论文研究-单侧空间忽视患者在人际空间和人际空间中忽视的差异资源-CSDN文库

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Case Reports in Clinical Medicine, 2018, 7, 513-525

http://www.scirp.org/journal/crcm

ISSN Online: 2325-7083

ISSN Print: 2325-7075

DOI:

10.4236/crcm.2018.710045 Oct. 8, 2018 513 Case Reports in Clinical Medicine

Differences of Neglect in Peripersonal Space

and Extrapersonal Space in a Patient with

Unilateral Spatial Neglect

Daisuke Kimura

, Ken Nakatani

, Masako Notoya

, Aiko Imai

, Hiroki Bizen

, Minoru Toyama

Kazumasa Yamada

Department of Occupational Therapy, Faculty of Health Sciences, Kansai University of Health Sciences, Osaka, Japan

Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan

Department of Speech and Hearing Sciences and Disorders, Kyoto Gakuen University, Kyoto, Japan

Faculty of Care and Rehabilitation, Seijoh University, Aichi, Japan

Abstract

Unilateral spatial neglect (USN) is characterized by neglect in

peripersonal

and extrapersonal space, the disparity of which is unknown. We assessed

these forms of neglect in a patient with USN. We promoted sight scanning in

extrapersonal space and used an eye camera to measure gaze movement. We

found left-sided sight scanning in peripersonal space, but right-side-

biased

sight scanning in extrapersonal space. Additionally, line of sight was cor-

rected when the patient was instructed to look left in extrapersonal space and

to focus the line of sight at the center. Gaze measurement thus helped to as-

sess disparities in spatial neglect in USN.

Keywords

Unilateral Spatial Neglect, Extrapersonal Space, Peripersonal Space

1. Introduction

Healthy people are able to look around their space and attend to both the right

and left sides. These normal perceptions in peripersonal and extrapersonal spac-

es are bilateral. Unilateral spatial neglect (USN) describes the failure to attend to

one side of space. USN is regarded as a higher brain dysfunction that most

commonly follows right hemisphere damage; the frequency of USN is high in

these patients, approximately 40% [1]. Most USN cases improve within six

How to cite this paper:

Kimura, D., Na-

katani, K

., Notoya, M., Imai, A., Bizen, H.,

Toyama, M

. and Yamada K. (2018) Differ-

ences of Neglect in Peripersonal Space and

Extrapersonal Space in a Patient with U

ilateral Spatial Neglect

Case Reports in

Clinical Medicine

, 513-525.

https:

//doi.org/10.4236/crcm.2018.710045

Received:

September 11, 2018

Accepted:

October 5, 2018

Published:

October 8, 2018

8 by authors and

Scientific

Research Publishing Inc.

This work is licensed

under the Creative

Commons Attribution International

License (CC BY

4.0).

http://creativecommons.org/licenses/by/4.0/

Open Access

D. Kimura et al.

DOI:

10.4236/crcm.2018.710045 514 Case Reports in Clinical Medicine

months [2], however, USN persists in 25% of patients [3]. This can severely af-

fect the ability to carry out activities of daily living (ADL). For instance, patients

with left USN may not eat food on the left side of their plate, or may forget to

use the brake on a wheelchair if it is located on the left-hand side. In this way,

USN has a great influence on ADL, and it is a factor that makes it difficult to re-

turn discharge to home.

USN is commonly evaluated using desk evaluations, which include, for exam-

ple, the line cancellation and line bisection tasks. A correlation has been reported

between desk evaluation results and ability to perform ADL [4]. However, desk

evaluation results can be improved by using the compensation strategy that aims

attention to the left side [4], however, behavior may be unadaptable in daily liv-

ing [5] [6]. Indeed, a previous study reported a difference between desk evalua-

tion results and ADL performance, whereby desk evaluation results do not nec-

essarily predict USN symptoms in ADL [7]. One explanation for these conflict-

ing findings may be the individual differences in the types of spatial neglect.

