Objective To explore the factor structure of the Kessler Foundation Neglect Assessment Process (KF-NAP), and evaluate the prevalence and clinical significance of spatial neglect among stroke survivors. Design Inception cohort. Setting Inpatient rehabilitation facility (IRF). Participants 121 participants with unilateral brain damage from their first stroke were assessed within 72 hours of admission to an IRF, and 108 were assessed again within 72 hours before IRF discharge. Interventions Usual and standard IRF care. Main Outcome Measures During each assessment session, occupational therapists measured patients’ functions with the KF-NAP, Functional Independence Measure (FIM™) and Barthel Index (BI). Results The KF-NAP showed excellent internal consistency with a single-factor structure. The exploratory factor analysis revealed the KF-NAP to be unique from both the FIM and BI even though all three scales were correlated. 67.8% of the participants at admission and 47.2% at discharge presented with symptoms of spatial neglect (KF-NAP > 0). Participants showing the disorder at IRF admission were hospitalized longer than those showing no symptoms. Among those presenting with symptoms, the regression analysis showed that the KF-NAP scores at admission negatively predicted FIM scores at discharge, after controlling for age, FIM at admission, and length of stay. Conclusions The KF-NAP uniquely quantifies symptoms of spatial neglect by measuring functional difficulties that are not captured by the FIM or BI. Using the KF-NAP to measure spatial neglect, we found the disorder persistent after inpatient rehabilitation, and replicated previous findings showing that spatial neglect adversely affects rehabilitation outcome even after prolonged IRF care.

The studies reported here used an interference paradigm to determine whether a long-term consolidation process (i.e., one lasting from several hours to days) occurs in the learning of two implicit motor skills, learning of a movement sequence and learning of a visuo-motor mapping. Subjects learned one skill and were tested on that skill 48 h later. Between the learning session and test session, some subjects trained on a second skill. The amount of time between the learning of the two skills varied for different subjects. In both the learning of a movement sequence and the learning of a visuo-motor mapping, we found that remote memories were susceptible to interference, but the passage of time did not afford protection from interference. These results are inconsistent with the long-term consolidation of these motor skills. A possible difference between these tasks and those that do show long-term consolidation is that the present tasks are not dynamic motor skills.The notion that memories initially exist in a labile state and with time become stable was first proposed in 1900 by Müller and Pilzecker (cited in Lechner et al. 1999). These researchers found that memory for a list of words was disrupted if new information was learned less than 1 min later, but not if learned 10 min later. They concluded that the memories had undergone a stabilization process, which they termed consolidation. In the current study, we will use the term consolidation to refer to the stabilization of memory (i.e., a decrease in susceptibility to forgetting via decay or interference) in the absence of further practice of that memory. There are two putative phases of consolidation processes, short-term consolidation processes, which operate over a period of seconds to hours post-training and are mediated by local cellular mechanisms resulting in longterm potentiation (LTP), and long-term consolidation processes, which operate over a period of hours to months post-training and are mediated by neural reorganization (for review, see McGaugh 2000;Dudai 2002). The focus of the current study is on long-term consolidation processes. Much of the research on long-term consolidation processes has focused on explicit memory tasks, tasks in which memory is demonstrated through conscious recollection of previously learned information (Schacter 1987). Although less consolidation research has focused on implicit memory tasks, tasks in which memory is revealed through performance and does not require conscious recollection of learned information, recent interest in the long-term consolidation of motor learning is one exception (BrashersKrug et al. 1996). The experiments described here were designed to assess whether a long-term consolidation process is ubiquitous for different components of motor skill learning.Although there is much evidence that a long-term process of consolidation is evident in performance on explicit memory tasks (e.g., Squire et al. 1989;Zola-Morgan and Squire 1990), it is not immediately apparent that a long-term consolidation proc...

Abstract& Representation of sequential structure can occur with respect to the order of perceptual events or the order in which actions are linked. Neural correlates of sequence retrieval associated with the order of motor responses were identified in a variant of the serial reaction time task in which training occurred with a spatially incompatible mapping between stimuli and finger responses. After transfer to a spatially compatible version of the task, performance enhancements indicative of learning were only present in subjects required to make finger movements in the same order used during training. In contrast, a second group of subjects performed the compatible task using an identical sequence of stimuli (and different order of finger movements) as in training. They demonstrated no performance benefit, indicating that learning was response based. Analysis was restricted to subjects demonstrating low recall of the sequence structure to rule out effects of explicit awareness. The interaction of group (motor vs. perceptual transfer) with sequence retrieval (sequencing vs. rest) revealed significantly greater activation in the bilateral supplementary motor area, cingulate motor area, ventral premotor cortex, left caudate and inferior parietal lobule for subjects in the motor group (illustrating successful sequence retrieval at the response level). Retrieval of sequential responses occurs within mesial motor areas and related motor planning areas. &

Spatial neglect is a debilitating post-stroke neurocognitive disorder, associated with longer hospitalization and worse rehabilitation outcomes. Prior literature suggests a high prevalence of this disorder, but in reality clinicians have difficulty reliably identifying affected survivors. This discrepancy may result from suboptimal use of validated neglect assessment procedures. In this article, we suggest a validated assessment tool, sensitive to identify neglect and its functional consequences, the Catherine Bergego Scale (CBS). We provide detailed item-by-item CBS instructions for observation and scoring: the Kessler Foundation Neglect Assessment Process (KF-NAP). We describe a unique attribute of the CBS and the KF-NAP: rehabilitation researchers may be able to use them to measure both ecological outcomes, and specific, separable perceptual-attentional and motor-exploratory spatial behaviors.

