Of 5.7 million stroke survivors in the United States, up to 90% may have visuospatial deficits, linked to poor rehabilitation outcomes, an increase of clinical morbidity, and impairments in competent driving, shopping, sports, computer/internet use, and other activities. Right hemisphere (RH) stroke may critically reduce the capability to perceive, internally represent, and process spatially-distributed, global information, as well as the ability to activate automatic visuospatial response systems. These consequences of RH stroke and visuospatial impairment are established in the neuroscience literature, but current visuospatial behavioral treatments do not integrate these concepts. Translating our knowledge of the cognitive neuroscience of visuospatial disability into behavioral techniques may increase the impact of treatment on the high cost of stroke in acute rehabilitation care and functional disability. The proposed research aims to specifically tailor a promising treatment for visuospatial deficits in RH stroke survivors to clinical application in training RH stroke survivors with visuospatial deficits. We hypothesize that optimized standard visuospatial rehabilitation after RH stroke may require 1) specific training in global visual organization, and 2) practicing verbal self-instructions. Lastly, 3) training must transfer to functional task performance to improve disability. This application aims to integrate the three elements of successful therapy into a strategy for visuospatial rehabilitation, to be applied clinically and used in treatment trials. In the proposed research, we will examine whether teaching organizational strategies to increase global processing improves recall of a standard neuropsychological test of visuospatial impairment, the Rey-Osterrieth complex figure in stroke survivors with RH stroke, whether verbal instruction further augments this effect, and whether training effects generalize to everyday visuospatial tasks. This study may provide a treatment method for clinical use and study, but may also clarify the mechanisms of visuospatial deficits following RH stroke, contributing to translational science of vision and attention.
Visuospatial deficits are linked to impeding rehabilitation outcomes, increasing clinical morbidity, and inducing problems with dressing, driving, shopping, sports, computer/internet use, and other activities of daily living. The significance of the proposed research is to establish effective treatments for visuospatial deficits in right hemisphere stroke survivors so that functional disability and cost of rehabilitation care will be reduced.
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