Annals of Rehabilitation Medicine

Brain disorders

Feasibility of Computerized Visuomotor Integration System for Visual Field Defects and Spatial Neglect in Poststroke Patients: Hyeon-Taek Hong, Myeong Geun Jeong, Kyoung Tae Kim; Ann Rehabil Med 2024;48(2):146-154. Published online April 25, 2024; DOI: https://doi.org/10.5535/arm.230028

Objective
To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited.
Methods
The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert’s test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland–Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted.
Results
Ten patients with acute stroke completed the study. Bland–Altman plots revealed good agreements for Albert’s test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively.
Conclusion
The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.

Citations

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Tablet computer-based cognitive training for visuomotor integration in children with developmental delay: a pilot study
Jee Hyun Suh, Soo Jeong Han, Sun Ah Choi, Hyesung Yang, Sihyun Park
BMC Pediatrics.2024;[Epub] CrossRef

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Relationship Between Line Bisection Test Time and Hemispatial Neglect Prognosis in Patients With Stroke: A Prospective Pilot Study: Shinyoung Kwon, Wookyung Park, MinYoung Kim, Jong Moon Kim; Ann Rehabil Med 2020;44(4):292-300. Published online August 5, 2020; DOI: https://doi.org/10.5535/arm.19112

Abstract
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Objective
To determine the relationship between line bisection test (LBT) performance time and prognosis of hemispatial neglect (HSN) in stroke patients.
Methods
Data on stroke patients with HSN were prospectively collected. After patient recruitment and eligibility screening, the LBT, Motor-Free Visual Perception Test 3rd edition, and Korean version of Mini-Mental State Examination were performed at the time of admission and 4 weeks thereafter. The LBT performance time was also measured. All patients received conventional rehabilitation for 4 weeks. Based on the improvements in their LBT grades, the patients were divided into improved and non-improved groups. The evaluation results of the two groups were compared using Mann–Whitney U-tests and logistic regression was performed to predict the independence of each outcome.
Results
In total, 26 stroke patients with HSN were included, with 13 patients in each group. Significant differences were observed in the baseline LBT performance times between the improved and non-improved groups (p<0.05). Logistic regression analysis revealed associations between HSN prognosis, and baseline LBT performance time (odds ratio=0.95; 95% confidence interval, 0.90–1.00; p<0.05) and baseline Motor-Free Visual Perception Test 3rd edition (odds ratio=1.20; 95% confidence interval, 1.01–1.43; p<0.05).
Conclusion
A significant relationship was observed between the baseline LBT performance time and HSN prognosis.

Citations

Citations to this article as recorded by

Vestibular Dysfunction and the Leftward Deviation in the New Line Bisection Task Using Three-Dimensionally Transformed Rectangles
Teru Kamogashira, Shinnosuke Asakura, Hideaki Funayama, Kenji Ito, Noriaki Sunaga, Nao Shikanai, Fumihiko Itagaki, Toshitaka Kataoka, Shizuka Shoji, Megumi Koizumi, Shinichi Ishimoto
Audiology Research.2025; 15(4): 86. CrossRef
Is mental content an illusion?
Marco Facchin
Synthese.2025;[Epub] CrossRef
Application of immersive virtual reality for assessing chronic neglect in individuals with stroke: the immersive virtual road-crossing task
Julia Belger, Sebastian Wagner, Michael Gaebler, Hans-Otto Karnath, Bernhard Preim, Patrick Saalfeld, Anna Schatz, Arno Villringer, Angelika Thöne-Otto
Journal of Clinical and Experimental Neuropsychology.2024; 46(3): 254. CrossRef
Preservation of Cerebellar Afferent Pathway May Be Related to Good Hand Function in Patients with Stroke
Bo Kyung Shin, Hae-Yeon Park, Hanee Rim, Ji Yoon Jung, Sungwoo Paek, Yeun Jie Yoo, Mi-Jeong Yoon, Bo Young Hong, Seong Hoon Lim
Life.2022; 12(7): 959. CrossRef

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Risk Factor of Visuospatial Neglect: A Study of Association Between Visuospatial Neglect and Anemia: Ho Jeong Kim, Tae Sik Yoon, Soo Jeong Han; Ann Rehabil Med 2013;37(5):611-618. Published online October 29, 2013; DOI: https://doi.org/10.5535/arm.2013.37.5.611

Abstract
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Objective

To investigate the correlation between visuospatial neglect and anemia in patients with right cerebral infarction, as well as to identify the risk factor of neglect and furnish preliminary data on rehabilitation management.

