedback to lateral weight-shifting training affected some measurements of standing balance control of the left model.

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[Purpose] The purpose of this study was to identify the effects of oculo-motor exercise, functional electrical stimulation (FES), and proprioceptive neuromuscular facilitation (PNF) on the visual perception of patients. [Subjects and Methods] The subjects were randomly allocated to 3 groups: an oculo-motor exercise (OME) group, a FES with oculo-motor exercise (FOME) group, and a PNF with oculo-motor exercise (POME) group. The line bisection test (LBT), motor free visual test (MVPT), and Catherine Bergego Scale (CBS) were used to measure visual perception. These were performed 5 times per week for 6 weeks. [Results] The OME group and POME group showed significant improvements according to the LBT and MVPT results, but the FOME group showed no significant improvement. According to the CBS, all 3 groups showed significant improvements. The OME and POME groups showed improvement over the FOME group in the LBT and MVPT. However, there was no significant difference among the three groups according to the CBS. [Conclusion] These results indicate that oculo-motor exercise and PNF with oculo-motor exercise had more positive effects than FES with oculo-motor exercise on the visual perception of patients.

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[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 (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 . [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.

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Introduction: Prism adaptation (PA) is a promising treatment to improve

(USN). Egocentric and allocentric are the two types of USN in terms of reference frames, but no study was reported the PA affects allocentric frame selectively. This study therefore aimed to investigate whether the PA effect could be observed only on allocentric frame in healthy participants.

Method: Thirty right-handed participants (12 females and 18 males, mean age

.6 years), wore the right wedged prismatic glasses that created an optical shift of 5.7° to the left. They were asked to reach two visual targets with the right index finger 100 times alternately. Outcomes were measured through the line bisection task where lines of two different lengths (200 mm and 50 mm) were presented one by one in front of or on the left or right side of the participants.

Results: The subjective midpoint on the 200-mm line shifted significantly to the right after the PA, but not on the 50-mm line. Additionally, the degree of rightward deviation was not affected by the position of the presented line regardless of its length.

Discussion: These results indicate that the PA task induced allocentric

-like behavior. Hence, PA affected only the allocentric frame among healthy participants. The results of this study may contribute to the evaluation and treatment of allocentric .

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  半側空間無視の発現メカニズムの基本は, 空間性注意が身体から見て右に偏倚していることである。 注意が向かないとどうなるか？―注意が向けられなかった対象物やその部分は意識に上らない。花の絵は右側から半分描いておしまい。水平な線分は右寄りに印をつけて真ん中と判断する。すなわち, 注意が向いた中心から右側の情報で全体の判断が成立し, 花の絵では左の花びらがなく, 線分では左に長く伸びていても, それらは意識に上らず, あってもなくても関係ないのである。無視される左側の空間／対象の左側部分は, 意識から「失われた」空間／部分であり喪失感は生じない。本人にとっては「普通に」見えている, あるいは, 見ているつもりなのであろう。ただし, 言語性の処理が有意な左半球が健在なため, ヒトにおける半側空間無視の発現は結構複雑な様相を呈する。

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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。

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半側無視の有無や重症度を検査するための方法が数多く報告されている。しかし検査場面の成績が，無視現象全てを反映しているとは限らず，検査場面と日常生活及び訓練場面での成績が解離する場合がある。したがって検査場面だけではなく，日常生活や訓練場面における行動観察が必要である。また半側無視は視覚情報や電気刺激，体幹回旋など様々なモダリティーにより影響を受ける可能性があるため，同じ検査であっても使用するモダリティーの違いにより成績が異なる場合が多い。したがって半側無視に対する理学療法を行う際には，どのようなモダリティーが無視の改善に有効であるかを評価し検討していくことが重要でる。

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  半側空間無視は，空間性注意の右方偏倚を基本とし，課題に対する性急さ，用いる方略の不適切さなど，非空間性要因が加わった最終的表現形である。非空間性要因は，課題ごとに指示を工夫すると改善できる場合がある。注意の右方偏倚の矯正目的で「左を見て」と指示する際は，空間的フレームの明確な左側を示すと有効である。しかし，フレーム内の処理向上には，探索の跳躍を抑えるpacing を要する。保存された感覚を一側性に刺激する方法には，カロリック刺激，視運動性刺激，頸部筋振動刺激があり，刺激中の無視改善効果がある。プリズム順応は短時間で感覚—運動協調に変容を創り出し，持続性の無視改善効果が期待されている。しかし，効果は症例と課題によって異なり，今後の検討を要する。新旧の方法を交えて多角的にアプローチし，半側空間無視患者の日常生活活動向上を目指したい。

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[Purpose] This study aimed to clarify the effect of an adaptation of a deviation of the visual field in three axes on

cognition in patients with and distorted perception in three dimensions. [Participants and Methods] Fifteen patients with cerebrovascular disease and symptoms of were included. Forty-eight pointing movements with a camera attached to a head-mounted display changed in three axes were compared with the control condition in which the camera was deflected only in the horizontal plane as with the prism adaptation. The main outcome measures were subjective straight-ahead pointing, line bisection, line cancellation, and star cancellation. [Results] The head-mounted display adaptive therapy was performed under conditions that varied in all three axes. The results indicated that it was possible to deflect the subjective straight-ahead pointing position to the lower left direction. [Conclusion] In contrast to the prism adaptation, which deflects the visual field in a single axis in the horizontal plane, the tri-axial adaptation corrected the median cognition in the left–right direction as well as the cognition of the body center, including the vertical direction.

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Two cases of left (LUSN) were studied. One case is of a male patient, age 44. with serious LUSN accompanying left hemiparesis secondary to cerebral infarction. However, he revealed no hemianopsia in the visual field examination conducted on the Goldmann's kinetic perimeter, although an overall minor visual constriction was detected. The fact that his visual field examination did not bring out hemianopsia despite the presence of such a serious syndrome, makes this case particularly significant for the purpose of finding out the exact nature of USN. The other case, male, age 64, was also examined on the same kinetic perimeter and revealed the presence of homonymous lower left quadrantic hemianopsia. After about a month's treatment of , the patient made a remarkable progress in the simple tasks such as cancellation and explaining pictures. Then, the patient's visual field was examined again. It, however, demonstrated the persistent presence of homonymous lower left quadrantic hemianopsia. In other words, improvement in the degree of exhibited no correlation with the change in the dimension of hemianopsia in the Case 2 patient.

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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。

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