Publications by authors named "Antonia F Ten Brink"

27 Publications

  • Page 1 of 1

Characterising sensorimotor adaptation in Complex Regional Pain Syndrome.

Cortex 2021 Jul 22;140:157-178. Epub 2021 Apr 22.

Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom.

It has been suggested that sensorimotor conflict contributes to the maintenance of some pathological pain conditions, implying that there are problems with the adaptation processes that normally resolve such conflict. We tested whether sensorimotor adaptation is impaired in people with Complex Regional Pain Syndrome (CRPS) by characterising their adaption to lateral prismatic shifts in vision. People with unilateral upper-limb CRPS Type I (n = 17), and pain-free individuals (n = 18; matched for age, sex, and handedness) completed prism adaptation with their affected/non-dominant and non-affected/dominant arms. We examined 1) the rate at which participants compensated for the optical shift during prism exposure (i.e., strategic recalibration), 2) endpoint errors made directly after prism adaptation (sensorimotor realignment) and the retention of these errors, and 3) kinematic markers associated with strategic control. Direct comparisons between people with CRPS and controls revealed no evidence of any differences in strategic recalibration, including no evidence for differences in a kinematic marker associated with trial-by-trial changes in movement plans during prism exposure. All participants made significant endpoint errors after prism adaptation exposure, indicative of sensorimotor realignment. Overall, the magnitude of this realignment did not differ between people with CRPS and pain-free controls. However, when endpoint errors were considered separately for each hand, people with CRPS made greater errors (indicating more rather than less realignment) when using their affected hand than their non-affected hand. No such difference was seen in controls. Taken together, these findings provide no evidence of impaired strategic control or sensorimotor realignment in people with CRPS. In contrast, they provide some indication that there could be a greater propensity for sensorimotor realignment in the CRPS-affected arm, consistent with more flexible representations of the body and peripersonal space. Our study challenges an implicit assumption of the theory that sensorimotor conflict might underlie some pathological pain conditions.
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http://dx.doi.org/10.1016/j.cortex.2021.03.028DOI Listing
July 2021

Validation of the Bath CRPS Body Perception Disturbance Scale.

J Pain 2021 May 6. Epub 2021 May 6.

Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom; Centre for Pain Research, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom.

The Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") measures alterations in body perception. We assessed its internal consistency, known group validity, construct validity, and associations with demographic and clinical characteristics. We also evaluated changes in, and baseline predictors of B-CRPS-BPDS scores at follow-up. We included people with CRPS (N = 114) and pain-free controls (N = 69). People with CRPS obtained higher scores than pain-free controls on all B-CRPS-BPDS items, except the item on attention. Because this item also had an insufficient corrected item-total correlation, we propose a revised B-CRPS-BPDS (r-B-CRPS-BPDS) excluding this item. The internal consistency of the r-B-CRPS-BPDS was good. The r-B-CRPS-BPDS showed a large positive relationship with "motor neglect-like symptoms", indicating good construct validity. The r-B-CRPS-BPDS showed positive relationships with pain intensity, fear of movement, depression, and upper limb disability. There were no independent relationships with handedness, affected side, affected limb, disease duration, CRPS severity score, tension, anger, fatigue, confusion, and vigour. Finally, r-B-CRPS-BPDS scores did not consistently change over time. Our results demonstrate the utility of the r-B-CRPS-BPDS for measuring body perception disturbances in CRPS. PERSPECTIVE: This article evaluates the validity of the Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") in CRPS, and assesses relationships with demographic and clinical variables. The proposed revised B-CRPS-BPDS appears to be a valid measure of body perception disturbances in CRPS.
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http://dx.doi.org/10.1016/j.jpain.2021.04.007DOI Listing
May 2021

Validation of the Leiden Visual Sensitivity Scale and Visual Discomfort Scale in Chronic Pain Conditions.

Perception 2021 May 31;50(5):399-417. Epub 2021 Mar 31.

Department of Psychology, 1555University of Bath, UK; Centre for Pain Research, University of Bath, UK.

Discomfort provoked by normally innocuous visual stimuli has been reported by people with chronic pain. Visual discomfort may be higher in pain conditions in which central sensitization is implicated, such as Complex Regional Pain Syndrome (CRPS) and fibromyalgia. In an online study, we validated the Leiden Visual Sensitivity Scale (L-VISS) and Visual Discomfort Scale (VDS) in people with CRPS (=57), fibromyalgia (=75), and general chronic pain (=53); investigated whether these groups and pain-free controls (=125) differed in visual discomfort; and evaluated the effect of age. The L-VISS and VDS had good internal consistency. Both scales were positively related with experimentally induced visual distortions for mid-spatial frequency striped patterns, suggesting good construct validity. The scales were positively related with each other, and dissociated between the pain and pain-free groups in similar ways, suggesting good construct validity. There was no relationship between age and L-VISS scores and a small negative relationship between age and VDS scores. Visual discomfort was highest in the fibromyalgia group, followed by the CRPS group. This research confirms the utility of the L-VISS and VDS for measuring visual sensitivity in chronic pain and adds to evidence that central sensitization is an important mechanism of visual discomfort.
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http://dx.doi.org/10.1177/03010066211005327DOI Listing
May 2021

Ignoring space around a painful limb? No evidence for a body-related visuospatial attention bias in complex regional pain syndrome.

Cortex 2021 Mar 24;136:89-108. Epub 2020 Dec 24.

