Reducing Chronic Visuo-Spatial Neglect Following Right Hemisphere Stroke Through Instrument Playing

Abstract

Unilateral visuo-spatial neglect is a neuropsychological syndrome commonly resulting from right hemisphere stroke at the temporo-parietal junction of the infero-posterior parietal cortex. Neglect is characterized by reduced awareness of stimuli presented on patients’ contralesional side of space. Inspired by evidence of increased spatial exploration of patients’ left side achieved during keyboard scale-playing, the current study employed a music intervention that involved making sequential goal-directed actions in the neglected part of space, in order to determine whether this would bring about clinically significant improvement in chronic neglect. Two left neglect patients completed an intervention comprising four weekly 30-min music intervention sessions involving playing scales and familiar melodies on chime bars from right to left. Two cancellation tests [Mesulam shape, Behavioral Inattention Test (BIT) star], the neglect subtest from the computerized TAP (Test of Attentional Performance) battery, and the line bisection test were administered three times during a preliminary baseline phase, before and after the four intervention sessions during the intervention phase to investigate short-term effects, and 1 week after the last intervention session to investigate whether any changes in performance would persist. Both patients demonstrated significant short-term and longer-lasting improvements on the Mesulam shape cancellation test. One patient also showed longer-lasting effects on the BIT star cancellation test and scored in the normal range 1 week after the intervention. These findings provide preliminary evidence that active music-making with a horizontally aligned instrument may help neglect patients attend more to their affected side.

Improving left spatial neglect through music scale playing

“…The auditory feedback of pitch could be enriched by verbal information (e.g., segments of lyrics) to provide additional non‐spatial cueing. Furthermore, the modular nature of several ‘horizontal’ instruments (e.g., xylophones, computer‐controlled pads) allows extending already well‐learned melodies to progressively wider space areas (e.g., Bodak et al ., ). The well‐documented potential of auditory and musical stimuli in sustaining arousal and positive emotions could be used not only as a background support to the training.…”

“…In music therapy settings, sounds are frequently used to support spatial awareness, leveraging on various mechanisms such as the combined spatial–auditory mapping offered by musical instruments, the increase of arousal due to auditory stimulation, and the positive effect on cognitive performance of positive emotions elicited through music (see Guilbert, Clément, & Moroni, for a review). For example, a recent study has provided evidence of improvement in spatial neglect following a 4‐week music therapy intervention: Patients practiced scales and melodies on a custom chime‐bar instrument, in which the spacing between the bars could be progressively enlarged, thus inviting increasingly wide exploration (Bodak, Malhotra, Bernardi, Cocchini, & Stewart, ). The present paper deals with the specific mechanisms through which sounds may facilitate spatial exploration in patients with spatial neglect.…”

Impact of chronic hyponatremia on neurocognitive and neuromuscular function

“…Intactness of the functions of attention as prerequisite for effective behaviour in everyday life was assessed using the standardised computer test system “Test of Attentional Performance (TAP) 2.1” . The TAP has been developed in 1994 by Zimmermann & Fimm as an assessment of attention deficits in adults, and has since been validated and used as a reliable tool for attentional impairment in different trials . Within this procedure, simple reaction paradigms were chosen, in which participants had to react selectively to well discriminable, non verbal visual and acoustic stimuli by a simple motoric reaction (a simple keypress).…”

“…25 The TAP has been developed in 1994 26 by Zimmermann & Fimm as an assessment of attention deficits in adults, and has since been validated and used as a reliable tool for attentional impairment in different trials. [27][28][29][30][31] Within this procedure, simple reaction paradigms were chosen, in which participants had to react selectively to well discriminable, non verbal visual and acoustic stimuli by a simple motoric reaction (a simple keypress). During the tests, participants were seated in a quiet room in front of a black computer screen.…”

Can Specialised Electronic Musical Instruments Aid Stroke Rehabilitation?

“…Due to time constraints and fatigue some participants (n=5) were not able to play the SoundBoard. A third and final proposed intervention the Electronic Chime Bar was created inspired by a rehabilitation study of visual neglect [13]. However, due to a delay in completion this single prototype was not used until the final two music workshops and then was trialled by 20 of the participants.…”