Persistent postural-perceptual dizziness (PPPD) was derived from phobic postural vertigo and chronic subjective dizziness. Two key physical symptoms of PPPD are postural unsteadiness and visually induced dizziness. Although the underlying mechanism of PPPD is still enigmatic, the prognosis is good with adequate treatment. In this paper, diagnostic criteria, pathophysiology and treatment regarding PPPD will be reviewed.
Dizziness ; Perceptual Disorders ; Postural Balance ; Prognosis ; Vertigo

BACKGROUND: The study of ocular search pattern in normal subjects and patients with hemispatial neglect may help understand spatial cognition. However, only a few studies are available that investigated ocular search pattern even in normal controls. The present study was to investigate ocular search pattern of normal subjects during line bisection task. METHODS: Nine normal subjects (6 men and 3 women with mean age of 21.8+/-4.2 years) were requested to fix their eyes on the midpoint of the line that was presented on the monitor. Lines for bisection were varied according to the location (center, right-sided or left-sided) and length (short or long) and each subject performed 6 trials (one trial/condition). Horizontal eye movements were recorded using an infrared video-oculography and were analyzed in terms of the range and the direction of eye movements. RESULTS: Average range of fixation during line bisection was 20.1% of entire length that corresponded middle portion of the line. There was no directional preference in searching the line during line bisection task. CONCLUSIONS: We expected that normal subjects overtly look at both ends of the line before they bisect the line. On the contrary, they seem to use a strategy such that they directly go to the middle part of the line and then make fine adjustment while looking at both ends of line covertly. (J Korean Neurol Assoc 19(2):96~101, 2001)
Cognition ; Eye Movements ; Female ; Humans ; Male ; Perceptual Disorders

BACKGROUND: The study of ocular search pattern in normal subjects and patients with hemispatial neglect may help understand spatial cognition. However, only a few studies are available that investigated ocular search pattern even in normal controls. The present study was to investigate ocular search pattern of normal subjects during line bisection task. METHODS: Nine normal subjects (6 men and 3 women with mean age of 21.8+/-4.2 years) were requested to fix their eyes on the midpoint of the line that was presented on the monitor. Lines for bisection were varied according to the location (center, right-sided or left-sided) and length (short or long) and each subject performed 6 trials (one trial/condition). Horizontal eye movements were recorded using an infrared video-oculography and were analyzed in terms of the range and the direction of eye movements. RESULTS: Average range of fixation during line bisection was 20.1% of entire length that corresponded middle portion of the line. There was no directional preference in searching the line during line bisection task. CONCLUSIONS: We expected that normal subjects overtly look at both ends of the line before they bisect the line. On the contrary, they seem to use a strategy such that they directly go to the middle part of the line and then make fine adjustment while looking at both ends of line covertly. (J Korean Neurol Assoc 19(2):96~101, 2001)
Cognition ; Eye Movements ; Female ; Humans ; Male ; Perceptual Disorders

BACKGROUND: Metamorphopsia includes a broad spectrum of visual perceptual distortions, such as alteration of perceived object size or, rarely, altered perception of faces, termed prosopometamorphopsia. CASE REPORT: This report describes a patient who complained of metamorphopsia restricted to the center of the face, particularly the lower part of the face (nose and mouth), following infarction of the right medial temporooccipital lobe that included the fusiform face area. CONCLUSIONS: The fusiform face area is commonly believed to be a face-selective cortical region dedicated to the visual analysis of face stimuli. We speculate that any injury to this brain area could bring about prosopometamorphopsia involving whole or unilateral face perception, or very rarely, as in our case, distortion restricted to the central area of the face. Furthermore, there could be topographical correspondences between facial structures and the fusiform face area.
Brain ; Humans ; Infarction ; Mouth ; Nose ; Perceptual Distortion ; Vision Disorders

OBJECTIVE: To compare differences in postural changes during dual-task performance (DTP) between stroke patients and healthy controls, and to investigate the relationship between postural control and attention during DTP in stroke patients. METHOD: Twenty-nine subacute stroke patients who were able to stand independently and ten age-matched, healthy controls were enrolled in the study. The postural control of subjects was evaluated in all of the following four conditions using posturography: a simple standing state with eyes open (EO), a DTP with EO, a simple standing state with eyes closed (EC) and a DTP with EC. The dual-task was performed by standing while inversely repeating a given four-digit number. The parameters were stability index (SI) and weight distribution index (WDI) in posturography. Both visual and auditory inattention of the stroke patients were measured using the computer neuropsychologic test. RESULTS: In stroke patients, SI and WDI increased significantly during DTP (p<0.05) both their EO and EC status. The change of SI during DTP was positively correlated with the visual and auditory inattention in stroke patients (p<0.01) with their EO status. No significant correlations were noticed in WDI. CONCLUSION: Postural changes during DTP increased more in stroke patients than in healthy controls. Postural control showed a significant correlation with visual and auditory attention during the DTP in stroke patients. We therefore expect that dual-task training using postural control and attention will be an attractive treatment method for increasing postural stability in stroke patients.
Auditory Perceptual Disorders ; Eye ; Humans ; Neuropsychological Tests ; Stroke