Department of Psychology, University of Bath, Bath, United Kingdom; Centre for Pain Research, University of Bath, Bath, United Kingdom.

Background: Complex Regional Pain Syndrome (CRPS) is a disorder of severe chronic pain in one or more limb(s). People with CRPS report unusual perceptions of the painful limb suggesting altered body representations, as well as difficulty attending to their affected limb (i.e., a 'neglect-like' attention bias). Altered body representations and attention in CRPS might be related, however, existing evidence is unclear. We hypothesized that if there were a body-related visuospatial attention bias in CRPS, then any attention bias away from the affected side should be larger for or limited to circumstances when the (impaired) body representation is involved in the task versus when this is not the case.

Methods: We included 40 people with CRPS, 40 with other limb pain conditions, and 40 pain-free controls. In half of the people with pain, their upper limb was affected, in the other half their lower limb. We administered computerized tasks of spatial attention, including free viewing of images, shape cancellation, temporal order judgement, and dot-probe. The degree to which different versions of each task involved body representation was manipulated by one or more of the following: (1) presenting stimuli nearer versus further away from the body, (2) using body related versus neutral stimuli, and (3) inducing mental rotation of body parts versus no mental rotation. In addition to perceptual judgements, eye movements were recorded as a sensitive index of spatial attention. Bayesian repeated measures analyses were performed.

Results: We found no evidence for a (body-related) visuospatial attention bias in upper limb CRPS. Secondary analyses suggested the presence of a body-related visuospatial attention bias away from the affected side in some participants with lower limb CRPS.

Discussion: Our results add to growing evidence that there might be no general visuospatial attention bias away from the affected side in CRPS.
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http://dx.doi.org/10.1016/j.cortex.2020.12.007DOI Listing
March 2021

How does the number of targets affect visual search performance in visuospatial neglect?

J Clin Exp Neuropsychol 2020 12 4;42(10):1010-1027. Epub 2020 Nov 4.

Department of Experimental Psychology, Helmholtz Institute, Utrecht University , Utrecht, The Netherlands.

Introduction: Impairments in visual search are a common symptom in visuospatial neglect (VSN). The severity of the lateralized attention bias in visual search tasks can vary depending on the number of distractors: the more distractors, the more targets are missed. However, little is known about how the number of targets affect search performance in VSN. The aim of the current study was to examine the effect of the number of targets on hit rate in VSN.

Methods: We included 23 stroke patients with right-brain damage and VSN, 55 with right-brain damage without VSN, and 49 with left-brain damage without VSN, all admitted for inpatient rehabilitation. In a visual search task, patients had to find and tap targets, presented along with non-targets. The location and number of targets varied from trial to trial, allowing the evaluation of the effects of number and location of targets on hit rate.

Results: VSN patients detected a lower percentage of targets when more targets were present. For patients with right-brain damage without VSN, adding targets only reduced the hit rate of the most contralesional target. No effect of number of targets on hit rate was seen in patients with left-brain damage. Additionally, VSN patients found less contralesional targets than ipsilesional targets, made more delayed revisits, and had an initial rightward bias when compared to the other groups. There were no differences in search time, search consistency, or immediate revisits between groups. There was a moderate positive relation between the hit rate asymmetry score in our search task and conventional paper-and-pencil VSN tasks, and neglect behavior in daily life.

Conclusions: In VSN patients, a higher number of targets reduces the hit rate. The reduced hit rate in visual search evoked by additional targets should be taken into account when assessing visual search in VSN.
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http://dx.doi.org/10.1080/13803395.2020.1840520DOI Listing
December 2020

Increasing cognitive demand in assessments of visuo-spatial neglect: Testing the concepts of static and dynamic tests.

J Clin Exp Neuropsychol 2020 09 13;42(7):675-689. Epub 2020 Aug 13.

Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation , Utrecht, Netherlands.

Introduction: Numerous tests of visuo-spatial neglect (VSN) have been developed. In this study, we propose a clustering of VSN tests by making a distinction between static tests with low levels of cognitive demand (i.e. tests without movement or time-restrictions, such as paper-and-pencil tests) and dynamic tests with high levels of cognitive demand (i.e. tests incorporating movement and time-restrictions, such as virtual reality tests). The concepts of static and dynamic tests have not been systematically investigated so far. Here, we investigated (1) whether we would find dissociations between patients showing VSN on test within the static cluster but not on tests within the dynamic cluster, and vice versa; (2) whether differences in demographic or clinical characteristics could be identified between these groups of patients; and (3) whether the underlying factor structure would correspond to our proposed distinction between static and dynamic clusters of tests.

Method: Sixty-one patients with VSN completed three static tests (shape cancellation, line bisection, letter cancellation) and three dynamic tests (Catherine Bergego Scale, Mobility Assessment Course, simulated driving test).

Results: Thirteen percent of patients showed VSN on tests within the static cluster, 33% on tests within the dynamic cluster, and 54% on tests within both clusters. Patients with VSN on the dynamic tests (alone or in addition to static tests) had poorer motor function, poorer walking abilities and were more dependent in daily life than patients showing VSN on the static cluster alone. The underlying factor structure corresponded to our proposed conceptual distinction between static and dynamic clusters of tests.

Conclusions: Static and dynamic tests compose different clusters and double dissociations are shown between clusters. Future research involving data-driven approaches might result in a better understanding on how different tests of VSN relate to each other, and, more importantly, a better understanding of VSN and its phenotypes.
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http://dx.doi.org/10.1080/13803395.2020.1798881DOI Listing
September 2020

Sensitivity to Ambient Temperature Increases in Fibromyalgia and CRPS.

