Heminegligencia visuo-espacial izquierda en un bebé de 8 meses / Left hemispatial and visual neglect in an 8-month-old baby

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Rehabilitación de la anosognosia en pacientes con heminegligencia visuoespacial / Rehabilitation of anosognosia in patients with unilateral visuospatial neglect

Introducción. Habitualmente, el paciente con heminegligencia visuoespacial secundaria a un ictus no es consciente de que su percepción y exploración del espacio contralesional son defectuosas. Este fenómeno clínico, conocido como anosognosia, condiciona directamente el proceso rehabilitador y amplía sensiblemente su duración, al tiempo que dificulta la adhesión del paciente a dicho proceso. Objetivo. Valorar la eficacia de un programa de rehabilitación específico para el tratamiento de la anosognosia en pacientes que presentan heminegligencia visuoespacial. Pacientes y métodos. Se distribuyó a 12 pacientes con ictus hemisférico derecho en dos grupos. El grupo experimental recibió 15 sesiones de tratamiento cognitivo informatizado junto con 15 sesiones de rehabilitación específicas para la anosognosia. El grupo control realizó 15 sesiones de tratamiento cognitivo informatizado. A todos ellos se les administró, antes y después del tratamiento, una batería de test para evaluar la atención visuoespacial. El nivel de funcionalidad se valoró mediante la Catherine Bergego Scale. Resultados. Tras la intervención, el grupo control mostró diferencias psicométricas estadísticamente significativas. No sucedió lo mismo con el grupo experimental. No se obtuvieron diferencias en las comparaciones intergrupales pre y postratamiento, ni en las medidas psicométricas ni en la escala funcional. Conclusiones. Es necesario seguir realizando investigaciones que nos ayuden a mejorar el tratamiento de la anosognosia en pacientes que presentan heminegligencia visuoespacial. Se plantean algunas recomendaciones metodológicas surgidas de las limitaciones identificadas en el presente estudio

Introduction. Patients with unilateral visuospatial neglect secondary to a stroke are usually unaware of the fact that their perception and exploration of contralesional space are deficient. This clinical phenomenon, know as anosognosia, directly conditions the rehabilitation process and prolongs its duration to a significant extent, while also making it more difficult for the patient to adhere to it. Aim. To assess the efficacy of a specific rehabilitation programme for the treatment of anosognosia in patients presenting with unilateral visuospatial neglect. Patients and methods. Twelve patients with a stroke in the right hemisphere were divided into two groups. The experimental group received 15 sessions of computerised cognitive therapy along with 15 sessions of specific rehabilitation for anosognosia. The control group underwent 15 sessions of computerised cognitive treatment. All of them were administered, before and after treatment, a battery of tests to evaluate visuospatial attention. The level of functionality was evaluated by means of the Catherine Bergego Scale. Results. After the intervention, the control group showed statistically significant psychometric differences. The same did not occur with the experimental group. No differences were obtained in the pre- and post-treatment intergroup comparisons, or in the psychometric measures or on the functional scale. Conclusions. Further research is needed to help us improve the treatment of anosognosia in patients with unilateral visuospatial neglect. Some methodological recommendations emerge from the limitations identified in this study

Visual search in unilateral spatial neglect: The effects of distractors on a dynamic visual search task.

The objective of this study was to examine visual scanning performance in patients with Unilateral Spatial Neglect (USN) in a visual search task. Thirty-one right hemisphere stroke patients with USN were recruited. They performed a dynamic visual search task with two conditions, with and without distractors, while eye movements were monitored with an eye-tracker. The main goal of the task was to select target stimuli that appeared from the top of the screen and moved vertically downward. Target detection and visual scanning percentage were assessed over two hemispaces (right, left) on two conditions (distractor, no distractor). Most Scanned Regions (MSR) were calculated to analyze the areas of the screen where most points of fixation were directed to. Higher target detection rate and visual scanning percentages were found on the right hemispace on both conditions. From the MSRs we found that participants with a center of attention further to the right of the screen also presented smaller overall MSRs. Right hemisphere stroke patients with USN presented not only a significant rightward bias but reduced overall search areas, implying hyperattention does not only restrict search on the horizontal (right-left) axis but the vertical axis (top-bottom) too.