Methods

The line bisection test and Albert test were conducted on subjects with right cerebral infarction in order to analyze neglect severity. Multiple linear regression analysis was conducted to investigate correlation between neglect severity and hemoglobin and hematocrit level. Logistic regression analysis was applied to identify the risk factor of neglect.

Results

Visuospatial neglect was observed in 33 subjects out of 124. Hemoglobin and hematocrit were not directly correlated with visuospatial neglect severity, whereas infarct size was directly correlated. Subjects with visuospatial neglect were characterized by a large infarct size, a low score in the Mini-Mental State Examination and long hospital stay.

Conclusion

In this study, visuospatial neglect was found to be uncorrelated with anemia. It implies that emphasis should be placed on the early detection of anemia and neglect in patients with left hemiplegia, the formulation of respective therapeutic plans and improvement of prognosis. The study found that the possibility of a visuospatial neglect occurrence increases with infarct size. In this regard, it is required that visuospatial neglect was detected and treated in the earliest possible stage, notwithstanding the difficulty that lies in the precise measurement of the severity.

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Comparison of Effects of Repetitive Transcranial Magnetic Stimulation with High- or Low-frequency on Visuospatial Neglect in Stroke Patients.: Kim, Ji Sung , Kim, Jong Chan , Shin, Sung Hun , Kim, Yong Kyun; J Korean Acad Rehabil Med 2010;34(4):397-402.

Abstract
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Objective
To compare the effect of repetitive transcranial magnetic stimulation (rTMS) applied over the right or left parietal cortex with high- or low-frequency on visuospatial neglect in stroke patients. Method: Nineteen stroke subjects (10 males, 9 females) were enrolled. All subjects received 1,200 real rTMS over left parietal cortex at an intensity of 90% of motor thresholds with 1 Hz, sham rTMS over right parietal cortex with 20 Hz and real rTMS over right parietal cortex at same intensity with 20 Hz under randomized cross over design. To compare the effects of different rTMS protocols, letter cancellation test, line bisection test (near, far) and Ota's task were administered before and after rTMS. Results: Low frequency rTMS over left parietal cortex, compared with sham stimulation, significantly improve visuospatial neglect in Ota's task (p＜0.05). Conclusion: As low frequency rTMS over left parietal cortex showed beneficial effects on visuospatial neglect, low frequency rTMS can be used as a treatment modality for patients suffering from visuospatial neglect after stroke. (J Korean Acad Rehab Med 2010; 34: 397-402)

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Influence of Hemispatial Neglect on Trunk Control in Stroke Patients.: Lim, Kil Byung , Kim, Dug Young , Lee, Kyung Tae; J Korean Acad Rehabil Med 2009;33(4):463-469.

Abstract
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Objective
To evaluate the influence of hemispatial neglect on trunk balance control and functional ability in stroke patients. Method: Fourty eight inpatients exhibiting (n=25) or not exhibiting (n=23) hemispatial neglect following strokes within 6 months were matched for age and sex. Hemispatial neglect was assessed with a line bisection test (LBT) and a baking tray task test (BTT). Static and dynamic trunk balance control was assessed using a Balance Master System. Static balance control was measured with a weight bearing test and a Modified Clinical Sensory Interaction Balance Test (mCSIBT). Dynamic balance control was measured using a Limit of Stability (LOS) test and a rhythmic weight shift (RWS) test. A Functional Independence Measure (FIM) for functional ability and the Brunnstrom stage assessment for motor recovery were also recorded. Results: There was no statistical difference in the achievement of static trunk balance control between neglect and non-neglect patients. Where dynamic balance control was concerned, both LOS and RWS tests showed a deterioration in neglect patients compared to non-neglect patients (p＜0.05). The Brunnstrom stage correlated significantly with dynamic balance control only in non-neglect patients (p＜0.05) and the FIM score of neglect patients was significantly lower than that of non-neglect patients (p＜0.05). Conclusion: Stroke patients with hemispatial neglect displayed pronounced dynamic trunk instability and functional dependency compared to patients without it. However, the recovery of dynamic balance control may not relate to the degree of motor recovery in stroke patients with hemispatial neglect. (J Korean Acad Rehab Med 2009; 33: 463-469)