Pain Med 2020 12;21(12):3726-3729

Department of Psychology and Centre for Pain Research, University of Bath, Bath, UK.

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http://dx.doi.org/10.1093/pm/pnaa074DOI Listing
December 2020

Bodily changes and sensory sensitivity in complex regional pain syndrome and fibromyalgia.

Pain 2020 06;161(6):1361-1370

Department of Psychology, University of Bath, Bath, United Kingdom.

Complex regional pain syndrome (CRPS) and fibromyalgia are chronic pain conditions of unexplained origins. In addition to symptoms in the diagnostic criteria, patients can report changes to vision and other sensations or bodily functions. It is unclear whether these are greater than would be expected due to normal ageing, living with chronic pain generally, or common comorbidities of chronic pain such as depression or anxiety. We administered an on-line survey evaluating the frequencies and types of self-reported somatic symptoms, bodily changes, and sensory sensitivity in respondents with CRPS (n = 390), fibromyalgia (n = 425), and both CRPS and fibromyalgia ("CRPS+fibromyalgia"; n = 88) compared to respondents with other chronic pain conditions (n = 331) and pain-free controls (n = 441). The survey assessed somatic symptoms (Patient Health Questionnaire-15), bodily changes, pain/discomfort/distress triggers, and pain intensifiers. We conducted analysis of covariance's with age, sex, Patient Health Questionnaire-9 (measuring depression), Generalized Anxiety Disorder-7, pain duration in years, hours of pain per day, and number of pain-related medical diagnoses as covariates. After controlling for covariates, respondents with CRPS and/or fibromyalgia reported more somatic symptoms, changes in movement and biological responses, pain/discomfort/distress triggers, and pain intensifiers than pain(-free) control groups. Fibromyalgia specifically related to changes in vision and hearing, urinary/intestinal function, and drinking and eating. Complex regional pain syndrome related to changes in hair, skin, and nails; and infection and healing. The CRPS+fibromyalgia group presented with features of both disorders with minimal additional stressors or symptoms over and above these. Our findings suggest that CRPS and fibromyalgia share underlying pathophysiologies, although specific mechanisms might be different.
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http://dx.doi.org/10.1097/j.pain.0000000000001830DOI Listing
June 2020

Visual working memory capacity in Korsakoff's amnesia.

J Clin Exp Neuropsychol 2020 05 6;42(4):363-370. Epub 2020 Feb 6.

Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.

: Despite the interest in memory functioning in Korsakoff's syndrome (KS), visual working memory capacity in KS is still poorly understood. Results from the last decades on working memory limitations in KS appear to be mixed, clearly calling for further investigations.: We investigated visual working memory storage capacity of patients diagnosed with KS using a change detection paradigm. Nine patients diagnosed with KS and thirty age- and education- matched healthy controls were presented twice with 2, 3, 4, or 6 bars with different orientations and had to detect whether the orientation of the target bar had changed.: As a group, KS patients performed significantly worse than controls on all set sizes, with an average capacity of 1.13 items, compared to 1.75 items in the control participants. In case study analysis, 4 out of 9 patients performed significantly worse than control participants, while 5 had relatively intact visual working memory capacity. In patients, deficits in visual working memory could not be explained by other cognitive deficits.: Based on these results, we conclude that visual working memory deficits are a prominent characteristic in some, but not all KS patients. Training visual working memory capacity could possibly optimize other cognitive difficulties in this population.
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http://dx.doi.org/10.1080/13803395.2020.1722800DOI Listing
May 2020

The relationship between visuospatial neglect, spatial working memory and search behavior.

J Clin Exp Neuropsychol 2020 04 3;42(3):251-262. Epub 2020 Jan 3.

Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.

Visuospatial neglect (VSN) is characterized by a lateralized attentional deficit in the visual domain. In addition, patients with VSN might have an impairment in the temporary storage of spatial information in working memory (spatial working memory; SWM) that, like VSN, could impair systematic searching behavior. Several studies have demonstrated either SWM impairments or impaired searching behavior in VSN patients. Here, we related SWM performance to search behavior in patients with and without VSN. We assessed SWM using a novel task in a group of 182 stroke patients (24 with VSN, 158 without) and 65 healthy controls. We related SWM performance to available stroke-related and cognitive data. Patients with VSN exhibited lower SWM performance than patients without VSN and healthy controls. Additional control analyses indicated that differences in SWM performance are specific to visuospatial processing, instead of e.g. verbal working memory or the general level of physical disability. Last, we related SWM performance to visual search performance on cancellation tasks, one where their cancellation markings remained visible and another one where their prior cancellations markings were invisible to the patient and therefore patients had to remember which targets they had canceled. SWM performance correlated with search organization. Together, these results from a large sample of stroke patients corroborate the findings of earlier studies, while excluding several alternative explanations: SWM impairment is a part of the neglect syndrome, and SWM impairments are related to search behavior.
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http://dx.doi.org/10.1080/13803395.2019.1707779DOI Listing
April 2020

Trans-saccadic memory after right parietal brain damage.

Cortex 2019 11 28;120:284-297. Epub 2019 Jun 28.

Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands.

