Abstract
Background. Extinction is a common consequence of unilateral hemispheric stroke where patients fail to become consciously aware of a contralesional sensory stimulus only when it is presented with a competing ipsilesional stimulus. To date, the current literature on extinction lacks a clear overview of the frequency of extinction in the
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visual, tactile and auditory modality and its relation with relevant admission to inpatient rehabilitation data. Objective. In the current study three main purposes were addressed: 1) to map the frequency of multimodal extinction, 2) to evaluate the relation of extinction with relevant admission to inpatient rehabilitation data and the comorbidity of visuospatial neglect, and 3) to explore the neural correlates of extinction by applying voxel-based lesion symptom mapping (VLSM). Methods. 410 stroke patients were tested with the clinical confrontation test within the first two weeks after admission to the rehabilitation center for inpatient rehabilitation. With respect to the admission to inpatient rehabilitation data, patients with and without extinction were compared to each other on demographic and stroke characteristics (time post stroke, hemisphere of stroke, aetiology, communication, cognition, mobility and independence in ADL). The comorbidity with neglect and neglect behaviour were measured by means of the shape cancellation test, line bisection test and the Catherine Bergego Scale (CBS). Subsequently, the extinction subgroups were compared to each other on the above-mentioned data. VLSM was applied to 62 patients, of whom 20 showed extinction in one of more modalities. Results. 67 patients showed extinction, of whom 12, 23, 10 and 22 patients showed visual, tactile, auditory or multimodal extinction respectively. Patients with extinction comparable to patients without extinction on admission to rehabilitation data, except that extinction patients suffered more often from right hemispheric stroke were tested later and showed more often visual neglect. Extinction subgroups were comparable on all mentioned data. Furthermore, extinction patients showed more behavioural consequences at the level of basic activities of daily living than patients without extinction, by means of the CBS. With respect to VLSM, damage affecting the right hemisphere, most specifically areas in or around the temporo-parietal junction were linked to multimodal extinction; however, affected areas involved in sensory processing were also found. Conclusions: There are no direct implications on the care of extinction patients during inpatient rehabilitation. Nevertheless it is useful to screen for extinction to gain a quick impression of patients spatial awareness. Future research with respect to basic activities in daily life is indicated. More specifically, it would be elegant to add other (instrumental) activities that heavily rely on processing information bilaterally in a demanding surrounding. Keywords. Multimodal extinction, Frequency, Severity, Visuospatial neglect, Voxel-based lesion symptom mapping
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