Objective Spatial neglect is a failure or slowness to respond, orient, or initiate action towards contra-lesional stimuli, associated with functional disability that impedes stroke recovery. Early identification of specific neglect deficits may identify patients likely to experience chronic disability. However, psychometric evaluation of assessments has focused on subacute/chronic populations. We addressed this gap by assessing two neglect measures – the Behavioral Inattention Test (BIT) and the Catherine Bergego Scale (CBS) – in acute neglect. Design Correlational/Psychometric study. Setting Inpatient rehabilitation hospital. Participants Screening identified 51 consecutive right-hemisphere stroke patients with left neglect (BIT conventional score < 129 or CBS > 11) that tested an average of 22.3 days post-stroke. Interventions Not applicable. Main Outcome Measures We obtained BIT, CBS, and Barthel assessments for each participant, and clinical and laboratory measures of perceptual-attentional and motor-intentional deficits. Results The BIT demonstrated good reliability and loaded onto a single factor. Consistent with our theoretical prediction, principal components analysis of the CBS identified two underlying factors: “Where” perceptual-attentional items (CBS-PA) and embodied, motor exploratory items (CBS-ME). The CBS-ME uniquely predicted ADL deficits (Barthel Index), but did not predict clinical and laboratory assessments of motor-intentional bias. More severe neglect on CBS-PA correlated with greater “Where” perceptual-attentional bias on clinical and laboratory tests, but did not uniquely predict deficits in activities of daily living (ADLs). Conclusions Our results indicate that assessments of spatial neglect may be used to detect specific motor-exploratory deficits in spatial neglect. Obtaining CBS-ME scores routinely might improve detection of acute stage patients with spatial action deficits requiring increased assistance that may persist to the chronic stage.

Spatial neglect increases hospital morbidity and costs in around 50% of the 795,000 people per year in the USA who survive stroke, and an urgent need exists to reduce the care burden of this condition. However, effective acute treatment for neglect has been elusive. In this article, we review 48 studies of a treatment of intense neuroscience interest: prism adaptation training. Due to its effects on spatial motor ‘aiming’, prism adaptation training may act to reduce neglect-related disability. However, research failed, first, to suggest methods to identify the 50–75% of patients who respond to treatment; second, to measure short-term and long-term outcomes in both mechanism-specific and functionally valid ways; third, to confirm treatment utility during the critical first 8 weeks poststroke; and last, to base treatment protocols on systematic dose–response data. Thus, considerable investment in prism adaptation research has not yet touched the fundamentals needed for clinical implementation. We suggest improved standards and better spatial motor models for further research, so as to clarify when, how and for whom prism adaptation should be applied.

Prism adaptation may alleviate some symptoms of spatial neglect. However, the mechanism through which this technique works is still unclear. The current study investigated whether prism adaptation differentially affects dysfunction in perceptual-attentional “where” versus motor-intentional “aiming” bias. Five neglect patients performed a line bisection task in which lines were viewed under both normal and right-left reversed viewing conditions, allowing for the fractionation of “where” and “aiming” spatial bias components. Following two consecutive days of prism adaptation, participants demonstrated a significant improvement in “aiming” spatial bias, with no effect on “where” spatial bias. These findings suggest that prism adaptation may primarily affect motor-intentional “aiming” bias in post-stroke spatial neglect patients.

Proposals that adaptation with left-shifting prisms induces neglect-like symptoms in normal individuals rely on a dissociation between the post-adaptation performance of individuals trained with left- versus right-shifting prisms (e.g., Colent, et al. 2000). A potential problem with this evidence is that normal young adults have an a priori leftward bias (e.g., Jewell & McCourt, 2000). In Experiment 1, we compared the line bisection performance of young adults to that of aged adults, who as a group may lack a leftward bias in line bisection. Participants trained with both left- and right-shifting prisms. Consistent with our hypothesis, while young adults demonstrated aftereffects for left, but not right prisms, aged adults demonstrated reliable aftereffects for both prisms. In Experiment 2, we recruited a larger sample of young adults, some of whom were right-biased at baseline. We observed an interaction between baseline bias and prism-shift, consistent with the results of Experiment 1: Left-biased individuals showed a reduced aftereffect when training with right-shifting prisms and right-biased individuals showed a reduced aftereffect when training with left-shifting prisms. These results suggest that previous failures to find generalizable aftereffects with right-shifting prisms may be driven by participants’ baseline biases rather than specific effects of the prism itself.