Introduction: Spatial remapping, the process of updating information across eye movements, is an important mechanism for trans-saccadic perception. The right posterior parietal cortex (PPC) is a region that has been associated most strongly with spatial remapping. The aim of the project was to investigate the effect of damage to the right PPC on direction specific trans-saccadic memory. We compared trans-saccadic memory performance for central items that had to be remembered while making a left- versus rightward eye movement, or for items that were remapped within the left versus right visual field.

Methods: We included 9 stroke patients with unilateral right PPC lesions and 31 healthy control subjects. Participants memorized the location of a briefly presented item, had to make one saccade (either towards the left or right, or upward or downward), and subsequently had to decide in what direction the probe had shifted. We used a staircase to adjust task difficulty (i.e., the distance between the memory item and probe). Bayesian repeated measures ANOVAs were used to compare left versus right eye movements and items in the left versus right visual field.

Results: In both conditions, patients with right PPC damage showed worse trans-saccadic memory performance compared to healthy control subjects (for the condition with left- and rightward gaze shifts, BF = 3.79; and when items were presented left or right, BF = 6.77), regardless of the direction of the gaze or the initial location of the memory item. At the individual level, none of the patients showed a direction specific deficit after leftward versus rightward saccades, whereas two patients showed worse performance for items in the left versus right visual field.

Conclusion: Damage in the right PPC did not lead to gaze direction specific impairments in trans-saccadic memory, but instead caused more general spatial memory impairments.
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http://dx.doi.org/10.1016/j.cortex.2019.06.006DOI Listing
November 2019

Simulated driving: The added value of dynamic testing in the assessment of visuo-spatial neglect after stroke.

J Neuropsychol 2020 03 16;14(1):28-45. Epub 2018 Oct 16.

Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands.

Background: Visuo-spatial neglect (VSN) is generally assessed with neuropsychological paper-and-pencil tasks, which are often not sensitive enough to detect mild and/or well-compensated VSN. It is of utmost importance to develop dynamic tasks, resembling the dynamics of daily living.

Objective: A simulated driving task was used to assess (1) differences in performance (i.e., position on the road and magnitude of sway) between patients with left- and right-sided VSN, recovered VSN, without VSN, and healthy participants; (2) the relation between average position and VSN severity; and (3) its diagnostic accuracy in relation to traditional tasks.

Methods: Stroke inpatients were tested with a cancellation task, the Catherine Bergego Scale and the simulated driving task.

Results: Patients with left-sided VSN and recovered VSN deviated more regarding position on the road compared to patients without VSN. The deviation was larger in patients with more severe VSN. Regarding diagnostic accuracy, 29% of recovered VSN patients and 6% of patients without VSN did show abnormal performance on the simulated driving task. The sensitivity was 52% for left-sided VSN. Right-sided VSN was not well detected, probably due to the asymmetric layout.

Conclusions: Based on these results, the simulated driving task should not be the only task to assess VSN, especially in its current form. Given the heterogenic nature of VSN, the assessment should always consist of several tasks varying in nature and complexity and include a dynamic task to detect mild and/or recovered VSN. A symmetric design should be used when designing novel tasks to assess right-sided VSN.
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http://dx.doi.org/10.1111/jnp.12172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154737PMC
March 2020

Multi-target visual search organisation across the lifespan: cancellation task performance in a large and demographically stratified sample of healthy adults.

Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2019 09 17;26(5):731-748. Epub 2018 Sep 17.

a Department of Experimental Psychology, Helmholtz Institute, Utrecht University , Utrecht , Netherlands.

Accurate tests of cognition are vital in (neuro)psychology. Cancellation tasks are popular tests of attention and executive function, in which participants find and 'cancel' targets among distractors. Despite extensive use in neurological patients, it remains unclear whether demographic variables (that vary among patients) affect cancellation performance. Here, we describe performance in 523 healthy participants of a web-based cancellation task. Age, sex, and level of education did not affect cancellation performance in this sample. We provide norm scores for indices of spatial bias, perseverations, revisits, processing speed, and search organisation. Furthermore, a cluster analysis identified four cognitive profiles among participants, characterised by many omissions (N=18), many revisits (N=18), relatively poor search organisation (N=125), and relatively good search organisation (N=362). Thus, patient scores pertaining to search organisation should be interpreted cautiously: Given the large proportion of healthy individuals with poor search organisation, disorganised search in patients might be pre-existing rather than disorder-related.
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http://dx.doi.org/10.1080/13825585.2018.1521508DOI Listing
September 2019

Peripersonal and extrapersonal visuospatial neglect in different frames of reference: A brain lesion-symptom mapping study.

Behav Brain Res 2019 01 22;356:504-515. Epub 2018 Jun 22.

Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands. Electronic address:

Introduction: Visuospatial neglect can occur in peripersonal and extrapersonal space. The dorsal visual pathway is hypothesized to be associated with peripersonal, and the ventral pathway with extrapersonal neglect. We aimed to evaluate neural substrates of peripersonal versus extrapersonal neglect, separately for egocentric and allocentric frames of reference.

Methods: This was a retrospective study, including stroke patients admitted for inpatient rehabilitation. Approximately 1 month post-stroke onset, computerized cancellation (egocentric) and bisection tasks (egocentric and allocentric) were administered at 30 cm and 120 cm. We collected CT or MRI scans and performed voxel-based lesion-symptom mapping for the cancellation, and subtraction analyses for the line bisection task.

