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1

Therapeutic training in post-stroke disturbances of vision

100%

Leśniak M., Seniów J.

Medical Rehabilitation

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2007

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vol. 11(4)

9-14

EN

Introduction: Vision disturbances are a frequent sequel of stroke. Damage to primary or secondary visual cortical areas can lead to chronic or temporary dysfunction of vision that hampers recovery from stroke. Nevertheless, they are rarely regarded as a prominent problem for neurorehabilitation.Aim of the study: This paper presents a review of current knowledge on possible therapeutic interventions in one of the most frequent vision disturbances following vascular brain damage, i.e. visual field defects.Study form: We reviewed data from the literature pertaining to theoretical background of various therapeutic approaches to vision disturbances as well as empirical evidence of the effectiveness of these approaches.Conclusions: The analysed data suggest that improvement of visual function in post-stroke patients is possible with the help of a therapeutic training that uses preserved functions such as visual scanning or residual vision. The objectively observed training-induced improvement of visual field defects and of the related deficits is frequently reflected in a better performance during activities of daily-living.

2

HOW PURE IS PURE ALEXIA? A NEUROPSYCHOLOGICAL ANALYSIS OF A CASE SERIES OF PATIENTS WITH ALEXIA DUE TO LEFT HEMISPHERIC STROKES

81%

Leśniak M. M., Zielińska A. J., Czepiel W., Seniów J.

Acta Neuropsychologica

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2020

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vol. 18(4)

493-506

EN

The aim of this study was to analyze a case series with acquired alexia after stroke within the posterior areas of the left hemisphere, in the context of the current criteria for pure alexia and their relevance to the set of symptoms observable in clinical practice. Seven patients with ischemic strokes and an initial diagnosis of pure alexia were enrolled for detailed analysis. The evaluation consisted of neuropsychological assessment in the form of standardized tests and non-standardized reading tasks, while oculomotor activity during reading was measured. Language functions, visual object and space perception, verbal and nonverbal memory, and visuospatial constructional ability were among the domains assessed. In five of the participants, pure alexia was recognized based on sig- nificant and specific discrepancies between test scores, indicating primary abnormalities in the visual processing of letter strings as a basic mechanism of the disorder. In most of the patients, coexisting cognitive deficits were revealed; however, these were dispropor- tionately milder and less functionally significant than reading disturbances. Pure alexia is a relatively rare disorder after a stroke, but it considerably affects the quality of everyday independent functioning. Its clinical characteristics in practice rarely meet all the criteria proposed in the subject literature. The differential diagnosis of this form of alexia and other reading disorders requires detailed clinical analysis.

3

Apathy syndrome as a consequence of brain injury – a difficult problem in neurorehabilitation

81%

Seniów J., Komajda R., Zaborski J.

Medical Rehabilitation

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2005

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vol. 9(2)

3-7

PL

Pierwotne, biologiczne zaburzenie czynnika motywacyjnego w najszerzej rozumianym wymiarze celowego, świadomego zachowania człowieka jest w praktyce klinicznej znaną konsekwencją uszkodzenia mózgu i stanowi poważne utrudnienie w prowadzeniu procesu rehabilitacji. Deficyt motywacji, nazywany inaczej zespołem apatii, jest szczególnie często obserwowany u chorych po udarze i urazie mózgu. Powoduje ograniczenie emocjonalnego przeżywania i żywego reagowania na otoczenie, utratę troski o siebie i innych, bierne uczestnictwo w procesie rehabilitacji. Wszystko to drastycznie utrudnia fizyczny i społeczny powrót do zdrowia. Hipotetycznie przyjmuje się, że patomechanizmem apatii jest dysfunkcja czołowo-podkorowego systemu neuronalnego, obejmującego przyśrodkowe części kory przedczołowej oraz wzgórze i jądra podstawy. W wyniku uszkodzenia wymienionych struktur następuje dysfunkcja systemu dopaminergicznego, który jest nazywany „behawioralnym systemem aktywującym” bowiem moduluje m.in. stan wzbudzenia, uwagi i emocji. Apatia może współwystępować z zaburzeniami poznawczymi, ale te dwa elementy są traktowane jako względnie rozdzielne. Celem artykułu jest szczegółowy opis zespołu apatii oraz zwrócenie uwagi profesjonalistom praktycznie zajmującym się neurorehabilitacją na biologiczne podłoże zachowań niektórych chorych, którym niesłusznie przypisuje się brak zaangażowania i słabą motywację do aktywnego uczestnictwa w procesie rehabilitacji. Autorzy – na podstawie przeglądu piśmiennictwa omawiają problemy diagnostyki różnicowej oraz leczenia. Zwraca się uwagę na odróżnianie apatii od depresji, otępienia i zaburzeń świadomości. Ciągle brak systematycznych badań na temat skutecznej farmakoterapii w organicznym zespole apatii. W artykule prezentowane są wyniki wstępnych badań klinicznych, sugerujących m.in. skuteczność terapeutyczną agonistów dopaminy i innych stymulantów.

EN

Primary, biological dysfunction of motivational factor in a widely understood goal-oriented behaviour is in clinical practice a wellknown consequence of brain injury, and it causes serious difficulties in neurorehabilitation. The deficit of motivation, also known as apathy syndrome, is particularly frequently observed in patients with stroke and other type of brain injury. It results in limitation of emotional expression and reacting to the environment, loss of ability to care about oneself and others, and causes passive participation in rehabilitation. All these symptoms significantly decrease the chances of physical and social recovery. Hypothetically, it is claimed that the dysfunction of fronto-subcortical neural system, overlapping medial parts of prefrontal cortex, thalamus and basal ganglia, is a pathomechanism of apathy. Damage of these structures results in dysfunction of dopaminergic system which is called a “behavioural activating system” as it modulates the level of activation, attention and emotions. Apathy can co-exist with cognitive impairment, but these two deficits are treated relatively separately. This paper aims to make a detailed description of the apathy syndrome and to draw attention of professionals working in neurorehabilitation to biological foundation of some patients’ behaviour, who are wrongly described as not dedicated and motivated to participate actively in rehabilitation. The authors – on the grounds of literature review – describe problems of differential diagnosis and treatment. They draw attention to differentiating apathy from depression, dementia and consciousness disorder. There are still no systematic studies about efficient pharmacotherapy in the organic apathy syndrome. This paper presents preliminary results of clinical studies suggesting therapeutic efficacy of dopamine agonists and other stimulants.

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2 Medical Rehabilitation

1 Acta Neuropsychologica

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1 Czepiel W.

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1 Leśniak M.

1 Leśniak M. M.

1 Zaborski J.

1 Zielińska A. J.

Therapeutic training in post-stroke disturbances of vision

HOW PURE IS PURE ALEXIA? A NEUROPSYCHOLOGICAL ANALYSIS OF A CASE SERIES OF PATIENTS WITH ALEXIA DUE TO LEFT HEMISPHERIC STROKES

Apathy syndrome as a consequence of brain injury – a difficult problem in neurorehabilitation