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Hemimyelia — Clinical Guidelines

Overview

Hemimyelia, often associated with hemispatial neglect following unilateral brain damage, involves impaired awareness and interaction with the contralateral side of space, affecting various cognitive and motor functions. 1 2 3

Diagnosis

Clinical Presentation: Impaired awareness and interaction with the contralateral side of space, often following right parietal stroke.

Neurological Examination: Identification of neglect through tasks like line bisection, copying complex figures, and behavioral observations.

Imaging: MRI or CT scans to identify structural brain lesions contributing to neglect.

Neuropsychological Testing: Specific tests such as the Albert's Test for neglect severity grading. 4

Management

Occupational Therapy with Video Feedback: Effective for remediation and relearning functional tasks by enhancing patient awareness of neglect behaviors. 4

Neurofeedback Training: Real-time fMRI neurofeedback targeting visual cortex activity shows promise in up-regulating affected areas and reducing neglect severity. 1

Environmental Manipulations: Adjusting gravitational input (e.g., supine positioning) may temporarily alleviate neglect symptoms by influencing spatial processing biases. 2

Special Populations

No Specific Data Provided: Abstracts do not cover management specifics for pregnancy, pediatrics, elderly, or comorbidities related to hemimyelia.

Key Recommendations

Implement occupational therapy incorporating video feedback to enhance patient awareness and remediation of neglect behaviors. (Evidence: Moderate 4)

Consider real-time fMRI neurofeedback as an adjunctive therapy to improve cortical activity and functional outcomes in patients with hemineglect. (Evidence: Weak 1)

Explore environmental modifications, such as altering gravitational input, to temporarily alleviate symptoms in patients with hemispatial neglect. (Evidence: Weak 2)

References

1 Robineau F, Saj A, Neveu R, Van De Ville D, Scharnowski F, Vuilleumier P. Using real-time fMRI neurofeedback to restore right occipital cortex activity in patients with left visuo-spatial neglect: proof-of-principle and preliminary results. Neuropsychological rehabilitation 2019. link 2 Pizzamiglio L, Vallar G, Doricchi F. Gravity and hemineglect. Neuroreport 1995. link 3 Karnath HO, Huber W. Abnormal eye movement behaviour during text reading in neglect syndrome: a case study. Neuropsychologia 1992. link90062-q) 4 Söderback I, Bengtsson I, Ginsburg E, Ekholm J. Video feedback in occupational therapy: its effects in patients with neglect syndrome. Archives of physical medicine and rehabilitation 1992. link

Hemimyelia