Non-invasive Brain Stimulation and Prism Adaptation in Art Constructive Errors in Painting

Abstract

Introduction: This study aimed to investigate the influence of neglect and the effect of prism adaptation (PA) combined with continuous Theta-burst transcranial magnetic stimulation (cTBS) on the art constructive errors in painting rehabilitation of stroke patients with neglect.

Methods: Fourteen patients with neglect and art constructive errors in painting secondary to stroke were randomly assigned to the rehabilitation group and received PA combined with the inhibitory protocol of cTBS over the intact parietal cortex; the control group received PA combined with sham cTBS for two weeks in ten daily sessions. Patients were assessed for art constructive errors in painting in figure copying test (FCT), and coloring test (CT) before and after the intervention. Art constructive errors in painting were classified into omission, deformation, size, neglect of warm colors, and perseveration of errors. Neglect was evaluated using the line bisection task (LBT), figure copying test (FCT), and coloring test (CT).

Results: All patients showed a significant improvement in art constructive errors in painting (measured using the pattern of painting' errors in FCT and CT), and neglect (measured using LBT, FCT, and CT) (P<0.05). Omission, neglect of warm colors, and deformation were the most frequent errors.

Conclusion: Neglect and rehabilitation influence the painting system in stroke patients. Both approaches improved art constructive errors in painting and neglect symptoms.

Keywords: Brain stimulation; Coloring; Neglect; Painting; Prism; Rehabilitation.

Figure 1.

The classification of art constructive errors in the painting of patients with neglect used in this study The figure on the left side of the columns shows the response of the patients with art constructive errors in painting in the Coloring test (CT) and neglect before the intervention. The patients changed often warm colors (yellow, light green, and red) to cold colors, which are characterized by cold, hard, and metallic colors, such as gray, black, dark green, brown, and marine blue (neglect in warm colors), and minimal color on the left side. Those on the right side of the columns are examples of the response of the patients with art constructive errors in painting in the CT and neglect of rehabilitation after 10 sessions. The patients used both warm colors and cold colors in the final paper msc.b) Minimal size color on the left side errors before rehabilitation; msc. a) minimal size color on the left side errors after rehabilitation; cc.b) cold colors used (neglect of warm colors) before rehabilitation; cc.a) cold colors used (neglect of warm colors) after rehabilitation; oc.b: omission color errore before rehabilitation; oc.a, omission color errore after rehabilitation; pc.b)perseveration color errors before rehabilitation; Pc.a) perseveration color errors after rehabilitation; sc.b) small size copying errors before rehabilitation; sc.a) small size copying errors after rehabilitation; dc.b, deformation copying errors before rehabilitation; dc.a) deformation copying errors after rehabilitation; oco.b) omission copying errore before rehabilitation; oco.a) omission copying errore after rehabilitation; pco.b) perseveration copying errors before rehabilitation; pco.a) perseveration copying errors after rehabilitation; P.total errors b) total errors score of art constructive errors in painting before rehabilitation; P.total errors a) total errors score of art constructive errors in painting after rehabilitation; cTBS) continuous theta-burst transcranial magnetic stimulation. Abbreviations PA: Prism adaptation; FCT: Figure copying test; CT: Coloring test; LBT: Line bisection test.

Figure 2.

The classification of art constructive errors in painting in the figure copying test (FCT) in stroke patients with neglect used in this study The figure on the left side of the columns shows the response of the patients with art constructive errors in painting in FCT and neglect before the intervention. Those on the right side of the columns are examples of the response of the patients with art constructive errors in painting in FCT and neglect of rehabilitation after 10 sessions.

Figure 3.

Art constructive errors in painting and visuospatial neglect measurement before and after the rehabilitation The figure on the left side shows patients with the classification of art constructive errors of painting in the figure copying test and coloring test of rehabilitation without painting practice before and after 10 sessions. The figure on the right side shows stroke patients’ scores in the neglect and art constructive errors in painting (total errors) of rehabilitation before and after 10 sessions. The rehabilitation significantly in art constructive errors in painting (measured using the pattern of painting’ errors in FCT and CT), and neglect symptoms (measured by LBT, FCT, and CT). Asterisks indicate results that were significant using repeated-measures ANOVA (^*P<0.05; time factor) and repeated-measures ANOVA (group×time factor; ^**P<0.05).