SPECIAL INTEREST GROUP MEETING Cognitive Neurorehabilitation S. Clarke & G. Rode Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle. Hospices Civils de Lyon, gilles.rode@chu-lyon.fr 23 May 2013 Lyon Neuroscience Research Center
AIM OF THE S.I.G.
NEGLECT Heilman et al., 1985; Vallar, 1998; Halligan et al., 2003 Jeannerod et Biguer, 1987; Bisiach, 1999; Kerkhoff, 2001
A COMPLEX DEFICIT
GOAL 1
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
ANATOMY OF NEGLECT Thiebaut de Schonen et al., 2012
CORPOREAL NEGLECT n=52
EXTRACORPOREAL NEGLECT n=52
OBJECT-CENTRED DEFICIT
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
GOAL 2
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)
EVIDENCE BASE APPROACH Cognitive rehabilitation for spatial neglect following stroke. Bowen A & Lincoln NB Cochrane Database Syst Rev. 2007
EVIDENCE BASE APPROACH
EVIDENCE BASE APPROACH Method Studies Participants (T+C) Prism adaptation 5 140 Limb activation 2 52 Left eye patching 2 88 Visuomotor feedback 1 14 Visual scanning 1 15 Continuous TBS 1 18 12 327
EVIDENCE BASE APPROACH
GOAL 3
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)
INTEGRATED APPROACH STROKE COGNITIVE DEFICIENCY ACTIVITY LIMITATION PARTICIPATION RESTRICTION Environmental factors Personal factors The International Classification of Functioning (W.H.O 2001)
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)
FUTURE
OPTOKINETIC STIMULATION Kherkhoff et al., 2006 Stimmer et al., 2009
PRISM ADAPTATION Saj et al. Cortex 2013
OFFERS
OFFERS