Combination treatment in the rehabilitación of visuospatial neglect / Tratamiento combinado en la rehabilitación de la negligencia visuo-espacial

BACKGROUND: Visuo-spatial neglect predicts longer hospitalization, poorer recovery of motor skills and greater functional limitation. The aim of the present study was to analyze whether the combined administration of computerized cognitive rehabilitation with right hemifield eye-patching in patients with left spatial neglect following a right hemisphere stroke is more effective than computerized cognitive rehabilitation applied in isolation. METHOD: Randomized clinical trial conducted in 28 patients. These were grouped into two experimental groups: single treatment group (ST) (n= 15) and combined treatment group (CT) (n= 13). All received an average of 15 one-hour sessions of computerized cognitive rehabilitation using the Guttmann, NeuroPersonalTrainer® telerehabilitation platform. Those patients in the TC group performed the sessions wearing a visual device with which the right hemifield of each eye was occluded. RESULTS: Following treatment, both the ST and the TC group showed improvements in neuropsychological examination protocol although there were no differences pre- and post-treatment on the functional scale in either group. Likewise, no statistically significant differences were observed in intergroup comparison. CONCLUSIONS: The results from this study indicate that combination treatment is not more effective than rehabilitation applied in isolation

ANTECEDENTES: la negligencia visuo-espacial predice mayor tiempo de hospitalización, peor recuperación de las habilidades motoras y limitaciones funcionales. El objetivo fue analizar si la administración combinada de rehabilitación cognitiva informatizada junto con el right hemifield eye patching, en participantes que presentan negligencia espacial izquierda como consecuencia de un ictus hemisférico derecho, es más eficaz que la rehabilitación cognitiva informatizada aplicada de forma aislada. MÉTODO: ensayo clínico aleatorizado realizado con 28 participantes. Dos grupos experimentales: grupo tratamiento único (TU) (n= 15) y grupo tratamiento combinado (TC) (n= 13). Todos ellos recibieron una media de 15 sesiones de rehabilitación cognitiva informatizada de una hora de duración mediante la plataforma de telerehabilitación Guttmann, NeuroPersonalTrainer®. Los participantes del grupo TC las ejecutaron con un dispositivo visual que llevaba el hemicampo derecho de cada ojo ocluido. RESULTADOS: tras el tratamiento, tanto el grupo TU como el TC mostraron mejoras en el protocolo de exploración neuropsicológica aunque no hubo diferencias pre- y post-tratamiento en la escala funcional en ninguno de los dos grupos. Asimismo, no se observaron diferencias estadísticamente significativas en la comparación intergrupal. CONCLUSIONES: los resultados derivados de este estudio indican que el tratamiento combinado no es más eficaz que la rehabilitación aplicada de forma aislada

Combination treatment in the rehabilitation of visuo-spatial neglect.

BACKGROUND: Visuo-spatial neglect predicts longer hospitalization, poorer recovery of motor skills and greater functional limitation. The aim of the present study was to analyze whether the combined administration of computerized cognitive rehabilitation with right hemifield eye-patching in patients with left spatial neglect following a right hemisphere stroke is more effective than computerized cognitive rehabilitation applied in isolation. METHOD: Randomized clinical trial conducted in 28 patients. These were grouped into two experimental groups: single treatment group (ST) (n= 15) and combined treatment group (CT) (n= 13). All received an average of 15 one-hour sessions of computerized cognitive rehabilitation using the Guttmann, NeuroPersonalTrainer® telerehabilitation platform. Those patients in the TC group performed the sessions wearing a visual device with which the right hemifield of each eye was occluded. RESULTS: Following treatment, both the ST and the TC group showed improvements in neuropsychological examination protocol although there were no differences pre- and post-treatment on the functional scale in either group. Likewise, no statistically significant differences were observed in intergroup comparison. CONCLUSIONS: The results from this study indicate that combination treatment is not more effective than rehabilitation applied in isolation.

[What is hidden behind the Baking Tray Task? Study of sensibility and specificity in right-hemispheric stroke patients]. / Que se esconde tras el Baking Tray Task? Estudio de sensibilidad y especificidad en sujetos con ictus hemisferico derecho.

