Rehabilitation of hemineglect of the left arm using movement detection bracelets activating a visual and acoustic alarm
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RESEARCH
Open Access
Rehabilitation of hemineglect of the left arm using movement detection bracelets activating a visual and acoustic alarm Jose M. Trejo-Gabriel-Galan1*, V. Rogel-Melgosa1, S. Gonzalez2, J. Sedano2, J. R. Villar3 and N. Arenaza-Basterrechea1
Abstract Background: Hemineglect is frequent after right hemisphere stroke and prevents functional independence, but effective rehabilitation interventions are lacking. Our objective was to determine if a visual-acoustic alarm in the hemineglect arm activated by a certain discrepancy in movement of both hands can enhance neglect arm use in five tasks of daily living. Methods: In this pre-post intervention study 9 stroke patients with residual hemineglect of the arm were trained for 7 days in five bimanual tasks of daily living: carrying a tray, button fastening, cutting food with knife and fork, washing the face with both hands and arm sway while walking. This was done through motion sensors mounted in bracelets on both wrists that compared movement between them. When the neglect-hand movement was less than a limit established by two fuzzy logic based classifiers, a visual-acoustic alarm in the neglect-hand bracelet was activated to encourage its use in the task. Results: Both motion and function of the neglect hand improved during the seven days of training when visualacoustic alarms were active but a worsening to baseline values occurred on day 8 and day 30 when alarms where switched off. Improvement was limited to vision-dependent tasks. Conclusions: Neglect-hand improvement with this approach is limited to bimanual activities in which an object is manipulated under vision control, but no short or long term learning happens. Keywords: Hemisensory neglect, Neglect rehabilitation, Fuzzy logic, Activities of daily living, Medical device Abbreviations: FRBC, Fuzzy rule based classifier
Background In visual-spatial hemineglect (also known as hemiinattention) patients with a lesion of the right cerebral hemisphere are not aware of objects in the left visual field despite not having a visual deficit. When it encompasses left limbs, as well as lacking awareness of them, the patient does not use the left arm in spite of not having paralysis. Neglect predicts not regaining functional independence [1]. In more than 85 % of patients with right hemispheric stroke, hemineglect is found in at least one pencil and paper tests such as cancellation of lines and marking lines in their middle point, copy of superimposed shapes or of a figurative drawing. But in 36 % * Correspondence: [email protected] 1 Hospital Universitario de Burgos, Ave. Islas Baleares 3, 09006 Burgos, Spain Full list of author information is available at the end of the article
of cases, neglect in activities of daily living cannot be detected by these tests [2]. Among the 28 standardized tests for hemineglect [3], the Catherine Bergego scale is one of the most used and asks about performance of the patient in activities of daily living but does not measure the performance itself. Several rehabilita
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