Assessment of visual space recognition of patients with unilateral spatial neglect and visual field defects using a head mounted display system.

[Purpose] The purpose of this study was the development of a method for presenting diverse visual information and assessing visual space recognition using a new head mounted display (HMD) system. [Subjects] Eight patients: four with unilateral spatial neglect (USN) and four with visual field defects (VFD). [Methods] A test sheet was placed on a desk, and its image was projected on the display of the HMD. Then, space recognition assessment was conducted using a cancellation test and motion analysis of the eyeballs and head under four conditions with images reduced in size and shifted. [Results] Leftward visual search was dominant in VFD patients, while rightward visual search was dominant in USN patients. The angular velocity of leftward eye movement during visual search of the right sheet decreased in both patient types. Motion analysis revealed a tendency of VFD patients to rotate the head in the affected direction under the left reduction condition, whereas USN patients rotated it in the opposite direction of the neglect. [Conclusion] A new HMD system was developed for presenting diverse visual information and assessing visual space recognition which identified the differences in the disturbance of visual space recognition of VFD and USN patients were indicated.

Reliability, validity, and factor structure of the Cognitive Behavioral Rating Scale for stroke patients.

The aim of this study was to explore the reliability, validity, and factor structure of a newly developed Cognitive Behavioral Rating Scale (CBRS), designed to assess cognitive function through observation. The study included 180 stroke patients and 58 orthopedic patients. The CBRS and the Functional Independence Measure (FIM) were administered. Data on discharge disposition were also collected. The inter-rater reliability, construct validity, concurrent validity, predictive validity, and factor structure of the CBRS were evaluated. The interclass correlation coefficient was 0.736 (P<0.0001). Cronbach's α for the CBRS was 0.92. Patients with stroke showed a significantly higher total CBRS score than those with orthopedic problems (P<0.0001). Spearman's rank correlation coefficient (rs) was -0.70 (P<0.01) for the total FIM score and the CBRS, and -0.72 (P<0.01) for the cognitive FIM and the CBRS. The return-to-home group had a significantly lower CBRS total score than the not-to-home group (P<0.01). The CBRS comprised three factors: (i) 'language and performance', (ii) 'control of performance', and (iii) 'space-self relation.' The CBRS appears to have a high reliability and validity for the assessment of cognitive function.

Assessment of visual space recognition in patients with visual field defects using head mounted display (HMD) system: case study with severe visual field defect.

For the quantitative assessment of visual field defects of cerebrovascular patients, we developed a new measurement system that could present various kinds of visual information to the patient. In this system, we use a head mounted display as the display device. The quantitative assessment becomes possible by adding the capability to measure the eye movement and the head movement simultaneously by means of a video apparatus of motion analysis. In our study, we examined the effectiveness of this system by applying it to a patient with serious visual field defects. The visual image of the reduced test paper was presented to the patient, the effect on his/her spatial recognition and eye movement was investigated. The results indicated the increase in the ration of visual search in the reduced side. With the reduced image, the decrease of the angular velocity of eye movement was recognized in the visual search in the defected side. In the motion analysis, the head movement was not observed while the eye movements appeared corresponding to each different conditions. This fact led us to confirm that the patient coped with this kind of test by the eye movement. In this analysis, the effectiveness and the usefulness of the developed system were confirmed that enables us to evaluate the abnormal and compensation movement of the eyes.

Change in the Mechanical Energy of the Body Center of Mass in Hemiplegic Gait after Continuous Use of a Plantar Flexion Resistive Ankle-foot Orthosis.