INTRODUCTION: Tham and Tegner proposed the Baking Tray Task (BTT) as a fast simple assessment test for detecting spatial negligence. However, very few studies have examined its validity as a diagnostic test. AIM: To analyse the diagnostic validity of the BTT by measuring its specificity and sensitivity in a sample of subjects with right hemisphere strokes. SUBJECTS AND METHODS: Forty-eight patients with right hemisphere vascular lesions were distributed in two groups (negligence group, n = 35; non-negligence group, n = 13) according to the scores obtained in a battery of visuospatial examination tests. The participants' performance on the BTT was compared with that of a healthy control group (n = 12). RESULTS: The results showed a high level of sensitivity of the BTT, but low specificity. The performance on the BTT of eight of the 13 members of the non-negligence group was suggestive of negligence. CONCLUSIONS: The BTT has proved to be a sensitive test for the detection of spatial negligence. Yet, based on its low specificity, its use alone as a single diagnostic test is not recommended.

TITLE: Que se esconde tras el Baking Tray Task? Estudio de sensibilidad y especificidad en sujetos con ictus hemisferico derecho.Introduccion. Tham y Tegner propusieron el Baking Tray Task (BTT) como una prueba de evaluacion rapida y simple para la deteccion de negligencia espacial. No obstante, apenas existen estudios que hayan examinado su validez como prueba diagnostica. Objetivo. Analizar la validez diagnostica del BTT, midiendo su especificidad y sensibilidad, en una muestra de sujetos con ictus hemisfericos derechos. Sujetos y metodos. Cuarenta y ocho pacientes con lesiones vasculares hemisfericas derechas distribuidos en dos grupos (grupo negligencia, n = 35; grupo no negligencia, n = 13) en funcion de las puntuaciones obtenidas en una bateria de exploracion visuoespacial. La ejecucion de los participantes en el BTT se comparo con un grupo control sano (n = 12). Resultados. Los resultados mostraron una alta sensibilidad del BTT, pero una baja especificidad. Ocho de los 13 integrantes del grupo no negligencia obtuvieron un rendimiento en el BTT sugestivo de negligencia. Conclusiones. El BTT se muestra como un test sensible para la deteccion de la negligencia espacial. Sin embargo, basandonos en su baja especificidad, no es recomendable su uso aislado como prueba unica de diagnostico.

¿Qué se esconde tras el Baking Tray Task? Estudio de sensibilidad y especificidad en sujetos con ictus hemisférico derecho / What is hidden behind the Baking Tray Task? Study of sensibility and specificity in right-hemispheric stroke patients

Introducción. Tham y Tegnér propusieron el Baking Tray Task (BTT) como una prueba de evaluación rápida y simple para la detección de negligencia espacial. No obstante, apenas existen estudios que hayan examinado su validez como prueba diagnóstica. Objetivo. Analizar la validez diagnóstica del BTT, midiendo su especificidad y sensibilidad, en una muestra de sujetos con ictus hemisféricos derechos. Sujetos y métodos. Cuarenta y ocho pacientes con lesiones vasculares hemisféricas derechas distribuidos en dos grupos (grupo negligencia, n = 35; grupo no negligencia, n = 13) en función de las puntuaciones obtenidas en una batería de exploración visuoespacial. La ejecución de los participantes en el BTT se comparó con un grupo control sano (n = 12). Resultados. Los resultados mostraron una alta sensibilidad del BTT, pero una baja especificidad. Ocho de los 13 integrantes del grupo no negligencia obtuvieron un rendimiento en el BTT sugestivo de negligencia. Conclusiones. El BTT se muestra como un test sensible para la detección de la negligencia espacial. Sin embargo, basándonos en su baja especificidad, no es recomendable su uso aislado como prueba única de diagnóstico (AU)