Results: We included 98 patients for the cancellation and 129 for the bisection analyses. The right parahippocampal gyrus, hippocampus, and thalamus were associated with egocentric peripersonal neglect as measured with cancellation. These areas were also associated with extrapersonal neglect, together with the right superior parietal lobule, angular gyrus, supramarginal gyrus, lateral occipital cortex, planum temporale and superior temporal gyrus. Lesions in the right parietal, temporal and frontal areas were associated with both peripersonal and extrapersonal egocentric neglect as measured with bisection. For allocentric neglect no clear pattern of associated brain regions was observed.

Discussion: We found right hemispheric anatomical correlates for peripersonal and extrapersonal neglect. However, no brain areas were uniquely associated with peripersonal neglect, meaning we could not conclusively verify the ventral/dorsal hypothesis. Several areas were uniquely associated with egocentric extrapersonal neglect, suggesting that these brain areas can be specifically involved in extrapersonal, but not in peripersonal, attention processes.
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http://dx.doi.org/10.1016/j.bbr.2018.06.010DOI Listing
January 2019

What Does It Take to Search Organized? The Cognitive Correlates of Search Organization During Cancellation After Stroke.

J Int Neuropsychol Soc 2018 05 4;24(5):424-436. Epub 2017 Dec 4.

1Center of Excellence in Rehabilitation Medicine,Brain Center Rudolf Magnus,University Medical Center Utrecht, andDe Hoogstraat Rehabilitation,Utrecht,The Netherlands.

Objectives: Stroke could lead to deficits in organization of visual search. Cancellation tests are frequently used in standard neuropsychological assessment and appear suitable to measure search organization. The current aim was to evaluate which cognitive functions are associated with cancellation organization measures after stroke.

Methods: Stroke patients admitted to inpatient rehabilitation were included in this retrospective study. We performed exploratory factor analyses to explore cognitive domains. A digital shape cancellation test (SC) was administered, and measures of search organization (intersections rate and best r) were computed. The following cognitive functions were measured by neuropsychological testing: neglect (SC, line bisection; LB, Catherine Bergego Scale; CBS, and Balloons Test), visuospatial perception and construction (Rey Complex Figure Test, RCFT), psychomotor speed (Trail Making Test; TMT-A), executive functioning/working memory (TMT-B), spatial planning (Tower Test), rule learning (Brixton Test), short-term auditory memory (Digit Span Forward; DSF), and verbal working memory (Digit Span Backward; DSB).

Results: In total, 439 stroke patients were included in our analyses. Four clusters were separated: "Executive functioning" (TMT-A, TMT-B, Brixton Test, and Tower Test), "Verbal memory" (DSF and DSB), "Search organization" (intersections rate and best r), and "Neglect" (CBS, RCFT copy, Balloons Test, SC, and LB).

Conclusions: Search organization during cancellation, as measured with intersections rate and best r, seems a distinct cognitive construct compared to existing cognitive domains that are tested during neuropsychological assessment. Administering cancellation tests and analyzing measures of search organization could provide useful additional insights into the visuospatial processes of stroke patients. (JINS, 2018, 24, 424-436).
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http://dx.doi.org/10.1017/S1355617717001254DOI Listing
May 2018

Prism Adaptation in Rehabilitation? No Additional Effects of Prism Adaptation on Neglect Recovery in the Subacute Phase Poststroke: A Randomized Controlled Trial.

Neurorehabil Neural Repair 2017 Dec 1;31(12):1017-1028. Epub 2017 Dec 1.

1 University Medical Center Utrecht, Netherlands.

Background: Patients with neglect ignore or respond slower to contralesional stimuli. Neglect negatively influences independence in activities of daily living (ADL). Prism adaptation (PA) is one of the most frequently studied treatments, yet there is little evidence regarding positive effects on neglect behavior in ADL.

Objective: To assess whether PA in the subacute phase ameliorates neglect in situations of varying complexity.

Methods: A total of 70 neglect patients admitted for inpatient stroke rehabilitation received either PA or sham adaptation (SA) for 2 weeks, with full access to standard treatment. There were 7 time-dependent measurements (baseline and 1-4, 6, and 14 weeks after start of treatment). The primary outcome was change of neglect as observed during basic ADL with the Catherine Bergego Scale (CBS). Secondary outcomes were changes in performance on a dynamic multitask (ie, the Mobility Assessment Course [MAC]) and a static paper-and-pencil task (ie, a shape cancellation task [SC]).

Results: In all, 34 patients received PA and 35 SA. There were significant time-dependent improvements in performance as measured with the CBS, MAC, and SC (all F > 15.57; P < .001). There was no significant difference in magnitude of improvement between groups on the CBS, MAC, and SC (all F < 2.54; P > .113].

Conclusions: No beneficial effects of PA over SA in the subacute phase poststroke were observed, which was comparable for situations of varying complexity. Heterogeneity of the syndrome, time post-stroke onset, and the content of treatment as usual are discussed. Basic knowledge on subtypes and recovery patterns would aid the development of tailored treatment.
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http://dx.doi.org/10.1177/1545968317744277DOI Listing
December 2017

Dynamic assessment of visual neglect: The Mobility Assessment Course as a diagnostic tool.

J Clin Exp Neuropsychol 2018 03 14;40(2):161-172. Epub 2017 May 14.

a Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus , University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.

Introduction: Visual neglect is a frequent disorder following stroke and is often diagnosed by neuropsychological assessment. However, paper-and-pencil tasks have low predictive value as they lack sensitivity to capture neglect in complex, dynamic situations, such as activities of daily living. Aims of the current study were to assess the feasibility of the Mobility Assessment Course (MAC), a visual search multitask, to assess neglect, and its relation with existing neglect tasks.

