dual-tasking approaches for a more sensitive …recent (2019) clinical studies 2019 fesn symposium...

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Dual-tasking approaches for a more sensitive diagnosis

Mario Bonato

Department of General Psychology, University of Padua

2019 FESN Symposium USN from diagnosis to rehabilitation

Subtitle

Doing two things together is difficult. Multitasking/divided attention as a way to get rid of compensatory strategies and measure core residual abilities


A computer can help neuropsychologists because it allows…

Standardized proceduresAdaptive difficultyEasy scoring

But also: Presenting stimuli in a way which exacerbates the presence of deficits and mirrors everyday task demands



Often not so severe... After few weeks


Brief presentation time helps... (also to control for eye movements)

Contralesional omissions for

right hemisphere-damaged

(RHD) patients with (black

squares) vs. without (grey

triangles) left neglect

(adapted from Natale et al., 2007)

Several pioneering studies by

Bartolomeo, Karnath…

“Number two”

Top-down manipulation

Single Task: “left”

Visual Dual Task: “a” “left”

Auditory Dual Task: “4…6” “left”

Bonato et al., Neuropsychologia2010, Neuropsychology 2012 (With Zorzi, Umilta’ & Priftis )

10 RHD pts, 3 months from right-hemisphere stroke

Correct Responses

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* *


Same patients: normal at TMT-A but impaired at TMT-BBonato et al., Behav

Neurol 2013

Once you have a sensitive method you can use it to…

Empirically challenge well-established characteristics of neglect

1. It soon stabilizes after the acute phase

2. It is uncommon after left brain damage


Iperattenzione a destra ? C

ON

TRA

LESI

ON

AL

OM

ISSI

ON

STest #1 After 2/3 months from stroke NEGLECT

severity in cancellation tasks is thought to stabilize.Genuine deficit remission or compensatory strategies (insensitive tests) ?

Njiboer et al., Cortex (2014)


2019 FESN Symposium USN from diagnosis to rehabilitation Bonato, Front Hum Neurosci, 2015Case GB, no motor deficits

Left targets in RHD N-


Bonato, Front Hum Neurosci, 2015

Bonato, Front Hum Neurosci, 20152019 FESN Symposium USN from diagnosis

to rehabilitation

Bonato, Front Hum Neurosci, 2015

Conclusion Test # 1

Neglect does not stabilize after the acute phase. The presence AND the time-course of neglect remission are closely determined by the task at hand


Test #2: Uncommon after left hemisphere damage (?) 5 % of patients only ?


What if...

...the low prevalence of neglect after left brain damage is due to insensitive testing methods ?


10 CHRONIC LEFT hemisphere STROKE patients (LHD) Normal performance at paper and pencil tests

Blini et al, Neuropsychologia, 2016

Special issue: spatial and non spatial aspects of attention


“Number two”

Top-down manipulation

Single Task: “right side”

Visual Dual Task: “triangle” “right side”

Auditory Dual Task: “train” “right side”



Omissions


Prompted study with MCI only(ms by Z Romeo in preparation)

Clinical relevance with stats computed at individual level…

Is it “too” sensitive ???


Resembles the Useful Field of View test


i.e. one of the best predictors of the risk of car crashes in the elderly

14 LHD patientsvs. 13 RHD patients

NO neglect

Direct comparison chronic RHD vs LHD


Zaira Romeo(IRCCS San Camillo

Lido-Venice/ Unipd)


*

*

**

**

* *

Control

LHD

RHD

Romeo et al., in preparation

12 Right AND 9 left CVA patients

tested within 1 week from stroke

• 8 patients had extinction: 5 RH 3 LH

• No extinction detected with the finger confrontation test

(Naert et al., in preparation)

Also feasible in acute phase

Single Task Dual Task

LHD

RHD

Recent (2019) clinical studies


Antoine et al. (J Neuropsych) used for patients selectionAndres et al. (JINS) two single cases post rehab. One with vertical omissions. Made task available in psychopy.Bonato et al. (FHN) adapted version to highight differences within ipsilesionalhemispace (for hemianopia-severe neglect)

Lisi et al., Biol Psychol

2015

Disentanged task difficulty from number of items in WM

Dividing attention in healthy participants: Pupil dilation

Dividing attention in healthy participants: ERPs

Increased early negative component under visual loadCorrelates of error responses index a threshold criterion (decreased N1/N2 for unilateral and increased for bilateral)


Romeo et al., Neuropsychologia, in press

Dividing attention in healthy participants: asymmetry in behavior

WM load impacted more left that right-sided target


Naert et al., Frontiers Human Neurosci, 2018

Take home messages

Sensitive tasks change what we know about neglect in term of frequency, severity, recovery, rehabilitation effectiveness

Never base a diagnosis of neglect (absence) on paper and pencil tests (only)


Mario Bonato, Department of General Psychology, University of Padova

[email protected]


Thank you for your attention…al resources

mailto:[email protected]

Asymmetry index


5% ???


a computer can help because it allows…


Bonato & Cutini, JCEN, 2016

Response: «both sides»

*

*

ns

*

*ns

«R

igh

t» r

esp

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ses

to le

ftta

rget

s (%

)

«R

igh

t» r

esp

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to le

ftta

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s (%

)

«B

ilate

ral»

res

po

nse

sto

left

targ

ets

(%

)

Response: «right» Response: «right»


a computer can help because it allows…


MCI only

Romeo et al., in preparation


dual-tasking approaches for a more sensitive …recent (2019) clinical studies 2019 fesn symposium...

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