HEMISPATIAL THEORY OR ATTENTIONAL HEMISPHERIC SPECIALIZATION MODEL BY HEILMAN

The right hemisphere has a dominant role, it allocates attention to both hemispaces, whereas
the left hemisphere allocates attention only to the contralateral hemispace.

1) Both hemispheres allocate attention to the contralateral hemispace and the balance is
maintained through interhemispheric inhibition.
2) The left hemisphere is thought to exert a more substantial rightward bias than the
leftward bias of the right hemisphere (leading to a stronger imbalance afrter right
hemispheric damage).

The attentional vector becomes even stronger.

BISIACH’S REPRESENTATIONAL THEORY

Horizontal anisometry of the medium for space representation in patients with neglect.

This medium has been hypothesized to be progressively relaxed, in patients suffering from
unilateral neglect, proceeding from the ipsilesional toward the contralesional side.

Neglect has been found to be associated with lesion of right inferior Parietal lobule and Frontal
areas which are often damaged or dysfunctional in patients with left neglect

From the study of the brain regions responsible for the different symptoms of neglect to the
study of brain areas that belong, as subcomponents, to more complex circuits responsible for
the processes of attention / representation space.

Corbetta et. Al: Neglect is due to alteration of two fronto-parietal circuits

1) The lesion is generally centred on the VENTRAL ATTENTION NETWORK which is a right
lateralized system
2) But the lesion to the VAN also affects activity of the DORSAL ATTENTION NETWORK
which is bilateral system

Disruption of right parieto-frontal networks for spatial attention and representation may
underlie neglect symptoms.

Hallman theory: When we use fMRI we can see a change in the network where the decreased
activity in the left hemisphere are also related to a decreased activity in the right.

Damage to Superior Longitudinal Fasciculus, which disconnects parietal and frontal cortices, is
significantly involved in the causation and severity of the neglect syndrome. BREAK DOWN
FUNCTIONAL CONNECTIVITY

1) Intraoperative electrical stimulation of a site corresponding to light SLF II induces

dramatic rightward line bisection shift in patient during brain surgery.
 2) Right hemisphere SLF II volumes positively correlate with leftward bisection biases in
healthy participants.
3) SLF FALTAAA

TREATMENT IN PACIENT NEGLECT:

Prismatic glasses TOP DOWN

Randomised control triad to demonstrate the effectiveness of the treatments.

Higher quality studies don’t show the same efficacy than low quality studies

 TOP DOWN APPROACH: We are involving the patient adaptation, VOLUNTARY

ATTENTIONAL ORIENTING towards the contralesional space.

VISUAL SCANNING TRAINING

2 DIFFERENT TYPES OF APPROACHES: Top down and bottom up

BOTTOM UP

Prismatic Adaptation (PA)

Vestibular caloric stimulation (Cold water in the contralesional ear), Galvanic Vestibular
Stimulation, optokinetic stimulation: Visual stimulation, Neck muscles vibration, trunk rotation,
proprioceptive stimulation, (right eye patching, right eye patching has been has been tested
but it does not seem to produce consistent improvement).

IMPORTANT THE PAPER SHE IS GIVING US TO PROFUNDISE IN NEGLECT

VISUAL SCANNING TRAINING

VST exercises voluntary orienting of spatial attention.

Patients are required to actively pay attention to stimuli presented in the contralesional side,
receiving the therapist’s feedback about their performance.

The gradual increase of difficulty levels and the concomitant feedback re

NEGLECT REHABILITATION

Diller and colleagues who propose the VST, also acknowledged this.
TMS: Can inhibit and increase the cortical excitability. Can induce a seizure.

tDCS: Two electrodes, one positive and other negative that produce different effects in cortical
excitability: Increase or decrease cortical excitability. Cannot induce a seizure.

Inhibition of the healthy hemisphere:

Low frequency: 1Hz tms (less than 5Hz)

cTBS (Continuous Theta Burst Stimulaiton): 40second stimulation can provide 1 hour results.

Cathodal tDCS

Excitation of the lesioned hemisphere

High frequency (high intensity) rTMS

iTBS intermittent (Theta Burst Stimulation)

Anodal tDCS

3 neglect patients (disease duration: 3-5 months)

1 Hz rTMS (900 stimuli) to the healthy hemisphere PPC

Intensity 90% of Motor Threshold

Every other day for 2 weeks.

VISUO-SPATIAL TASKS

-landmark

-line bisection

-clock drawing

15 days before (time 1)

Before starting (time 2)

At the end (time 3)

15 days after treatment (time 4)