Method: Stroke patients admitted for inpatient rehabilitation and healthy controls were tested with the MAC in different corridors. Participants had to move through a corridor, finding and reporting 24 targets attached to the walls. In addition, the shape cancellation, line bisection, and Catherine Bergego Scale (CBS) were used in order to compare the MAC with existing diagnostic tools for neglect.

Results: Administering the MAC was feasible, as 112 of 113 patients completed the MAC with a median duration of 4.09 min. Depending on the corridor where the assessment took place, in 88.5-93.3% of assessments all targets were visible. The number of omissions (total and contralesional) and the asymmetry score (contralesional-ipsilesional omissions) on the MAC as well as collisions and corrections, were higher for patients with neglect than for those without neglect. Depending on the neglect task used, 4.0-18.6% of patients without neglect on neuropsychological tasks or the CBS showed neglect on the MAC. Vice versa, 17.2-29.3% of patients who showed neglect at neuropsychological assessment or the CBS did not do so on the MAC. Finally, a moderate to strong positive relation was seen between neglect at neuropsychological assessment, the CBS, and the MAC.

Conclusions: The MAC is an ecological task in which both quantitative and qualitative data on neglect can be collected. In order to assess the presence of neglect and neglect severity in a dynamic way, the MAC could be administered in conjunction with neuropsychological assessment.
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http://dx.doi.org/10.1080/13803395.2017.1324562DOI Listing
March 2018

Pharmacological Treatment of Visuospatial Neglect: A Systematic Review.

J Stroke Cerebrovasc Dis 2017 Apr 23;26(4):686-700. Epub 2017 Feb 23.

Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.

Objectives: The aims of the current review were (1) to give an overview of human studies investigating pharmacotherapy to ameliorate visuospatial neglect and (2) to evaluate the quality of those studies.

Methods: A systematic literature search using PubMed, Scopus, and ResearchGate was conducted in regard to studies that evaluated pharmacological interventions aiming to ameliorate poststroke visuospatial neglect. The search was limited in the following features: species (human), adults (≥18 years of age), language (English), and type of neglect (visuospatial). Two independent authors extracted data on study content and effectiveness and evaluated the quality of studies and methods.

Results: A total of 11 studies were identified. Three studies were considered to be of moderate quality, the others of low quality. Seven studies represented dopaminergic treatment; 3 studies represented cholinergic treatment; and 1 study represented noradrenergic treatment. Three dopaminergic studies showed primarily positive effects of dopaminergic stimulation on visuospatial neglect, whereas three others showed adverse effects. All 3 cholinergic studies found positive effects in some outcome measures concerning visuospatial neglect. Noradrenergic stimulation improved maintenance of attention when exploring space.

Conclusions: Currently, cholinergic therapy might be the best option for future research. However, we must emphasize the explorative nature and the limited quality of the reviewed studies.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.02.012DOI Listing
April 2017

Differences between left- and right-sided neglect revisited: A large cohort study across multiple domains.

J Clin Exp Neuropsychol 2017 Sep 12;39(7):707-723. Epub 2016 Dec 12.

a Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus , University Medical Center Utrecht, and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.

Unilateral spatial neglect (USN) is a syndrome that can occur after right- and left-hemisphere damage. It is generally accepted that left-sided USN is more severe than right-sided USN. Evidence for such a difference in other domains is lacking. Primary aims were to compare frequency, severity, region specificity, cognition, physical functioning, and physical independence between left and right USN. Secondary aims were to compare lesion characteristics. A total of 335 stroke patients admitted for inpatient rehabilitation were included. The severity of the lateralized attentional deficit was measured with a shape cancellation and line bisection test (in peripersonal and extrapersonal space) and the Catherine Bergego scale. The Mini-Mental State Examination, Stichting Afasie Nederland score, search organization (i.e., best R and intersections rate), Motricity Index, balance, mobility, and self-care were assessed. Measures were statistically compared between left, right, and no USN patients. Lesion overlay plots were compared with lesion subtraction analyses.

Results: Left USN (15.82%) was more frequent than right USN (9.25%). Demographic and stroke characteristics were comparable between groups. The lateralized attentional deficit was most severe in left USN. USN in both peripersonal and extrapersonal space was more frequently left-sided in nature. Search efficiency was lower in left USN. Balance was poorer in right USN. No differences between left and right USN were found for cognitive ability, communication, motor strength, mobility, and self-care. Most patients with left USN had right-hemispheric lesions, whereas patients with right USN could have lesions in either the left or the right hemisphere. To conclude, left and right USN are both common after stroke. Although the lateralized attention deficit is worse in left than in right USN, consequences at the level of physical functioning and physical independence are largely comparable. From a clinical perspective, it is important to systematically screen for USN, both after right- and after left-hemisphere damage.
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http://dx.doi.org/10.1080/13803395.2016.1262333DOI Listing
September 2017

Corrigendum to "The right hemisphere is dominant in organization of visual search-A study in stroke patients" [Behav. Brain Res. 304 (2016) 71-79].

Behav Brain Res 2017 02 4;319:234. Epub 2016 Dec 4.

Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands. Electronic address:

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http://dx.doi.org/10.1016/j.bbr.2016.11.034DOI Listing
February 2017

Predictors of physical independence at discharge after stroke rehabilitation in a Dutch population.

