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Rehabilitation in chronic spatial neglect strengthens resting‐state connectivity
Author(s) -
Wåhlin Anders,
Fordell Helena,
Ekman Urban,
Lenfeldt Niklas,
Malm Jan
Publication year - 2019
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13048
Subject(s) - resting state fmri , intraparietal sulcus , physical medicine and rehabilitation , rehabilitation , psychology , functional magnetic resonance imaging , neglect , functional connectivity , saccadic masking , stroke (engine) , medicine , neuroscience , eye movement , psychiatry , mechanical engineering , engineering
Objectives Rehabilitation of patients with chronic visuospatial neglect is underexplored, and little is known about neural mechanisms that can be exploited to promote recovery. In this study, we present data on resting‐state functional connectivity within the dorsal attention network (DAN) in chronic neglect patients as they underwent training in a virtual reality (VR) environment that improved left‐side awareness. Methods The study included 13 patients with visuospatial neglect persisting more than six months after a right‐sided stroke. The patients underwent resting‐state functional magnetic resonance imaging (fMRI). Scans were collected at baseline and after five weeks of intense training. We specifically examined resting‐state functional connectivity within the DAN. In addition, using spatial concordance correlation, we compared changes in the spatial topology of the DAN with that of other networks. Results We found a longitudinal increase in interhemispheric functional connectivity between the right frontal eye field and the left intraparietal sulcus following training (before: 0.33 ± 0.17 [mean ± SD]; after: 0.45 ± 0.13; P = 0.004). The spatial concordance analyses indicated that training influenced the DAN connectivity more than any of the other networks. Conclusion Intense VR training that improved left‐sided awareness in chronic stroke patients also increased sporadic interhemispheric functional connectivity within the DAN. Specifically, a region responsible for saccadic eye movement to the left became more integrated with the left posterior parietal cortex. These results highlight a mechanism that should be exploited in the training of patients with chronic visuospatial neglect.