Introduction. Tham and Tegnér proposed the Baking Tray Task (BTT) as a fast simple assessment test for detecting spatial negligence. However, very few studies have examined its validity as a diagnostic test. Aim. To analyse the diagnostic validity of the BTT by measuring its specificity and sensitivity in a sample of subjects with right hemisphere strokes. Subjects and methods. Forty-eight patients with right hemisphere vascular lesions were distributed in two groups (negligence group, n = 35; non-negligence group, n = 13) according to the scores obtained in a battery of visuospatial examination tests. The participants’ performance on the BTT was compared with that of a healthy control group (n = 12). Results. The results showed a high level of sensitivity of the BTT, but low specificity. The performance on the BTT of eight of the 13 members of the non-negligence group was suggestive of negligence. Conclusions. The BTT has proved to be a sensitive test for the detection of spatial negligence. Yet, based on its low specificity, its use alone as a single diagnostic test is not recommended (AU)

Relación entre el funcionamiento ejecutivo y la conducta en niños con parálisis cerebral / Relationship between executive functioning and behaviour in children with cerebral palsy

Introducción. La parálisis cerebral se define como un grupo de trastornos del desarrollo del movimiento y la postura que cursa con déficits cognitivos, alteraciones emocionales, de conducta y sociales. Objetivo. Estudiar la relación entre el funcionamiento ejecutivo y la conducta en niños con parálisis cerebral a partir de las respuestas aportadas por padres y profesores en el Behavior Rating Inventory of Executive Function (BRIEF) y el sistema de evaluación de la conducta adaptativa (ABAS-II). Pacientes y métodos. La muestra quedó formada por 46 niños con parálisis cerebral, con una edad media de 10,26 ± 2,95 años. Del total, 44 niños se distribuyeron en el Gross Motor Function Classification System (GMFCS) en nivel I (n = 16), nivel II (n = 3), nivel III (n = 11), nivel IV (n = 10) y nivel V (n = 4). Resultados. Los resultados mostraron relación entre el BRIEF y el ABAS-II; además, se obtuvieron discrepancias entre las respuestas aportadas por padres y profesores, tanto en el ABAS-II como en el BRIEF. Asimismo, se halló relación entre el GMFCS y los subíndices de vida en el hogar, índice práctico y autocuidado del ABAS-II. Conclusiones. Se encontró relación entre el funcionamiento ejecutivo y la conducta adaptativa en niños con parálisis cerebral. Se hallaron discrepancias en las respuestas aportadas por padres y profesores. Por último, los datos muestran que, a mayor afectación motora, mayores dificultades en el hogar, en el índice práctico y en el autocuidado (AU)

Introduction. Cerebral palsy is defined as a group of developmental disorders of movement and posture that causes social and cognitive deficits, emotional, and behavior disturbances. Aim. To study the relationship between executive functioning and behavior in children with cerebral palsy from the answers given by parents and teachers on the Behavior Rating Inventory of Executive Function (BRIEF) and on the System Assessment Adaptive Behavior (ABAS-II). Patients and methods. The sample consisted on 46 children with CP with a mean age of 10.26 ± 2.95 years. Forty-four of the 46 children were distributed in Gross Motor Function Classification System (GMFCS) into level I (n = 16), level II (n = 3), level III (n = 11), level IV (n = 10) and level V (n = 4). Results. The results showed a relationship between BRIEF and ABAS-II. Furthermore, discrepancies between the responses from parents and teachers, both in the ABAS-II and in the BRIEF, were obtained. Conclusions. We found a significant relationship between executive functioning in children with cerebral palsy and adaptive behavior. We found discrepancies in the answers given by parents and teachers. Finally, the data showed that the higher motor impairment increases difficulties at home (AU)

Déficits neuropsicológicos en la hemiplejía alternante infantil: estudio de un caso / Neuropsychological deficits in alternating hemiplegia of childhood: a case study

Introducción. La hemiplejía alternante infantil es un síndrome del neurodesarrollo de etiología incierta, caracterizado por la presencia de ataques transitorios de hemiplejía. Las características adicionales incluyen crisis epilépticas, distonía, anomalías motoras oculares y déficits en el funcionamiento cognitivo. Caso clínico. Niña de 7 años con hemiplejía alternante infantil. Los primeros síntomas comenzaron a los 17 meses en forma de debilidad en los miembros inferiores, migrañas, nistagmo y crisis hemipléjicas que alternaban ambos hemicuerpos. Se administró la escala de inteligencia de Wechsler para niños IV (WISC-IV) y el Conners Continuous Performance Test II (CPT-II), así como las escalas de Conners para padres (CPRS-48) y profesores (CTRS-28) y el Behavior Rating Inventory Executive Function (BRIEF). Conclusiones. En nuestro estudio encontramos déficits en atención sostenida, reducción de la velocidad de procesamiento de la información, y dificultades en la comprensión, expresión verbal y memoria de trabajo. Además, los padres y profesores comunicaron conductas problemáticas, y dificultades en la capacidad de inhibición, en el autocontrol y en la regulación de emociones. (AU)