Int J Rehabil Res 2017 Mar;40(1):37-45

aCenter of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht bDepartment of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee cCoronel Institute for Occupational and Environmental Health, Academic Medical Center, University of Amsterdam, Amsterdam dUniversity of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen eRoessingh Rehabilitation Center, Enschede fRevant Rehabilitation Center Breda, Breda gRijndam Rehabilitation Centre, Rotterdam, The Netherlands.

The aim of this study was to identify predictors, available at admission, of physical independence at discharge from inpatient rehabilitation. Secondary aims were to identify predictors of functional gain and length of stay (LOS). We included 1310 adult stroke patients who were admitted for inpatient rehabilitation in five Dutch rehabilitation centres. Data on the Utrecht Scale for Evaluation of Clinical Rehabilitation at admission and discharge (physical and cognitive independence, mood, pain and fatigue), age, sex and in a subsample stroke characteristics as well were collected. A prediction model was created using random coefficient analysis. None of the stroke characteristics were independently associated with physical independence or functional gain at discharge, or LOS. Higher physical and cognitive independence scores and severe pain at admission were predictors of higher physical independence scores at discharge. Furthermore, lower physical independence scores, higher cognitive independence scores, less pain at admission and younger age predicted more functional gain. Finally, lower physical and cognitive independence scores at admission and younger age predicted longer LOS. Physical independence at admission was the most robust predictor for rehabilitation outcome in a Dutch rehabilitation setting. To a lesser extent, age, cognitive independence and pain predicted rehabilitation outcome after stroke. Treatment of cognition and pain should be taken into account during rehabilitation. Further work needs to be carried out to establish whether focusing on these factors improves outcome after rehabilitation.
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http://dx.doi.org/10.1097/MRR.0000000000000198DOI Listing
March 2017

The right hemisphere is dominant in organization of visual search-A study in stroke patients.

Behav Brain Res 2016 05 11;304:71-9. Epub 2016 Feb 11.

Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands. Electronic address:

Cancellation tasks are widely used for diagnosis of lateralized attentional deficits in stroke patients. A disorganized fashion of target cancellation has been hypothesized to reflect disturbed spatial exploration. In the current study we aimed to examine which lesion locations result in disorganized visual search during cancellation tasks, in order to determine which brain areas are involved in search organization. A computerized shape cancellation task was administered in 78 stroke patients. As an index for search organization, the amount of intersections of paths between consecutive crossed targets was computed (i.e., intersections rate). This measure is known to accurately depict disorganized visual search in a stroke population. Ischemic lesions were delineated on CT or MRI images. Assumption-free voxel-based lesion-symptom mapping and region of interest-based analyses were used to determine the grey and white matter anatomical correlates of the intersections rate as a continuous measure. The right lateral occipital cortex, superior parietal lobule, postcentral gyrus, superior temporal gyrus, middle temporal gyrus, supramarginal gyrus, inferior longitudinal fasciculus, first branch of the superior longitudinal fasciculus (SLF I), and the inferior fronto-occipital fasciculus, were related to search organization. To conclude, a clear right hemispheric dominance for search organization was revealed. Further, the correlates of disorganized search overlap with regions that have previously been associated with conjunctive search and spatial working memory. This suggests that disorganized visual search is caused by disturbed spatial processes, rather than deficits in high level executive function or planning, which would be expected to be more related to frontal regions.
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http://dx.doi.org/10.1016/j.bbr.2016.02.004DOI Listing
May 2016

Does prism adaptation affect visual search in spatial neglect patients: A systematic review.

J Neuropsychol 2018 03 11;12(1):53-77. Epub 2016 Feb 11.

Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, The Netherlands.

Prism adaptation (PA) is a widely used intervention for (visuo-)spatial neglect. PA-induced improvements can be assessed by visual search tasks. It remains unclear which outcome measures are the most sensitive for the effects of PA in neglect. In this review, we aimed to evaluate PA effects on visual search measures. A systematic literature search was completed regarding PA intervention studies focusing on patients with neglect using visual search tasks. Information about study content and effectiveness was extracted. Out of 403 identified studies, 30 met the inclusion criteria. The quality of the studies was evaluated: Rankings were moderate-to-high for 7, and low for 23 studies. As feature search was only performed by five studies, low-to-moderate ranking, we were limited in drawing firm conclusions about the PA effect on feature search. All moderate-to-high-ranking studies investigated cancellation by measuring only omissions or hits. These studies found an overall improvement after PA. Measuring perseverations and total task duration provides more specific information about visual search. The two (low ranking) studies that measured this found an improvement after PA on perseverations and duration (while accuracy improved for one study and remained the same for the other). This review suggests there is an overall effect of PA on visual search, although complex visual search tasks and specific visual search measures are lacking. Suggestions for search measures that give insight in subcomponents of visual search are provided for future studies, such as perseverations, search path intersections, search consistency and using a speed-accuracy trade-off.
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http://dx.doi.org/10.1111/jnp.12100DOI Listing
March 2018

Lack of multisensory integration in hemianopia: no influence of visual stimuli on aurally guided saccades to the blind hemifield.

PLoS One 2015 2;10(4):e0122054. Epub 2015 Apr 2.

Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.

