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Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation
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Recovering repressed visual memories and in parietal lobe syndrome using vestibular stimulation

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  • 1. Recovering RepressedM48 Visual Memories and in Parietal Lobe Syndrome Using Vestibular Stimulation Authors: Srinivasan V. Avathvadi Bijoy K. Menon | Nithyanandam V. AllimuthuRogers R. Diane | Ramachandran S. Vilayanur Monday, October 9, 2006 Poster Session II
  • 2. Recovering Repressed Visual Memories and in Parietal Lobe Syndrome Using Vestibular Stimulation Authors: Srinivasan V. Avathvadi | Bijoy K. Menon | Rogers R. Diane Ramachandran S. Vilayanur | Nithyanandam V. Allimuthu Srinivasan V. Avathvadi, Bijoy K. Menon, Rogers R. Diane, Ramachandran S. Vilayanur and Nityanandam V. Allimuthu Neurology, Institute of Neurology, Madras Medical College, Chennai, Tamilnadu, India; Centre for Brain and Cognition, University California - San Diego, San Diego, CA Objective: 1)Does vestibular stimulation through caloric test reverse neglect, mental imagery tasks and mirror agnosia? Background:Unilateral neglect may be temporarily reduced by vestibular stimulation. Designs/Methods: Our patient had Left hemiplegia,visual neglect, anosognosia. CT Brain showed right occipitoparieto temporal infarct.She reported and pointed objects kept to her right and left side of her room ,before, during and after cold caloric testing. Mental imagery was tested by blindfolding her She reached for the reflection of a pencil in a mirror placed on right and the pencil was on left (dubbedmirror agnosia by VS Ramachandran and E.Altschuler) Results : First she reported objects placed on her right. When cold caloric test in her left ear produced nystagmus,her neglect disappeared.She reported all objects, when mental imagery was tested.After thirty minutes, she could report and point to objects on her right only. When caloric test was repeated and during mental imagery,she reported all objects. It eliminated neglect but not mirror agnosia .Conclusion:a) vestibular stimulation eliminates neglect for mental imagery giving access to previously repressed inaccessible memories b) Mirror agnosia is caused by right parietal damage rather than being a direct consequence of neglect. Monday, October 9, 2006 Poster Session II
  • 3. Recovering Repressed Visual Memories and inParietal Lobe Syndrome Using Vestibular Stimulation PROF.A.V.SRINIVASAN, MD, DM, Ph.D, F.A.A.N, F.I.A.N, Bijoy K. Menon Nithyanandam V. Allimuthu Rogers R. Diane Ramachandran S. Vilayanur INSTITUTE OF NEUROLOGY MADRAS MEDICAL COLLEGE,CHENNAI October 09, 2006 - Chicago, USA
  • 4. Introduction
  • 5. NEGLECT Definition  Neglect has been defined as “the failure to report, respond, or orient to novel or meaningful stimuli presented to the side opposite a brain lesion, when this failure cannot be attributed to either sensory or motor defects.” Category  Memory and representational deficits  Motor Neglect  Sensory Neglect
  • 6. NEGLECT - cont.. Anatomy  Posterior parietal cortex, frontal lobe, cingulate gyrus, striatum and thalamus. Explanation  Attentional orienting system  Failure to construct a complete mental representation of contralesional space Incidence  Stone et al 80% - visual neglect  Denes et al 17% - unilateral spacial neglect – right CVA Prognosis  Poor outcome and lower scores on FIM
  • 7. Objective and Background Does vestibular stimulation through caloric test reverse neglect, mental imagery tasks and mirror agnosia? Unilateral neglect may be temporarily reduced by vestibular stimulation
  • 8. Designs/Methods: Case vignette Our patient had Left hemiplegia,visual neglect, anosognosia. CT Brain showed right occipitoparieto temporal infarct. She reported and pointed objects kept to her right and left side of her room, before, during and after cold caloric testing.
  • 9. Designs/Methods: Mental imagery was tested by blindfolding her She reached for the reflection of a pencil in a mirror placed on right and the pencil was on left (dubbed mirror agnosia by VS Ramachandran and E. Altschuler)
  • 10.  On visual imagery, neglect and caloric tests Visual imagery Bisiach’s test Our test
  • 11. Video of caloric test and Nystagmus
  • 12. Video of Neglect
  • 13. Video of disappearance of Neglect
  • 14. On ‘ Mirror Agnosia’Mirror Agnosia on the Right
  • 15. After caloric test, Mirror Agnosia on the Left
  • 16. ‘Mirror Agnosia’ to front
  • 17. Results : First she reported objects placed on her right. When cold caloric test in her left ear produced nystagmus, her Neglect disappeared. She reported all objects, when mental imagery was tested.
