Alertness-training in neglect: Behavioral and imaging results

Issue title: Plasticity in Spatial Neglect – Recovery and Rehabilitation

Article type: Research Article

Authors: Sturm, W. | Thimm, M. | Küst, J. | Karbe, H. | Fink, G.R.^;

Affiliations: Department of Neurology, Section Clinical Neuropsychology, University Hospital RWTH Aachen, Germany | Institute of Medicine, Research Centre Jülich, Germany | Department of Neurology, Cognitive Neurology, University Hospital RWTH Aachen, Germany | Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany

Note: [] Corresponding author: Prof. Dr. Walter Sturm, Department of Neurology, Section Clinical Neuropsychology, University Hospital RWTH Aachen, Pauwelsstraße 30, D 52074 Aachen, Germany. Tel.: +49 241 8089826; Fax: +49 241 8082598; E-mail: sturm@neuropsych.rwth-aachen.de

Abstract: Purpose: It has been proposed that the right hemisphere alerting network co-activates, either directly or via the brainstem, the spatial attention system in the parietal cortex. The observation that measures of impaired alertness and sustained attention can be used to predict the outcome of neglect might suggest such a relationship, too. The aim of the present study was to investigate the effects of alertness training on hemispatial neglect. Method: A three-week computerised alertness training was applied to patients with chronic (> 3 months) stable visuospatial hemineglect. Training effects were investigated both in a single case and in a group of 7 patients by means of neuropsychological tests and functional magnetic resonance imaging (fMRI). Results: After the training, the patients showed a significant improvement in a neglect test battery above any natural fluctuation during a three-week baseline phase. Improvements in the neglect tasks were accompanied by an increase of both right and left hemisphere frontal, anterior cingulate and superior parietal activation, areas known to be associated with both alertness and spatial attention. Four weeks after the end of the training, the patients' neglect test performance had mostly returned to baseline. Despite decreases of activation in some of the initially reactivated areas, increases in neural activity bilaterally in frontal areas, in the right anterior cingulate cortex, the right angular gyrus and in the left temporoparietal cortex remained. An Optokinetic Stimulation Training (OKS) in a control group of another 7 neglect patients led to comparable behavioral results. After the training, however, there was a reactivation mainly in posterior parts of both hemispheres suggesting training specific functional reorganization. Conclusion: The limited stability of the behavioral and reactivation results over time demonstrates that a three-week alertness or OKS training alone does not result in long lasting behavioral improvements and stable reactivation patterns in every patient. We rather suggest that combining alertness and spatial attention oriented training procedures might lead to a more stable amelioration of neglect symptoms.

Keywords: Neglect, spatial attention, functional reactivation, recovery of function, stroke, plasticity

Journal: Restorative Neurology and Neuroscience, vol. 24, no. 4-6, pp. 371-384, 2006