In patients with visual hemifield defects residual visual functions may be present, a phenomenon called blindsight. The superior colliculus (SC) is part of the spared pathway that is considered to be responsible for this phenomenon. Given that the SC processes input from different modalities and is involved in the programming of saccadic eye movements, the aim of the present study was to examine whether multimodal integration can modulate oculomotor competition in the damaged hemifield. We conducted two experiments with eight patients who had visual field defects due to lesions that affected the retinogeniculate pathway but spared the retinotectal direct SC pathway. They had to make saccades to an auditory target that was presented alone or in combination with a visual stimulus. The visual stimulus could either be spatially coincident with the auditory target (possibly enhancing the auditory target signal), or spatially disparate to the auditory target (possibly competing with the auditory tar-get signal). For each patient we compared the saccade endpoint deviation in these two bi-modal conditions with the endpoint deviation in the unimodal condition (auditory target alone). In all seven hemianopic patients, saccade accuracy was affected only by visual stimuli in the intact, but not in the blind visual field. In one patient with a more limited quadrantano-pia, a facilitation effect of the spatially coincident visual stimulus was observed. We conclude that our results show that multisensory integration is infrequent in the blind field of patients with hemianopia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122054PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383622PMC
March 2016

You never know where you are going until you know where you have been: Disorganized search after stroke.

J Neuropsychol 2016 09 11;10(2):256-75. Epub 2015 Mar 11.

Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, The Netherlands.

Disorders in spatial exploration can be expressed in a disorganized fashion of target cancellation. There is debate regarding whether disorganized search is related to stroke in general, to right brain damage or to unilateral spatial neglect (USN) in particular. In this study, 280 stroke patients and 37 healthy control subjects performed a computerized shape cancellation test. We investigated the number of perseverations and several outcome measures regarding disorganized search: Consistency of search direction (best r), distance between consecutive cancelled targets and intersections with paths between previous cancelled targets. We compared performance between patients with left and right brain damage (L, R) and with and without USN (USN+, USN-), resulting in four subgroups: LUSN-, RUSN-, LUSN+, and RUSN+. Higher numbers of intersections were found for the left brain- and right brain-damaged patients with USN and for the right brain-damaged patients without USN, compared to healthy control subjects. Furthermore, right brain-damaged patients with USN showed a higher number of intersections compared to right brain-damaged patients without USN and compared to left brain-damaged patients with USN. To conclude, disorganized search was most strongly related to the neglect syndrome, and patients with more severe USN were even more impaired.
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http://dx.doi.org/10.1111/jnp.12068DOI Listing
September 2016

Study protocol of 'Prism Adaptation in Rehabilitation': a randomized controlled trial in stroke patients with neglect.

BMC Neurol 2015 Feb 4;15. Epub 2015 Feb 4.

Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands.

Background: A frequent disorder after stroke is neglect, resulting in a failure to report or respond to contralesional stimuli. Rehabilitation of neglect is important, given the negative influence on motor recovery, independence in self-care, transfers, and locomotion. Effects of prism adaptation (PA) to alleviate neglect have been reported. However, either small groups or no control group were included and few studies reported outcome measurements on the level of activities of daily living (ADL). The current ongoing RCT investigates the short- and long-term effects of PA in a large population in a realistic clinical setting. Measures range from the level of function to the level of ADL.

Methods/design: Neglect patients in the sub-acute phase after stroke are randomly assigned to PA (n = 35) or sham adaptation (SA; n = 35). Adaptation is performed for 10 consecutive weekdays. Patients are tested at start of the study, 1 and 2 weeks after starting, and 1, 2, 4 and 12 weeks after ending treatment. Primary objectives are changes in performance on neuropsychological tests and neglect in ADL. Secondary objectives are changes in simulated driving, eye movements, balance, visual scanning and mobility, subjective experience of neglect in ADL and independence during ADL.

Discussion: If effective, PA could be implemented as a treatment for neglect.

Trial Registration: This trial is registered at the Dutch Trial Register # NTR3278 .
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http://dx.doi.org/10.1186/s12883-015-0263-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326203PMC
February 2015

Neglecting posture: differences in balance impairments between peripersonal and extrapersonal neglect.

Neuroreport 2014 Dec;25(17):1381-5

aDepartment of Experimental Psychology, Helmholtz Institute, Utrecht University bBrain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.

Neglect is a heterogeneous disorder and may be specific for only peripersonal or extrapersonal space. Behavioural consequences at the level of independency in basic activities of daily living differ between patients with peripersonal and those with extrapersonal neglect. One of the most important factors that determine independency in basic activities of daily living is balance. Here, potential differences in postural imbalance between patients with peripersonal and those with extrapersonal neglect were investigated. A total of 81 stroke patients were screened within the first 2 weeks after admission to the rehabilitation centre. Mediolateral (horizontal) and anteroposterior (vertical) displacements of the centre of pressure (CoP) were measured using a Nintendo Wii Balance Board in an eyes-open and eyes-closed condition. Patients with peripersonal neglect showed a significant displacement of mediolateral CoP from the ideal CoP, but not in the anteroposterior dimension or postural sway. Patients with extrapersonal neglect did not differ from the no-neglect patients in terms of displacement of both mediolateral and anteroposterior CoP and postural sway. There were no differences between the eyes-open and eyes-closed conditions in any of the groups. Consequences of region-specific neglect on postural imbalance appear to be very specific and cannot be accounted for by neglecting visual information only. The current findings might directly reflect a relation between body perception and body representation and (actions in) peripersonal space. When diagnosing neglect, it is relevant to distinguish the type of region-specific neglect and, when needed, to adjust the rehabilitation programme accordingly.
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http://dx.doi.org/10.1097/WNR.0000000000000277DOI Listing
December 2014