Driver re-education after stroke - case study

The article presents the characteristics of a case study - stroke survivors with unilateral neglect syndrome, mechanisms used in re-education training and elements of functional rehabilitation. The focus was on an important diagnostic problem in the field of occupational medicine and the return to driving for people after stroke. The aim of the research work undertaken was to justify the experimental description of the driver after a stroke and to confirm the possibility of returning to driving, including compulsory re-education. Literature analysis, review of legal acts, characteristics of adaptation devices and conclusions from the case study were also carried out.

DYNAMIC OF UPPER LIMB SENSORIMOTOR RECOVERY ASSESSED ON THE FUGL-MEYER SCALE IN POST-STROKE PATIENTS WITH NEGLECT SYNDROME RECEIVING COMBINED PHYSICAL THERAPY AND ERGOTHERAPY

The aim: To assess the effect of the modified combined program of physical therapy and ergotherapy on the indicators of upper limb recovery in the patients with the left unilateral neglect. Materials and methods: The study involved 58 patients diagnosed with the right hemisphere stroke followed by neglect syndrome. Patients were randomly divided into main group (MG) and control group (CG) according to the ratio of 1:1. Physical therapy of CG patients included proprioceptive neuromuscular facilitation (PNF), balance training, ergotherapeutic intervention, and exercises improving fine motor skills. Specially developed intervention program of MG patients took into account patient’s individual capabilities and needs. It included PNF, balance training and upright posture correction, constraint-induced movement therapy, dual task activities, stimulation of the affected side in daily activities, targeted therapy. The length of intervention comprised 3 months in both groups. Results: According to the results of the primary examination, the groups had no differences in demographic variables, clinical history (NIHSS scale, the Glasgow Coma Scale and Albert’s Test) and Fugl-Meyer assessment of upper limb sensorimotor recovery. Statistical analysis of the final scores of the Fugl-Meyer scale confirmed that MG had statistical advantages in all measured items of the motor function domain, as well as in a number of proprioceptive sensitivity indicators. Conclusions: The obtained results confirm better efficacy of the modified program of physical therapy and ergotherapy, received by MG patients.

Temporal preparation in patients with Neglect syndrome

The right parietal cortex has been widely associated with a spatial orienting network. Its damage frequently produces the Neglect syndrome consisting in deficits in spatial attention to the left hemifield. Neglect has also been related to temporal deficits (such as the estimation of the duration of a stimulus or the discrimination of two stimuli that occur at the same spatial location but at different time intervals). Such attentional deficits have been much less studied in the temporal as compared to the spatial domain. The current research focused on the study of temporal attention processes in patients with Neglect syndrome, specifically, on temporal preparation. We recruited 10 patients with Neglect syndrome, 10 patients without Neglect syndrome, as well as 11 healthy individuals. Each participant completed an experimental task which measures three main temporal preparation effects described in the literature: Temporal orienting and Foreperiod effects (both related to control mechanisms and prefrontal areas) and Sequential effects (automatic in nature and related to parietal and subcortical structures). The results showed a deficit in the sequential effects only in those patients who suffered from Neglect syndrome. The results suggest a causal relation between Neglect syndrome and the automatic mechanisms of temporal preparation. Since our sample of Neglect patients had suffered lesions mainly in the parietal cortex, the results are discussed taking into account the role of the parietal lobe in the processing of time and the models explaining sequential effects.

Corpus Callosum and Neglect Syndrome: Clinical Findings After Meningioma Removal and Anatomical Review

ABSTRACTTwo types of neglect are described: hemispatial and motivational neglect syndromes. Neglect syndrome is a neurophysiologic condition characterized by a malfunction in one hemisphere of the brain, resulting in contralateral hemispatial neglect in the absence of sensory loss and the right parietal lobe lesion being the most common anatomical site leading to it. In motivational neglect, the less emotional input is considered from the neglected side where anterior cingulate cortex harbors the most frequent lesions. Nevertheless, there are reports of injuries in the corpus callosum (CC) causing hemispatial neglect syndrome, particularly located in the splenium. It is essential for a neurosurgeon to recognize this clinical syndrome as it can be either a primary manifestation of neurosurgical pathology (tumor, vascular lesion) or as a postoperative iatrogenic clinical finding. The authors report a postoperative hemispatial neglect syndrome after a falcotentorial meningioma removal that recovered 10 months after surgery and performs a clinical, anatomical, and histological review centered in CC as key agent in neglect syndrome.