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Combining left neck muscle vibration to voluntary arm movements: To new perspectives in the therapeutic care in neglect

Abstract : Association d'une stimulation vibratoire cervicale gauche à un mouvement d'atteinte manuelle : vers une nouvelle prise en charge thérapeutique de la NSU Introduction Among "Bottom-Up" treatments of Unilateral Spatial Neglect (USN), left neck muscle vibration may reduce clinical symptoms in patients with right-sided brain damage. The major interest of this stimulation is that the patient is unaware of perceptual and behavioral changes induced 1 due to the the left shifting of whole egocentric coordinate system. Furthermore, several studies have shown superior effects of combination treatments when their own effects were convergent 2. However, their practical applications are often conflicting with the constraints of patient care. This study aimed to assess the effects of a protocol combining left neck muscle vibration to voluntary arm movements in the peri-personal space on the egocentric and allocentric perceptions of patients with left-sided spatial neglect (USNleft). Method 5 USNleft patients (54.5 ± 5.5 years) were asked to perform the Marguerite test and a straight-ahead test (20 ballistic pointing without vision) before combination protocol (Pre), immediately after (Post0), one hour later (Post1h). During 15 minutes left trapezius muscle vibration (100Hz-300µm), they were asked to point to one of 5 lit targets [0° (straight ahead), 10° and 20° on the right and on the left], from the base of the chin rest with their right index finger, as quickly as possible. Results The results [median (± IQR)] suggested a reduction of neglect symptoms for at least 1 hour after the combination protocol. The Marguerite test at Pre [18.2 (± 10.7)] showed an evolution by step of the laterality index 3 with a dramatic decreasing at Post0 [6.6 (± 9.0)] then a maintain underneath the pathological level despite a small reduction of this effect at Post1h [9.0 (± 11.7)] and Post24h [10.0 (± 2.63)] on. The SSA errors [11.2° (± 6.1)] indicated a left lasting deviation after the protocol: Post0 [5.0° (± 2.8)], Post1h [6.6° (± 5.4)]. The Post24h values of 2 patients are missing due to unavailability of the device. Discussion Combining left neck vibration to voluntary arm movements showed allocentric and egocentric improvements lasting for at least 1 hour, and our data in progress even suggest during 24 hours. Non-invasive and simple to use, these promising findings for the rehabilitation of spatial cognition disorders argue in favor of the ecological use of the vibratory tool during the rehabilitation sessions. Reference 1. Luauté J, Halligan P, Rode G, Rossetti Y, Boisson D. Visuo-spatial neglect: A systematic review of current interventions and their effectiveness. Neurosci Biobehav Rev. 2006;30(7):961-982. 2. Kerkhoff G. Modulation and rehabilitation of spatial neglect by sensory stimulation.
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Marina Badin, Nicolas Vidalie, Jean-Marie Beis, Guillaume Chapelet, Jean Paysant, et al.. Combining left neck muscle vibration to voluntary arm movements: To new perspectives in the therapeutic care in neglect. Annals of Physical and Rehabilitation Medicine, Elsevier Masson, 2017, 60 (Suppl), pp.e5. ⟨10.1016/⟩. ⟨hal-02003711⟩



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