  • 18. Results : After thirty minutes, she could report and point to objects on her right only. When caloric test was repeated and during mental imagery, she reported all objects. It eliminated neglect but not mirror agnosia.
  • 19. Results
  • 20. Discussion Our patient had all the three major categories of attentional deficit. Vestibular stimulation improved all the three categories temporarily till the stimulation persisted. After 30min - Neglect returned Mirror agnosia did not disappear.
  • 21. DISCUSSION – CONT.. Treatment of Neglect Attentional Mechanisms – Training of attention - Weinverg – Activation of sustained attention system Representational Deficit – Smania – Visual and movement imagery exercises Caloric Stimulation – Vallar G – In our Patient, this stimulation are used
  • 22. DISCUSSION – CONT..Treatment of Neglect  Galvanic Stimulation – Rorsman  Neck muscle Propioception – Karnath  Prism Method – Rossetti  Eye patch – Butter & Kirch  Mirror Method – V S Ramachandran
  • 23. Remission of Neglect - Discussion Neural pathways responsible for remission following vestibular stimulation through caloric stimulation are unknown vestibular stimulation eliminates neglect for mental imagery giving access to previously repressed inaccessible memories Mirror agnosia is caused by right parietal damage rather than being a direct consequence of neglect.
  • 24. Conclusion: a) vestibular stimulation eliminates neglect for mental imagery giving access to previously repressed inaccessible memories b) Mirror agnosia is caused by right parietal damage rather than being a direct consequence of neglect.
  • 25. We Thank Prof. V.S.Ramachandran, M.D., Ph.D., Director Centre for Brain and Cognitive Sciences University of California, San Diego, USA
  • 26. REFERENCES Swan- Unilateral Spatial Neglect in physical therapy, 81(9): 1572 Stone SP, Halligan PW, Greenwood RJ,-The incidence of neglect phenomena and related disorders in patients with an acute right or left hemisphere stroke, Age Ageing. 1993;22:46-52 Denes G, Semenza C, Stoppa E, Lis A, Unilateral spatial neglect and recovery from hemiplegia: a follow-up study, Brain;1982;105(pt3): 543-552 Ramachandran VS, Altschuler EL, Hillyer S. Mirrl agnosia. Proc R Soc Lond. 1997;264:645-647 Bisiach E, Luzzatti C, Unilateral neglect of representational space. Cortex. 1978; 14:129-133 Weingberg J, Diller L, Gordon WA, et al, Training sensory awareness and spatial organization in people with right brain damage, Arch Phys, Med Rehabil 1979;60;491-496 Samania N, Bazoli F, Piva D, Guidetti G. Visuomotor imagery and rehabilatation of neglect Arch Phys, Med Rehabil 1997;78;432-436
  • 27. REFERENCES Cont.. Vallar G, Sterzi R, Bottini G, et al, Temporary remission of left hemianesthesia after vestibular stimulation: a sensory neglect phenomenon, Cortex 1990;26;123-131 Rorsman I, Magnusson M, Johanssion BB, Reduction of visuo spatial neglect with vestibular galvanic stimulation, Scand J Rehabil Med, 1999;31:117-124 Karnath HO, Christ K, Hartje W, Decrease of contralateral neglect by neck muscle vibration and spatial orientation of trunk midline, Brain, 1993;116:383-396 Rossetti Y, Rode G, Pisella L et al, Prism adaptation to rightward optical deviation rehebilitates left hemispatial neglect, Nature 1998;395:166-169 Butter CM, Kirsch N, Combined and separate effects of eye patching and visual stimulation on unilateral neglect following stoke, Arch Phys, Med Rehabil 1992;73;1133-1139 Ramachandran VS, Altschuler EL, Stone et al. Can mirrors alleviate visual hemineglect? Mad Hypotheses,1999;52;302-305. Ian H. Robertson, John C. Marshall, Unilateral Neglect: clinical and Experimental studies.

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