Rehabilitation in chronic neglect using VR strengthens connectivity between nodes of the dorsal attention network

• More knowledge is required about the neural mechanisms of functional recovery of spatial neglect in chronic phase after stroke. In this functional magnetic resonance imaging (fMRI) study, we aimed to evaluate changes in resting state functional connectivity (FC) within the dorsal attention network (DAN) in chronic neglect after scanning training in VR that previously shown improvement in left side awareness in behavioral tests and activity of daily living. (Fordell et al 2016)Method: Thirteen subjects with chronic spatial neglect (mean duration ¼ 43 months, SD ¼ 29 months) underwent resting state fMRI at baseline and after 15 hours RehAtt training (3x1hr / week for 5 weeks). RehAtt scanning training in 3D includes multi-sensory stimulation and is controlled by their contra-lesional hand using a robotic pen (force-feedback). The analysis specifically examined resting state functional connectivity within the DAN. In addition, using spatial concordance correlation, changes in the spatial topology of the DAN to other networks were analyzed.Results: We found an increase in interhemispheric FC between the right FEF and the left IPS following training (pre: 0.33 0.17 [mean SD]; post: 0.45 0.13; p ¼ 0.004). The spatial concordance analyses indicated that training had stronger influence on the DAN compared to other networks.Conclusion: VR training that improved left side awareness in chronic stroke patients also increased connectivity within the DAN. Specifically, a region responsible for saccadic eye movement to the left became more integrated with the left posterior parietal cortex. These results highlight a mechanism that can be exploited in the rehabilitation of chronic spatial neglect

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

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