ABSTRACT

Animal and human literature supports spatial-motor “Aiming” bias, a frontal-subcortical syndrome, as a core deficit in spatial neglect. However, spatial neglect treatment studies rarely assess Aiming errors. Two knowledge gaps result: spatial neglect rehabilitation studies fail to capture the impact on motor-exploratory aspects of functional disability. Also, across spatial neglect treatment studies, discrepant treatment effects may also result from sampling different proportions of patients with Aiming bias. We review behavioural evidence for Aiming spatial neglect, and demonstrate the importance of measuring and targeting Aiming bias for treatment, by reviewing literature on Aiming spatial neglect and prism adaptation treatment, and presenting new preliminary data on bromocriptine treatment. Finally, we review neuroanatomical and network disruption that may give rise to Aiming spatial neglect. Because Aiming spatial neglect predicts prism adaptation treatment response, assessment may broaden the ability of rehabilitation research to capture functionally-relevant disability. Frontal brain lesions predict both the presence of Aiming spatial neglect, and a robust response to some spatial neglect interventions. Research is needed that co-stratifies spatial neglect patients by lesion location and Aiming spatial neglect, to personalize spatial neglect rehabilitation and perhaps even open a path to spatial retraining as a means of promoting better mobility after stroke.

摘要

动物和人类文献支持空间运动“瞄准”偏差（一种额叶皮质下综合症），作为空间忽视的核心缺陷。然而，空间忽视治疗研究很少评估瞄准错误。结果存在两个知识差距：空间忽视康复研究未能捕捉到功能障碍对运动探索方面的影响。此外，在空间忽视治疗研究中，对不同比例的具有瞄准偏差的患者进行抽样也可能导致不同的治疗效果。我们回顾了瞄准空间忽视的行为证据，并通过回顾关于瞄准空间忽视和棱镜适应治疗的文献，并提出了溴隐亭治疗的新初步数据，证明了测量和瞄准瞄准偏差对治疗的重要性。最后，我们回顾了可能导致瞄准空间忽视的神经解剖学和网络中断。由于瞄准空间忽视可以预测棱镜适应治疗反应，因此评估可能会扩大康复研究捕获功能相关残疾的能力。额叶脑损伤预示着瞄准空间忽视的存在，以及对某些空间忽视干预措施的强烈反应。需要进行研究，通过病变位置和瞄准空间忽视对空间忽视患者进行共同分层，以个性化空间忽视康复，甚至可能开辟一条空间再训练之路，作为中风后促进更好活动能力的一种手段。