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Title: Hemispatial neglect : an evaluation of novel assessment methods and rehabilitation
Author: Raghavan, Charumati
ISNI:       0000 0004 7430 5405
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2017
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Hemispatial neglect, is a major cause of post-stroke disability and poor functional recovery. Hence, identifying sensitive methods to assess and rehabilitate neglect is important. Chapters 3 and 4 focused on development of novel assessment techniques for representational neglect. The 'Shopping Mall' and 'Clock Cueing' tasks improved upon previous tests and were useful in identifying dissociations in representational neglect based on type of stimuli (topological, non-topological) and time of assessment (pre-stroke, post-stroke) in chronic stroke patients. Chapters 5 and 6 investigated the efficacy of offline inhibitory repetitive Transcranial Magnetic Stimulation (rTMS) in producing short (<1 month) and long term (>6 months) changes in visual neglect behaviour. Overall, the findings from these chapters were limited due to lack of sufficient power. After controlling for the effect of baseline performance, the Intervention group's Activities of Daily Living scores significantly improved in the short-term post rTMS, as compared to the Control group. The fMRI task attempted to recruit attention-based top down modulation of sensory activity. It revealed relative hypoactivation of the right occipital lobe in the four left neglect patients tested, both pre and post rTMS, when compared to elderly controls. Chapter 7 explored cognitive predictors of spatial and object neglect in the sub-acute stage after controlling for demographic and stroke related factors, using multivariate blocked logistic regressions. Cognitive performance indicative of spatial attention and selective attention to local features predicted both spatial and object neglect. In addition, coding of spatial relations between features also predicted spatial neglect. Suggestions for combining neglect rehabilitation techniques to target these cognitive processes are discussed. Overall, this thesis provides novel methods to improve representational neglect assessment and highlights the importance of ancillary cognitive domains in contributing to both representational and visual neglect. The rTMS research provides study design-related insights to incorporate in future studies with larger patient samples.
Supervisor: Husain, Masud ; Chechlacz, Magdalena Sponsor: Stroke Association
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Neuropsychology ; Psychology ; Neuroscience ; Spatial neglect ; Representational neglect ; Visual neglect ; rTMS ; Neuroplasticity ; Spatial attention ; Cognitive testing ; Rehabilitation ; Transcranial magnetic stimulation ; Object neglect