Rehabilitation of Unilateral Spatial Neglect: New Insights From Magnetic Resonance Perfusion Imaging

Hillis AE. Rehabilitation of unilateral spatial neglect: new insights from magnetic resonance perfusion imaging.ObjectiveTo illustrate how magnetic resonance perfusion imaging has provided insights regarding rehabilitation of different forms of hemispatial neglect.Data SourcesRecent studies of different types of neglect and their neural substrates and of rehabilitation strategies that might be differentially effective for different types of neglect.Study SelectionAuthor selected all articles on PubMed that were identified with the key words reference frame or perfusion-weighted imaging plus neglect plus rehabilitation and other relevant articles that were cited therein.Data ExtractionAn independent reviewer determined if the data presented provided evidence relevant to planning or developing rehabilitation for stroke patients with distinct forms of neglect.Data SynthesisResults from a number of studies converge on the hypothesis that hypoperfusion and/or infarct of right angular gyrus and intraparietal sulcus can cause viewer-centered neglect, whereas hypoperfusion and/or infarct of right superior temporal gyrus can lead to left stimulus-centered neglect. Distinct forms of rehabilitation might be differentially useful for distinct types of spatial neglect, even though an individual patient may have 2 or more types of neglect. Magnetic resonance perfusion imaging has also shown that fluctuations in neglect in the acute-subacute period after stroke are often due to changes in blood flow caused by changes in blood pressure.ConclusionsConsideration of neglect type and status of cerebral blood flow can be useful in planning strategies to ameliorate each individual’s deficits.