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Effect of Computer-based Cognitive Rehabilitation on Unilateral Spatial Neglect in Stroke Patients.: Lee, Sang Il , Chun, Min Ho; J Korean Acad Rehabil Med 2008;32(1):15-19.

Abstract
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Objective: To investigate the effect of computer-based cognitive rehabilitation on unilateral spatial neglect in stroke patients. Method: Twenty four stroke patients (7 men, 17 women) who had unilateral spatial neglect were recruited. Patients were randomly assigned to either case or control group. Case group received both classical neglect stimulation therapy (attention and compensation training) and computer-based cognitive rehabilitation, but control group received only classical neglect stimulation therapy. The effect of therapy was assessed with star cancellation test, line bisection test, MVPT (motor-free visual perception test), and MBI (modified Barthel index). Results: Four weeks after the therapy, both group showed significant improvement in star cancellation test, line bisection test, MVPT, and MBI. But there was no statistically significant difference between control and case group with each evaluation tool after 4 weeks treatment (p＞0.05). Conclusion: Computer-based cognitive rehabilitation has no additional benefit to the treatment of hemi-spatial neglect in stroke patients. (J Korean Acad Rehab Med 2008; 32: 15-19)

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Clinical Usefulness of Computer Assisted Line Bisection Task for the Assessment of Sensory-Attenional Aspect of Visuospatial Neglect.: Park, Sung Joon , Lee, Hee Dae , Min, Su Jung , Park, Se Hun , Lee, Peter K W , Kim, Yun Hee; J Korean Acad Rehabil Med 2006;30(1):1-6.

Abstract
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Objective
To assess the clinical usefulness of computer- assisted line bisection task for the patients with sensory- attentional visuospatial neglect. Method: Forty patients with unilateral hemispheric stroke (25 right, 15 left) and 15 normal age-matched subjects participated in this study. Computer-assisted line bisection task (CALBT) was designed using modified Milner landmark test to assess the sensory-attentional aspect of visuospatial neglect. Accuracy of response and reaction time for the transected lines, and response rate for the bisected lines were measured. Correlation between the results of CALBT and conventional line bisection test and Albert test was evaluated. Results: In patients with right hemispheric lesion, resultsof CALBT demonstrated shifting of attention to the right hemifield and neglect of the stimulus in the left hemifield. In contrast, patients with left hemispheric lesion showed significantly decreased attention to the right hemifield and shifting of attention to the left hemifield. Performances of CALBT correlated with the line bisection test, but not with the Albert test. Conclusion: Computed assisted line bisection task can be used for the quantitative assessment of the sensory attentional aspect of visuospatial attention in patients with unilateral neglect. (J Korean Acad Rehab Med 2006; 30: 1-6)

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The Effect of the Prism Therapy on the Stroke Patients with the Visuospatial Neglect Preliminary Study.: Han, Tai Ryoon , Shin, Hyung Ik , Kim, Sang Jun; J Korean Acad Rehabil Med 2001;25(3):412-417.

Abstract
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Objective: To investigate the effect of the prism which deviates the optical axis 10 degree rightward in the stroke patients who have visuospatial neglect and to evaluate how long it will last.

Method: The subjects were 9 left hemiplegic patients who showed the feature of hemineglect. The prism goggle was applied and the patients were trained the midline point direction exercise. It's effect was evaluated by the line bisection test and the Albert test at the pre-training, immediate, 2 hours and 6 hours after the training respectively.

Results: The line bisection test and Albert test were not improved significantly at each evaluation time after the training.

Conclusion: This result revealed the prism therapy does not have a significant effect on the line bisection task and Albert test in the hemineglect patients consistently. The line bisection result in the line located in the left or right side at the 2 hours after the training was improved but it could not exclude the training effect of the repetition of the test.