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      Relationship between the Head Deviation Angle and Hemineglect in Patients with Right Hemisphere Stroke

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          Abstract

          Background: Patients with hemineglect have been reported to have abnormal head posture. We attempted to determine the extent to which the angles are correlated with the severity of hemineglect. Methods: In a prospective, single-center, cross-sectional study on 40 patients with single right hemisphere stroke, we evaluated left hemineglect severity using the line bisection and line cancellation tests. Head deviation angles were measured at admission and discharge using a head device containing 3 graduated discs that determined the angles of head deviation in the sagittal, coronal and transverse planes. Results: Head angles in the transverse and coronal planes differed significantly between the left hemineglect and non-hemineglect groups. Scores obtained from the line bisection and line cancellation tests correlated with these angles. Furthermore, improvement in left hemineglect after rehabilitation training corresponded to a reduction in the angles. Conclusion: Stroke patients with hemineglect exhibited significant head deviations in the transverse and coronal planes. Deviation angles correlated with hemineglect test scores.

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          Most cited references31

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          A simple test of visual neglect.

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            Line bisection and unilateral visual neglect in patients with neurologic impairment.

            Unilateral visual neglect is a common symptom or sign in patients with lesions of the nondominant hemisphere. Several techniques have been used to demonstrate visual neglect. One such technique--asking a patient to bisect a horizontal line and expecting an estimate of center away from the side neglected--has been used for over 70 years but has not been statistically evaluated. We conducted a formal evaluation of this method and found that under special conditions, line-bisection performance can discriminate between patients with right-hemisphere lesions and patients with diffuse lesions, patients with left-hemisphere lesions, and hospital controls. When used to investigate visual neglect in an individual patient, the line-bisection test should be given in conjunction with other complementary procedures such as symmetric drawings and the Memory-for-Designs Test.
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              Hemispatial neglect: Subtypes, neuroanatomy, and disability.

              To assess the relative frequency of occurrence of motor, perceptual, peripersonal, and personal neglect subtypes, the association of neglect and other related deficits (e.g., deficient nonlateralized attention, anosognosia), and the neuroanatomic substrates of neglect in patients with right hemisphere stroke in rehabilitation settings. The authors assessed 166 rehabilitation inpatients and outpatients with right hemisphere stroke with measures of neglect and neglect subtypes, attention, motor and sensory function, functional disability, and family burden. Detailed lesion analyses were also performed. Neglect was present in 48% of right hemisphere stroke patients. Patients with neglect had more motor impairment, sensory dysfunction, visual extinction, basic (nonlateralized) attention deficit, and anosognosia than did patients without neglect. Personal neglect occurred in 1% and peripersonal neglect in 27%, motor neglect in 17%, and perceptual neglect in 21%. Neglect severity predicted scores on the Functional Independence Measure and Family Burden Questionnaire more accurately than did number of lesioned regions. The neglect syndrome per se, rather than overall stroke severity, predicts poor outcome in right hemisphere stroke. Dissociations between tasks assessing neglect subtypes support the existence of these subtypes. Finally, neglect results from lesions at various loci within a distributed system mediating several aspects of attention and spatiomotor performance.
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                Author and article information

                Journal
                ENE
                Eur Neurol
                10.1159/issn.0014-3022
                European Neurology
                S. Karger AG
                0014-3022
                1421-9913
                2012
                September 2012
                25 July 2012
                : 68
                : 3
                : 129-136
                Affiliations
                aDepartment of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, and bDepartment of Physical Medicine and Rehabilitation, Taitung Christian Hospital, Taitung, Taiwan, ROC
                Author notes
                *Dr. Chau-Peng Leong, Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niaosong Dist., Kaohsiung 833, Taiwan (ROC), Tel. +886 7 731 7123, ext. 8373, E-Mail cpleong@adm.cgmh.org.tw
                Article
                338311 Eur Neurol 2012;68:129–136
                10.1159/000338311
                22832205
                134e4f37-18e2-418e-845a-bc8b50082659
                © 2012 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 28 December 2011
                : 18 March 2012
                Page count
                Figures: 4, Tables: 2, Pages: 8
                Categories
                Original Paper

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Head posture,Hemispatial neglect,Right cerebral hemisphere,Stroke

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