The Doctor of Psychology specialized in attention processes Elisa Martín-Arévalo answers the pending doubts about her presentation of attention made last March in #NeuronUPAcademy.
Questions from the presentation on attention
1. Silvia Vallve: Could you extend the explanation in the intervention strategy after a brain injury and its most persistent deficits? In order to reach a balance in the two hemispheres in a neglect apart from the prismatic adaptation there could be stimulation of another kind, for example with more intense or softer colors through programmed slides? Thank you for the presentation, it was great!
Thank you very much for your question and thank you for your interest. Here’s a review that can answer your question in a general way (https://www.sciencedirect.com/science/article/abs/pii/S0149763406000169). If you have problems accessing the article, please write to me, without any problem, ([email protected]), as well as if you need any other information.
2. Eva Mª Cubero: As neuropsychologists and without the prismatic adaptation, how can we intervene in heminegligence to make it more effective? What is most within our reach is precisely what you have said has inconsistent results. We have had patients who have improved and compensated, but there are others who have not. It has a lot of influence when accompanied by anosognosia… How and where to get prismatic adaptation glasses? What is the protocol to follow for prismatic adaptation training?
Thank you very much for your question and thank you for your interest. I leave you a link to an article on prismatic fitting, where it gives you information about the protocol of intervention. If you have problems accessing the article, please write to me ([email protected]), no problem, as well as if you need any other information. (https://www.sciencedirect.com/science/article/pii/S0010945208706592)
As for where to get the glasses, although there are companies that do this commercially, one of the most effective ways is to collaborate with optometrists, who have materials for their creation.
Finally, in relation to your first doubt, it is true what you raise about the possible limitation to techniques that are more effective. In any case, if we assume the explanatory theory of hemigligence (interhemispheric imbalance), any cognitive approach that goes in the line of reestablishing it, could be adequate: for example, always work with competition of stimuli (to force both hemispheres to work together) rather than with unilateral stimuli on the negligent side. Part of the variability that you comment, added to the fact of presenting anosognosia (that entails worse prognosis in its intervention), would be what I commented in the presentation. Sometimes the absence of structural (neural) communication pathways makes rehabilitation impossible, so in those cases it would be necessary to move to more compensatory strategies.
3. Diana Moncada: How can we differentiate heminegligence from hemianopsia? How long would the treatment time be with prismatic adaptation?
Thank you very much for your question and thank you for your interest. I leave you a link to an article on prismatic adaptation, where you can find information on the intervention protocol. If you have problems accessing the article, please write to me ([email protected]), no problem, as well as if you need any other information. (https://www.sciencedirect.com/science/article/pii/S0010945208706592)
There is a lot of variability in terms of treatment. There are twice-weekly (for 15 minutes) intervention protocols for one month, which have found improvements in some functions in up to 6 months. However, it is true that one of the limitations of the technique is in its short duration, hence the research is in line to try to find interventions combined with – for example, neuromodulation – to try to increase their time of improvement.
Finally, a very simple way to differentiate heminegligence from hemianopsia is through the visual extinction technique by quadrants: For example, while a patient with heminegligence would be mainly impaired in being able to distinguish objects when both are competing (but could easily locate only one in any visual quadrant), a person with hemianopsia would show deficits in whichever quadrant it was, regardless of the number of objects in the visual field.
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