Spatial Working Memory Deficits Represent a Core Challenge for Rehabilitating Neglect.

Spatial working memory deficits represent a core challenge for rehabilitating neglect.

Front Hum Neurosci. 2013; 7: 334
Striemer CL, Ferber S, Danckert J

Left neglect following right hemisphere injury is a debilitating disorder that has proven extremely difficult to rehabilitate. Traditional models of neglect have focused on impaired spatial attention as the core deficit and as such, most rehabilitation methods have tried to improve attentional processes. However, many of these techniques (e.g., visual scanning training, caloric stimulation, neck muscle vibration) produce only short-lived effects, or are too uncomfortable to use as a routine treatment. More recently, many investigators have begun examining the beneficial effects of prism adaptation for the treatment of neglect. Although prism adaptation has been shown to have some beneficial effects on both overt and covert spatial attention, it does not reliably alter many of the perceptual biases evident in neglect. One of the challenges of neglect rehabilitation may lie in the heterogeneous nature of the deficits. Most notably, a number of researchers have shown that neglect patients present with severe deficits in spatial working memory (SWM) in addition to their attentional impairments. Given that SWM can be seen as a foundational cognitive mechanism, critical for a wide range of other functions, any deficit in SWM memory will undoubtedly have severe consequences. In the current review we examine the evidence for SWM deficits in neglect and propose that it constitutes a core component of the syndrome. We present preliminary data which suggest that at least one current rehabilitation method (prism adaptation) has no effect on SWM deficits in neglect. Finally, we end by reviewing recent work that examines the effectiveness of SWM training and how SWM training may prove to be a useful avenue for future rehabilitative efforts in patients with neglect. HubMed – rehab


To remove or to replace traditional electronic games? A crossover randomised controlled trial on the impact of removing or replacing home access to electronic games on physical activity and sedentary behaviour in children aged 10-12 years.

BMJ Open. 2013; 3(6):
Straker LM, Abbott RA, Smith AJ

To evaluate the impact of (1) the removal of home access to traditional electronic games or (2) their replacement with active input electronic games, on daily physical activity and sedentary behaviour in children aged 10-12 years.Crossover randomised controlled trial, over 6 months.Family homes in metropolitan Perth, Australia from 2007 to 2010.10-year-old to 12-year-old children were recruited through school and community media. From 210 children who were eligible, 74 met inclusion criteria, 8 withdrew and 10 had insufficient primary outcome measures, leaving 56 children (29 female) for analysis.A counterbalanced randomised order of three conditions sustained for 8 weeks each: no home access to electronic games, home access to traditional electronic games and home access to active input electronic games.Primary outcome was accelerometer assessed moderate/vigorous physical activity (MVPA). Secondary outcomes included sedentary time and diary assessed physical activity and sedentary behaviours.Daily MVPA across the whole week was not significantly different between conditions. However, compared with home access to traditional electronic games, removal of all electronic games resulted in a significant increase in MVPA (mean 3.8 min/day, 95% CI 1.5 to 6.1) and a decrease in sedentary time (4.7 min/day, 0.0 to 9.5) in the after-school period. Similarly, replacing traditional games with active input games resulted in a significant increase in MVPA (3.2 min/day, 0.9 to 5.5) and a decrease in sedentary time (6.2 min/day, 1.4 to 11.4) in the after-school period. Diary reports supported an increase in physical activity and a decrease in screen-based sedentary behaviours with both interventions.Removal of sedentary electronic games from the child’s home and replacing these with active electronic games both resulted in small, objectively measured improvements in after-school activity and sedentary time. Parents can be advised that replacing sedentary electronic games with active electronic games is likely to have the same effect as removing all electronic games.Australia and New Zealand Clinical Trials Registry (ACTRN 12609000279224). HubMed – rehab


Effects of a predefined mini-trampoline training programme on balance, mobility and activities of daily living after stroke: a randomized controlled pilot study.

Clin Rehabil. 2013 Jul 1;
Miklitsch C, Krewer C, Freivogel S, Steube D

Objective:To investigate the effects of a predefined mini-trampoline therapy programme for increasing postural control, mobility and the ability to perform activities of daily living after stroke.Design:Randomized non-blinded controlled pilot study.Setting:Neurological rehabilitation hospital.Subjects:First-time stroke; age 18-80 years; independent standing ability for a minimum of 2 minutes.Intervention:Patients were randomized into two groups: the mini-trampoline group (n = 20) received 10 sessions of balance training using the mini-trampoline over three weeks. The patients of the control group (n =20) participated 10 times in a group balance training also over three weeks.Main measures:Postural control (Berg Balance Scale, BBS), mobility and gait endurance (timed ‘up and go’ test, TUG; 6-minute walk test, 6MWT) and the ability to perform activities of daily living (Barthel Index, BI). Measurements were undertaken prior to and after the intervention period.Results:Both groups were comparable before the study. The mini-trampoline group improved significantly more in the BBS (P = 0.003) compared to the control group. Mean or median differences of both groups showed improvements in the TUG 10.12 seconds/7.23 seconds, the 6MWT 135 m/75 m and the BI 20 points/13 points for the mini-trampoline and control group, respectively. These outcome measurements did not differ significantly between the two groups.Conclusion:A predefined mini-trampoline training programme resulted in significantly increased postural control in stroke patients compared to balance training in a group. Although not statistically significant, the mini-trampoline training group showed increased improvement in mobility and activities of daily living. These differences could have been statistically significant if we had investigated more patients (i.e. a total sample of 84 patients for the TUG, 98 patients for the 6MWT, and 186 patients for the BI). HubMed – rehab


Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia – a randomized controlled trial.

Clin Rehabil. 2013 Jul 1;
Deppe W, Thuemmler K, Fleischer J, Berger C, Meyer S, Wiedemann B

Objective:To clarify whether modified constraint-induced movement therapy provides greater improvement than intensive bimanual training both for motor functions and spontaneous use of the paretic arm and hand in everyday life activities.Design:Randomized controlled, single-blind trial.Setting:Inpatient paediatric rehabilitation clinic.Subjects:Forty-seven children with unilateral cerebral palsy or other non-progressive hemiplegia (aged 3.3-11.4 years) were randomly assigned to either a modified constraint-induced movement programme (kid-CIMT) or intensive bimanual training.Interventions:Patients in the kid-CIMT group received 60 hours of unilateral constraint-induced and 20 hours of bimanual training over four weeks. Patients in the bimanual treatment group received 80 hours of bimanual training over four weeks.Main outcome measures:Melbourne Assessment of Unilateral Upper Limb Function and Assisting Hand Assessment.Results:Modified constraint-induced therapy provided a significantly better outcome for isolated motor functions of the paretic arm than bimanual training (gain in Melbourne Assessment, percent score: 6.6 vs. 2.3, P= 0.033). Regarding spontaneous use both methods led to similar improvement (gain in Assisting Hand Assessment, percent score: 6.2 vs. 4.6, P= 0.579). More-disabled children showed greater improvement than less-disabled ones (correlation with Assisting Hand Assessment pretreatment score r = -0.40). Age did not affect treatment outcome.Conclusions:Modified constraint-induced movement therapy can improve isolated functions of the hemiplegic arm better than intensive bimanual training, but regarding spontaneous hand use in everyday life both methods lead to similar improvement. Improvements are generally greater in more impaired children. Age does not affect outcome. HubMed – rehab