Introduction. Alternating hemiplegic of childhood is a predominantly sporadic neurodevelopmental syndrome of uncertain etiology, characterized by alternating transient attacks of hemiplegia. Additional features include tonic fits, dystonic posturing, ocular motor abnormalities and deficits in cognitive functioning. Case report. A girl of 7 years-old with alternating hemiplegic of childhood. The first symptoms debut at 17 months of age in the form of lower limb weakness, migraine, nystagmus and hemiplegic crisis alternating both hemibodies. We administrate the Wechsler Intelligence Scale for Children IV (WISC-IV), the Conners Continuous Performance Test II (CPT-II), the Conners scales for parents (CPRS-48) and teachers (CTRS-28) and the Behavior Rating Inventory Executive Function (BRIEF). Conclusions. In our study we found deficits in sustained attention, reduced speed of information processing, and difficulties in understanding, speaking and working memory. In addition, parents and teachers reported behavioral disturbances, difficulties inhibition capability, in self-control and in regulating emotions (AU)

[Neuropsychological deficits in alternating hemiplegia of childhood: a case study]. / Deficits neuropsicologicos en la hemiplejia alternante infantil: estudio de un caso.

INTRODUCTION: Alternating hemiplegic of childhood is a predominantly sporadic neurodevelopmental syndrome of uncertain etiology, characterized by alternating transient attacks of hemiplegia. Additional features include tonic fits, dystonic posturing, ocular motor abnormalities and deficits in cognitive functioning. CASE REPORT: A girl of 7 years-old with alternating hemiplegic of childhood. The first symptoms debut at 17 months of age in the form of lower limb weakness, migraine, nystagmus and hemiplegic crisis alternating both hemibodies. We administrate the Wechsler Intelligence Scale for Children IV (WISC-IV), the Conners Continuous Performance Test II (CPT-II), the Conners scales for parents (CPRS-48) and teachers (CTRS-28) and the Behavior Rating Inventory Executive Function (BRIEF). CONCLUSIONS: In our study we found deficits in sustained attention, reduced speed of information processing, and difficulties in understanding, speaking and working memory. In addition, parents and teachers reported behavioral disturbances, difficulties inhibition capability, in self-control and in regulating emotions.

TITLE: Deficits neuropsicologicos en la hemiplejia alternante infantil: estudio de un caso.Introduccion. La hemiplejia alternante infantil es un sindrome del neurodesarrollo de etiologia incierta, caracterizado por la presencia de ataques transitorios de hemiplejia. Las caracteristicas adicionales incluyen crisis epilepticas, distonia, anomalias motoras oculares y deficits en el funcionamiento cognitivo. Caso clinico. Niña de 7 años con hemiplejia alternante infantil. Los primeros sintomas comenzaron a los 17 meses en forma de debilidad en los miembros inferiores, migrañas, nistagmo y crisis hemiplejicas que alternaban ambos hemicuerpos. Se administro la escala de inteligencia de Wechsler para niños IV (WISC-IV) y el Conners Continuous Performance Test II (CPT-II), asi como las escalas de Conners para padres (CPRS-48) y profesores (CTRS-28) y el Behavior Rating Inventory Executive Function (BRIEF). Conclusiones. En nuestro estudio encontramos deficits en atencion sostenida, reduccion de la velocidad de procesamiento de la informacion, y dificultades en la comprension, expresion verbal y memoria de trabajo. Ademas, los padres y profesores comunicaron conductas problematicas, y dificultades en la capacidad de inhibicion, en el autocontrol y en la regulacion de emociones.

Cognitive rehabilitation with right hemifield eye-patching for patients with sub-acute stroke and visuo-spatial neglect: a randomized controlled trial.