[Purpose] The aim of this study was to investigate the changes in mechanical energy due to continuous use of a plantar flexion resistive ankle-foot orthosis (AFO) of subjects with chronic hemiplegia. [Subjects and Methods] The subjects were 5 hemiplegic patients using AFOs without a plantar flexion resistive function in their daily lives. We analyzed the gait of the subjects using a 3D motion capture system under three conditions: patients' use of their own AFOs; after being fitted with a plantar flexion resistive AFO; and after continuous use of the device. The gait efficiency was determined by calculating the mutual exchange of kinetic and potential energy of the center of mass. [Results] An increased exchange rate of the kinetic and potential energy was found for all subjects. A larger increase of energy exchange was shown on the non-paralyzed side, and after continuous use of the plantar flexion resistive AFO. [Conclusion] We found that continuous use of a plantar flexion resistive AFO increased the rate of mutual exchange between kinetic energy and potential energy. The change in the rate was closely related to the role of the non-paretic side, showing that the subjects needed a certain amount of time to adapt to the plantar flexion resistive AFO.

A case study of new assessment and training of unilateral spatial neglect in stroke patients: effect of visual image transformation and visual stimulation by using a Head Mounted Display system (HMD).

BACKGROUND: Unilateral spatial neglect (USN) is most damaging to an older stroke patient who also has a lower performance in their activities of daily living or those elderly who are still working. The purpose of this study was to understand more accurately pathology of USN using a new HMD system. METHODS: Two stroke patients (Subject A and B) participated in this study after gaining their informed consent and they all had Left USN as determined by clinical tests. Assessments of USN were performed by using the common clinical test (the line cancellation test) and six special tests by using HMD system in the object-centered coordinates (OC) condition and the egocentric coordinates (EC) condition. OC condition focused the test sheet only by a CCD. EC condition was that CCD can always follow the subject's movement. Moreover, the study focused on the effect of the reduced image condition of real image and the arrows. RESULTS: In Patient A who performed the common test and special tests of OC and EC conditions, the results showed that for the line cancellation test under the common condition, both of the percentage of the correct answers at the right and left sides in the test sheet was 100 percent. However, in the OC condition, the percentage of the correct answers at the left side in the test sheet was 44 percent and the right side was 94 percent. In the EC condition, the left side was 61 percent and the right side was 67 percent. In Patient B, according to the result of the use of reduced image condition and the arrows condition by HMD system, these line cancellation scores more increased than the score of the common test. CONCLUSIONS: The results showed that the assessment of USN using an HMD system may clarify the left neglect area which cannot be easily observed in the clinical evaluation for USN. HMD may be able to produce an artificially versatile environment as compared to the common clinical evaluation and treatment.

A preliminary study of clinical assessment of left unilateral spatial neglect using a head mounted display system (HMD) in rehabilitation engineering technology.

PURPOSE: Unilateral spatial neglect (USN) is a common syndrome in which a patient fails to report or respond to stimulation from the side of space opposite a brain lesion, where these symptoms are not due to primary sensory or motor deficits. The purpose of this study was to analyze an evaluation process system of USN in various visual fields using HMD in order to understand more accurately any faults of USN operating in the object-centred co-ordinates. METHOD: Eight stroke patients participated in this study and they had Left USN in clinical test, and right hemisphere damage was checked by CT scan. Assessments of USN were performed the BIT common clinical test (the line and the stars cancellation tests) and special tests the zoom-in condition (ZI) condition and the zoom-out condition (ZO) condition. The subjects were first evaluated by the common clinical test without HMD and then two spatial tests with HMD. Moreover, we used a video-recording for all tests to analyze each subject's movements. RESULTS: For the line cancellation test under the common condition, the mean percentage of the correct answers at the left side in the test paper was 94.4%. In the ZI condition, the left side was 61.8.% and the right side was 92.4.%. In the ZO condition, the left side was 79.9% and the right side was 91.7.%. There were significant differences among the three conditions. The results of the stars cancellation test also showed the same tendency as the line bisection test. CONCLUSION: The results showed that the assessment of USN using a technique of HMD system may indicate the disability of USN more than the common clinical tests. Moreover, it might be hypothesized that the three dimensional for USN test may be more related to various damage and occurrence of USN than only the two dimensional test.