The human brain has a standard perception of space. The range of the hand is

called peripersonal space, and the space outside this is called extrapersonal

space. USN is often characterized by neglect in both peripersonal and extraper-

sonal space. For instance, Buxbaum

et al

. [8] reported the onset of neglect in pe-

ripersonal space in one case, but without neglect in extrapersonal space, but in

another case, the opposite was true. Thus, even now, there is no consistent opi-

nion about neglect in these different spaces. This could explain the disparity be-

tween ADL results and desk evaluation results, and suggests that separate evalu-

ations for peripersonal and extrapersonal space are required for the true evalua-

tion of USN.

Differences between desk evaluation and ADL results can also be seen in clin-

ical practice. One approach to improve ADL in patients with USN involves cor-

recting spatial attention or visual search. For the approach targeting spatial at-

tention, patients adapt to the neglect space voluntarily via a language strategy (a

language-related cue for example, or a strategy of internal speech, such as “you

must turn attention to the left side”). In addition, USN is attracted by unilateral

stimulation, from which it is hard to release attention. Therefore, USN is inter-

preted as not visually scanning in one direction. In contrast, there is training to

correct sight scanning using the language strategy to the left side. Many clinical

practitioners use these methods, and it is assumed that the effects spill over into

ADL. However, this is not necessarily the case. For example, language strategies

may help patients with USN to adapt to peripersonal space (relevant to desk

evaluations), but this does not affect extrapersonal space (relevant to ADL), in

which neglect persists.

In extrapersonal space, Nakatani

et al

. [9] measured rotation of the head by

attention to the left side in a patient with left USN. Consequently, the patient

turned the head to the left trying to find the left side. However, their report did

not consider compensatory strategies such as sight scanning. Prior to this, re-

ports have analyzed the movement of the gaze point using an eye camera that

D. Kimura et al.

DOI:

10.4236/crcm.2018.710045 515 Case Reports in Clinical Medicine

tracks the sight scanning of a patient. Such an eye camera can observe move-

ment of the gaze point continuously and when the subject is in the active state,

the advantage of which is that the USN symptom can be clarified. For example,

Ishiai

et al

. [10] used an eye camera to record the movement of the gaze point

when a patient with USN who showed a left-side preference for visual search

performed the line bisection task.

In the current study, we describe the case of a patient with left USN following

right putamen bleeding, and in whom USN symptoms disappeared 85 days later,

according to desk examinations. Nevertheless, monitoring was necessary for the

ADL. We measured the movement of the gaze point of the left USN patient with

an eye camera and examined the following: 1) The difference between neglect in

peripersonal space and in extrapersonal space, and 2) The method to promote

sight scanning in extrapersonal space. Our findings seem to reveal the neurolog-

ical differences in spatial neglect in USN, and may facilitate the management of

USN.

2. Presentation of Case

The patient was a 75-year-old right-handed man. Following the development of

right headache and left hemiparesis in May 2010, he was urgently admitted to

hospital. On admittance, the patient showed anisocoria (Rt. 2 m/Lt. 3 m), severe

left hemiplegia, and left USN. The National Institutes of Health Stroke Scale

(NIHSS) [11] was 16/42 point at that time. A CT scan showed bleeding in the

left temporal lobe and the frontal lobe, and he was diagnosed with cerebral he-

morrhage. He was transferred to a specific hospital for rehabilitation 28 days

later.

The patient provided informed consent to participate in this study, which was

conducted in accordance with the tenets of the Declaration of Helsinki.

2.1. Neurological Findings

The patient showed lucidity, left central facial palsy, and left shift of tongue. Left

hemiplegia was upper limb stage I, lower limb stage II, and finger stage III. Knee

abduction-adduction and finger flexion was present, but only a little. The patient

showed deep tendon hyperreflexia of the left pectoralis, left biceps, left deltoid,

and brachioradialis. He showed the Hoffmann reflex and Babinski reflex. He did

not have hemianopia, apraxia, or aphasia.

2.2. Neuropsychological Findings

The patient scored 25/30 on the Mini-Mental State Examination. Bisection of

three 205-mm lines revealed slight rightward deviation (20 mm) from the mid-

point, and he received a diagnosis of USN

(Figure 1).

2.3. Neuroradiological Findings

Twenty-eight days later, a CT scan showed a high-density area of the right frontal

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