OBJECTIVE: To assess whether, following a right-hemisphere stroke, the combined administration of computer-based cognitive rehabilitation and right hemifield eye-patching in patients with visuo-spatial neglect is more effective than computer-based cognitive rehabilitation alone. METHODS: Twelve patients were randomized into two treatment groups: a single treatment group (n = 7) and a combination treatment group (n = 5). In both cases, the treatment consisted of a mean number of 15 sessions, each lasting 1 hour. Visuo-spatial neglect was assessed using a specific exploration protocol (Bell Cancellation Test, Figure Copying of Odgen, Line Bisection, Baking Tray Task and Reading Task). The functional effects of the treatment were assessed using the Catherine Bergego Scale. RESULTS: Significant between-group differences were observed when comparing the pre- and post-treatment scores for the Reading Task. No differences were observed in either group in the Catherine Bergego Scale administered at baseline and at the final intervention. CONCLUSION: The results obtained do not allow one to conclude that the combination treatment with cognitive rehabilitation and right hemifield eye-patching is more effective than cognitive rehabilitation alone. Although partial improvement in the performance of neuropsychological tests was observed, this improvement is not present at functional level.

Estimulación cognitiva en niños con parálisis cerebral / Cognitive stimulation in children with cerebral palsy

Introducción. La parálisis cerebral a menudo cursa con déficits cognitivos de atención, visuopercepción, funciones ejecutivas y memoria de trabajo. Objetivo. Analizar el efecto de un tratamiento de estimulación cognitiva sobre las capacidades cognitivas en niños con parálisis cerebral. Pacientes y métodos. Muestra de 15 niños con parálisis cerebral, con una edad media de 8,80 ± 2,51 años, clasificados mediante el Gross Motor Function Classification System (GMFCS) en nivel I (n = 6), nivel II (n = 4), nivel III (n = 2) y nivel V (n = 3). Los déficits cognitivos se evaluaron mediante la escala de inteligencia de Wechsler para niños (WISC-IV) y el Continuous Performance Test (CPT-II). Se administraron los cuestionarios para padres y profesores del Behavior Rating Inventory of Executive Function (BRIEF) y las escalas de evaluación de Conners (CPRS-48 y CTRS-28). Se realizó un programa de estimulación cognitiva dos horas semanales durante ocho semanas. Resultados. Se observaron diferencias estadísticamente significativas tras aplicar el tratamiento de estimulación cognitivo en el índice de razonamiento perceptivo de la WISC-IV. No se obtuvieron diferencias antes y después del tratamiento en las puntuaciones del Conners y del BRIEF. Tampoco se hallaron diferencias en los resultados de la WISC-IV en función del sexo ni en el GMFCS. Conclusión. El rendimiento cognitivo de los niños con parálisis cerebral mejora tras la aplicación de un programa de rehabilitación cognitiva (AU)

Introduction. Cerebral palsy is often accompanied by cognitive impairment affecting attention, visuoperception, executive functions and working memory. Aims. To analyse the effect of cognitive stimulation treatment on the cognitive capabilities in children with cerebral palsy. Patients and methods. Our sample consisted of 15 children with cerebral palsy, with a mean age of 8.80 ± 2.51 years, who were classified with the aid of the Gross Motor Function Classification System (GMFCS) on level I (n = 6), level II (n = 4), level III (n = 2) and level V (n = 3). Cognitive impairment was evaluated by means of the Wechsler Intelligence Scale for Children (WISC-IV) and the Continuous Performance Test (CPT-II). Both the questionnaires for parents and teachers from the Behavior Rating Inventory of Executive Function (BRIEF) and the Conners rating scales (CPRS-48 and CTRS-28) were administered. A cognitive stimulation programme was carried out at a rate of two hours a week for a total of eight weeks. Results. Statistically significant differences were observed after applying the cognitive stimulation treatment in the perceptive reasoning index of the WISC-IV. No differences were obtained on the Conners’ and the BRIEF scores before and after the treatment. Neither were any differences found in the results on the WISC-IV according to sex or on the GMFCS. Conclusions. The cognitive performance of children with cerebral palsy improves after applying a cognitive rehabilitation programme (AU)