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Review
. 2014 Dec;27(6):653-8.
doi: 10.1097/WCO.0000000000000148.

Spatial cognitive rehabilitation and motor recovery after stroke

A M Barrett  1 , Tufail Muzaffar
Affiliations
Review

Spatial cognitive rehabilitation and motor recovery after stroke

A M Barrett et al. Curr Opin Neurol. 2014 Dec.

Abstract

Purpose of review: Stroke rehabilitation needs to take major steps forward to reduce functional disability for survivors. In this article, we suggest that spatial retraining might greatly increase the efficiency and efficacy of motor rehabilitation, directly addressing the burden and cost of paralysis after stroke.

Recent findings: Combining motor and cognitive treatment may be practical, as well as addressing the needs after moderate-to-severe stroke. Spatial neglect could suppress motor recovery and reduce motor learning, even when patients receive appropriate rehabilitation to build strength, dexterity, and endurance. Spatial neglect rehabilitation acts to promote motor as well as visual-perceptual recovery. These findings, and the previous underemphasized studies, make a strong case for combining spatial neglect treatment with traditional exercise training. Spatial neglect therapies might also provide motor stimulation if people cannot participate in intensive movement therapies because of limited strength and endurance after stroke.

Summary: Spatial retraining, currently used selectively after right-brain stroke, may be broadly useful after stroke to promote rapid motor recovery.

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Conflict of interest statement

Conflicts of interest: The authors declare no scientific or financial conflicts of interest.

Figures

Figure 1
Figure 1
Results of Vallar et al. (1997), based on Figures 2 and 3 of that publication. Two patients with right brain stroke and spatial neglect (x axis, left hand group of bars = patient 1, right hand group of bars = patient 2) performed a hand grip before (white bar), during (black bar) and after (gray bar) optokinetic stimulation with leftward-moving dots, intended to reduce left neglect. In both patients, grip strength (in kg, y axis) increased during optokinetic stimulation.
Figure 2
Figure 2
Results of Chen et al. (2013), revised based on Figure 2 in that publication. Under-documentation of spatial neglect occurred across disciplines, including failure to document neglect in ¼ of patients by occupational therapists (striped bar), with nurses (black bar) and physicians (white bar) documenting the diagnosis of spatial neglect at even lower levels.
See this image and copyright information in PMC

References

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