Non-invasive Brain Stimulation and Prism Adaptation in Art Constructive Errors of Painting

Introduction: This study aimed to investigate the influence of neglect and the effect of Prism Adaptation (PA) combined with continuous Theta-Burst Transcranial Magnetic Stimulation (cTBS) on the art constructive errors of painting rehabilitation of stroke patients with neglect. Methods: Fourteen patients with neglect and art constructive errors of painting secondary to stroke were randomly assigned to the rehabilitation group and received PA combined with inhibitory protocol of cTBS over the intact parietal cortex; the control group received PA combined with sham cTBS for 2 weeks in 10 daily sessions. Patients have assessed for art constructive errors of painting in Figure Copying Test (FCT), and Coloring Test (CT) before and after the intervention. Art constructive errors of painting were classified into omission, deformation, size, neglect of warm colors, and perseveration of errors. Neglect was evaluated using the Line Bisection task (LBT), Figure Copying Test (FCT), and Coloring Test (CT). Results: All patients showed significant improvement in art constructive errors of painting (measured using pattern of painting’ errors in Figure Copying Test and Coloring Test), and neglect (measured using LBT, FCT, and CT) (p<0.05). Omission, neglect of warm colors, and deformation were the most frequent errors. Conclusion: Neglect and rehabilitation influences the painting system in stroke patients. Both approaches improved art constructive errors of painting and neglect symptoms.

Abstract NS9: Screening for Spatial Neglect in a Ward-based Environment Within Two Weeks From Stroke Onset: Preliminary Results of a Pilot Study

Background and purpose: Spatial neglect (SN) occurs frequently in patients with stroke, resulting in worse recovery. Without screening, the presence of SN may remain undetected and prevent initiation of alleviating strategies. There is limited evidence available to suggest bedside identification of SN in the subacute phase following stroke. Thus we set out to identify effective screening tests for SN. Method: The following index tests were used; (a) six conventional subtests of The Behavioural Inattention test (BIT), (b) an additional figure copying test, (c) a newly developed neglect experience questionnaire, and (d) an additional component added to the National Institute of Health Stroke Scale (NIHSS). The Catherine Bergego Scale (CBS) functioned as a reference frame to ascertain the presence of SN. Results: Consecutive stroke patients (N=125) were included from the Neurological Department of Landspitali University Hospital in Iceland, within two weeks following stroke. Of those 30 patients had SN. If all subtests of the BIT were administered, approximately 35% of stroke patients without SN would be incorrectly identified with the disorder. Statistically more patients without SN were identified as having SN if ≥ three tests of the BIT was administered (p=0.002). If patients did not, at stroke onset, comprehend why they had to go to the hospital, this was correlated to the presence of SN. The star cancellation and figure copying were the most sensitive paper-and pen tests to identify SN. Inclusion of an additional item to NIHSS correctly identified SN in 86% instances. Conclusion: Results contests the common belief that use of more tests increase identification of SN. Rather we found that the use a large test battery decreases sensitivity in the subacute phase following stroke. A short question about patients’ experiences of stroke onset and adding a novel item to the NIHSS provided new pragmatic ways of identifying SN. Results have been used to inform a larger cross-country study between Iceland and Lithuania, where psychometric properties of screening strategies are being further validated.

The Neural Substrates of Drawing: A Voxel-based Morphometry Analysis of Constructional, Hierarchical, and Spatial Representation Deficits

Deficits in the ability to draw objects, despite apparently intact perception and motor abilities, are defined as constructional apraxia. Constructional deficits, often diagnosed based on performance on copying complex figures, have been reported in a range of pathologies, perhaps reflecting the contribution of several underlying factors to poor figure drawing. The current study provides a comprehensive analysis of brain–behavior relationships in drawing disorders based on data from a large cohort of subacute stroke patients (n = 358) using whole-brain voxel-wise statistical analyses linked to behavioral measures from a complex figure copy task. We found that (i) overall poor performance on figure copying was associated with subcortical lesions (BG and thalamus), (ii) lateralized deficits with respect to the midline of the viewer were associated with lesions within the posterior parietal lobule, and (iii) spatial positioning errors across the entire figure were associated with lesions within visual processing areas (lingual gyrus and calcarine) and the insula. Furthermore, deficits in reproducing global aspects of form were associated with damage to the right middle temporal gyrus, whereas deficits in representing local features were linked to the left hemisphere lesions within calcarine cortex (extending into the cuneus and precuneus), the insula, and the TPJ. The current study provides strong evidence that impairments in separate cognitive mechanisms (e.g., spatial coding, attention, motor execution, and planning) linked to different brain lesions contribute to poor performance on complex figure copying tasks. The data support the argument that drawing depends on several cognitive processes operating via discrete neuronal networks and that constructional problems as well as hierarchical and spatial representation deficits contribute to poor figure copying.

Closing-in Behavior in Mild Cognitive Impairment: An Executive Deficit

This study explored Closing-in behavior (CIB), the tendency in figure copying to draw very close to or on top of the model, in mild cognitive impairment (MCI). The files of 154 people diagnosed with MCI were reviewed and CIB was identified in 21% of cases. Two approaches were used to explore CIB. First, we capitalized on the diverse cognitive profiles within MCI, subdividing the overall sample into people with and without memory deficits. The frequency of CIB was significantly higher in multidomain non-amnestic MCI than in multidomain amnestic MCI, suggesting that CIB is not associated with specific memory impairment. Second, we assessed the cognitive correlates of CIB, by selecting patients with MCI who completed a battery of executive, visuo-constructional and memory tasks. Sub-groups of patients with and without CIB showed a similar overall severity of cognitive decline and comparable performance in visuo-constructional and memory tasks, but those with CIB were slightly but significantly more impaired on executive function tasks. The study provides evidence against memory-based accounts of CIB, and supports recent suggestions that executive impairments are the dominant cognitive correlate of this clinical sign. (JINS, 2012, 18, 269–276)