Plasticity in Spatial Neglect - Recovery and Rehabilitation


Kerkhoff, G.,
Rosetti, Y.

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Brain repair, adaptive reorganisation, compensatory strategies, prostheses and medications all can contribute to functional recovery from spatial neglect and associated disorders after brain damage. Animal experiments, functional imaging studies and longitudinal outcome studies suggest that injured brains can change their function and connectivity, both on the behavioural and neural level, and both spontaneously (i.e. without intervention), as well as in response to specific treatments. However, many questions in this context remain still open. Some of these are: Is spontaneous recovery similar to treatment-induced-recovery? How often and how long should a treatment be applied? Another interesting question is whether topdown-compensatory strategies and bottom-up stimulation maneouvers can be combined to yield a better outcome? Despite significant progress in the development of novel and more effective treatments in the past 10 years little is known about the long-term-stability of such treatment-related improvements. Furthermore, patients differ considerably in their individual response to the same type of treatment. Although lesion size, location, diffuse lesions and related factors are without doubt relevant here, individual psychological factors like motivation, intelligence and affective style have not been considered until now. As they all influence cognitive functioning and the underlying neural circuitry in the healthy brain these parameters might all be relevant. Finally, how can the unawareness issue be successfully addressed? In conclusion, the study of these questions in spatial neglect provides excellent opportunities for an interdisciplinary exchange of research ideas between basic neuroscience, applied clinical neuropsychology, neurorehabilitation and neuro-technology.