PubMed · 15393490
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L B AMES. 1949. Bilaterality.. https://doi.org/10.1080/08856559.1949.10533507
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Left visuo-spatial neglect is a well-recognized predictor of poor functional outcome following right hemisphere stroke. Over the past 60 years, 18 different methods have been described and evaluated aimed at reducing the effects of this impairment. Although there are some grounds for optimism particularly in terms of short-term impairment-based effects, the range and degree of disability borne by many patients remain high and the clinical effectiveness of the different methods viewed in terms of long-lasting functional improvement (i.e. improvement of disabilities or handicap) is not clear. A systematic review of the available clinically relevant literature, using comparative and stringent levels of evidence, indicates that visual scanning training (VST), trunk rotation (TR) or repeated neck muscle vibrations (NMV) when associated with an extensive training program, mental imagery training, video feedback training and prism adaptation (PA) can be recommended for the rehabilitation of patients with left neglect. More studies however are needed to determine the optimal paradigm of limb activation (LA) eliciting a sustained functional improvement. Sensory stimulations alone and Fresnel prisms do not appear to be functionally relevant. For the other methods, the actual literature is not sufficient to conclude whether or not a long-term functional improvement can be achieved.
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BACKGROUND: The identification of the affected ear is crucial for the successful treatment of benign paroxysmal positional vertigo involving the horizontal canal (HC-BPPV) by using particle-repositioning maneuvers. OBJECTIVE: To determine the lateralizing value of lying-down nystagmus in HC-BPPV. METHODS: The authors prospectively investigated lying-down nystagmus in 152 consecutive patients with confirmed HC-BPPV (99 geotropic and 53 apogeotropic types). Lying-down nystagmus was induced by placing patients in a supine position. For the geotropic type of HC-BPPV, the affected ear was identified by assuming that nystagmus is more intense when the head is rotated to the affected side while supine. The reverse assumption was adopted for the apogeotropic type. RESULTS: Lying-down nystagmus was observed in 58 patients (38.2%), 36 (36.4%) of the geotropic and 22 (41.5%) of the apogeotropic type. The direction of lying-down nystagmus was mostly away from the affected ear in the geotropic type, but toward the affected ear in the apogeotropic type. Of the 16 geotropic patients in whom the affected ear was not identified initially, 7 with lying-down nystagmus showed resolution of vertigo after particle-repositioning maneuvers when the involved ear was identified by observing lying-down nystagmus. CONCLUSION: Lying-down nystagmus is a valuable sign for determining which ear is affected in benign paroxysmal positional vertigo involving the horizontal canal, especially when patients show symmetric nystagmus on turning the head to either side.