SPECIAL INTEREST GROUP MEETING

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SPECIAL INTEREST GROUP MEETING Cognitive

1 SPECIAL INTEREST GROUP MEETING Cognitive Neurorehabilitation S. Clarke & G. Rode Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle. Hospices Civils de Lyon, 23 May 2013 Lyon Neuroscience Research Center

2 AIM OF THE S.I.G.

3 NEGLECT Heilman et al., 1985; Vallar, 1998; Halligan et al., 2003 Jeannerod et Biguer, 1987; Bisiach, 1999; Kerkhoff, 2001

4 A COMPLEX DEFICIT

5 GOAL 1

6 NEGLECT SUBTYPES Extracorporeal space Corporel space Input/output Parts of space Attentional/intentional Contralateral neglect Representational neglect Altitudinal neglect Negative symptoms Hemiasomatognosia Anosognosia Motor neglect Reference frames Sensory modalities Object centered/space centered neglect Visual neglect (pseudohlh) Auditory neglect Sensory neglect Olfactory neglect Specific aspects Facial neglect Spatial dyslexia Perseverations Positive symptoms Somatoparaphrenia From Vallar NeuroImage 2001

7 ANATOMY OF NEGLECT Thiebaut de Schonen et al., 2012

8 CORPOREAL NEGLECT n=52

9 EXTRACORPOREAL NEGLECT n=52

10 OBJECT-CENTRED DEFICIT

11 SPACE-CENTRED DEFICIT Exploratory visuomotor component Anterior damage:, inf frontal gyrus, dorsolateral PF cortex Post part of middle frontal gyrus, white matter Perceptive visuospatial component Post damage: IPL, MSG, white matter Verdon et al., 2009

12 GOAL 2

13 STRATEGIES OF REHABILITATION COGNITIVE REPRESENTATION TOP-DOWN BOTTOM-UP SENSORI-MOTOR REPRESENTATION PERCEPTION ACTION The top-down approach (visual scanning training) The bottom-up approach (sensory stimulation, eye-patching, prism adaptation) Reduce the hyperexcitability of the left hemisphere (rtms, tdcs) Action on non lateralized attentionnal deficits (sustained attention)

14 EVIDENCE BASE APPROACH Cognitive rehabilitation for spatial neglect following stroke. Bowen A & Lincoln NB Cochrane Database Syst Rev. 2007

15 EVIDENCE BASE APPROACH

16 EVIDENCE BASE APPROACH Method Studies Participants (T+C) Prism adaptation Limb activation 2 52 Left eye patching 2 88 Visuomotor feedback 1 14 Visual scanning 1 15 Continuous TBS

17 EVIDENCE BASE APPROACH

18 GOAL 3

19 INTEGRATED APPROACH!"#$%&'()*+,%,)*!"#$%&"'&(%&("#$')$'* (((((((+%",(-./01#%/$ (((((((((201#3#1, 4)&1#0#5)1#%/ (((((((((6(71&.01.&'((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( ((((((((((((((((((((((((((((((((((( K18)2&16$1.+- J$2*&1+- H+3.&2* H+3.&2* (((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((( ((((-)*%".%/#$'0#(%)12 ((((((((((((((((((((((((((((((((( The International Classification of Functioning (W.H.O 2001)

20 INTEGRATED APPROACH STROKE COGNITIVE DEFICIENCY ACTIVITY LIMITATION PARTICIPATION RESTRICTION Environmental factors Personal factors The International Classification of Functioning (W.H.O 2001)

21 INTEGRATED APPROACH STROKE NEGLECT B.I.T GEREN Battery ACTIVITY PARTICIPATION LIMITATION RESTRICTION FIM ADL Quality of life SF-36 The International Classification of Functioning (W.H.O 2001)

22 FUTURE

23 OPTOKINETIC STIMULATION Kherkhoff et al., 2006 Stimmer et al., 2009

24 PRISM ADAPTATION Saj et al. Cortex 2013

25 OFFERS

26 OFFERS

Human Paleoneurology and the Evolution of the Parietal Cortex

Human Paleoneurology and the Evolution of the Parietal Cortex PARIETAL LOBE The Parietal Lobes develop at about the age of 5 years. They function to give the individual perspective and to help them understand space, touch, and volume. The location of the parietal