OBJECTIVE: To evaluate the effectiveness of family-engaged multidimensional team planning and management for patients with severe stroke and low functional status and to identify factors predictive of improved outcome at 1 month after admission. METHODS: We retrospectively evaluated 50 patients who underwent family-engaged multidimensional rehabilitation for recovery from severe stroke due to primary unilateral cerebral lesions. The rehabilitation consisted of three phases: comprehensive multidimensional assessment, intensive rehabilitation, and evaluation. Functional Independence Measure (FIM) scores were calculated and used to predict the patients’ status at discharge. RESULTS: Although all FIM scores significantly improved after 1 month of rehabilitation, the motor FIM (mFIM) score improved the most (from 20.5±1.0 to 32.6±2.0). The total FIM (tFIM) and mFIM scores continued to improve from the first month to discharge (mean mFIM efficiency, 0.33). The high-efficiency patient group (mFIM efficiency ≥0.19) had a significantly higher discharge-to-home rate (44% vs. 13%), lower frequency of hemispatial neglect, and more severe finger numbness than the low-efficiency patient group (mFIM efficiency <0.19). The regression analyses revealed that besides lower mFIM and cognitive FIM scores at admission, unilateral spatial neglect, systemic comorbidities, and age were predictive of worse 1-month outcomes and tFIM scores (conformity, R²=0.78; predictive power, Akaike information criterion value=202). CONCLUSION: Family-engaged multidimensional team planning and management are useful for patients with severe stroke and low functional status. Furthermore, FIM scores at admission, age, unilateral spatial neglect, and systemic comorbidities should be considered by rehabilitation teams when advising caregivers on the probability of favorable outcomes after rehabilitation.
Caregivers ; Cerebrovascular Disorders ; Comorbidity ; Fingers ; Humans ; Hypesthesia ; Perceptual Disorders ; Rehabilitation ; Retrospective Studies ; Stroke ; Symptom Assessment

OBJECTIVES: Patients with poor insight are commonly observed among schizophrenics and they show poor drug compliance and prognosis. This study aimed at examining the characteristics of psychopathology in patients with schizophrenia who have no insight. Understanding the features of inner psychopathology in schizophrenic patients with poor insight, we assumed, could lead to insight-promoting clues. METHODS: The subjects consisted of 69 patients with schizophrenia diagnosed by DSM-IV criteria. For identifying insight level in the patients, Scale to Assess Unawareness of Mental Disorder(SUMD) was applied. After subjects were divided into two groups depending upon insight level, psychopathological differences were evaluated by Kyung Hee-Frankfruter Beschwerde Fragebogen(K-FBF), which was known as one of the subjective psychological tests for the schizophrenics. RESULTS: There was no significant differences in demographic variables, duration of illness, and dose of medication between two groups. However, significantly high rate of involuntary admission and tendency of high frequency of admission were revealed in schizophrenic patients with poor insight. And, also poor insight group showed significantly high scores in the factors of sensorimotor disorder(subscales of psychomotor disorder, perceptual disorder and blocking symptoms included) and in language-cognitive disorder factor(subscales of language disorder and cognitive floating included) compared with patients who have insight. CONCLUSION: We was assumed that lack of insight in schizophrenics could include one of the symptoms based on neuropsychological or neurobiological abnormalities in brain. Moreover, it was revealed that patients with poor insight evaluated themselves as having more serious psychopathologies than patients who had insight. It has been already known that schizophrenic patients who lack in insight are reluctant to taking psychiatric care and lack in awareness of their illness. However, this study suggests that their inner psychopathology associated with insight can be understood with the use of subjective psychological test, i.e. K-FBF. For understanding the schizophrenic patients who lack in insight, not only checking the insight but also applying the subjective test such as K-FBF seems to be helpful.
Brain ; Compliance ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Language Disorders ; Perceptual Disorders ; Prognosis ; Psychological Tests ; Psychopathology* ; Schizophrenia

OBJECTIVE: To develop the Korean version of the Kessler Foundation Neglect Assessment Process (KF-NAP), which enables a more functional assessment of unilateral spatial neglect, by first translating it into Korean and then statistically standardizing it. METHODS: Two rehabilitation specialists translated the KF-NAP into Korean. The entire process of administering the Korean KF-NAP to 30 patients with brain disease was video-recorded. Five occupational therapists from 4 university hospitals nationwide evaluated the 30 video-recorded examination cases. We analyzed inter- and intra-reliabilities of the Korean KF-NAP using the intraclass coefficient and Pearson correlation coefficient. Internal consistency reliability of the assessment categories was also examined using Cronbach's alpha coefficient. RESULTS: For the construct validation study, the Korean KF-NAP was strongly correlated with the Albert's test and letter cancellation test (r ≥ 0.8; p < 0.05). The intraclass correlation coefficients for the first and second assessments of the Korean KF-NAP were 0.973 and 0.982, respectively, showing high reliability (p < 0.05). The intra-rater reliabilities exceeded 0.9 (p < 0.05), and Cronbach's alpha coefficient exceeded 0.8, showing internal consistency reliability. CONCLUSION: The Korean KF-NAP is a reliable and valid instrument for assessing hemispatial neglect symptoms in patients with brain diseases.
Brain Diseases ; Hospitals, University ; Humans ; Perceptual Disorders ; Rehabilitation ; Reproducibility of Results* ; Specialization ; Translating ; Translations

OBJECTIVE: To investigate the effects of short-term robot-assisted upper limb training on hemiplegic patients compared to conventional physical therapy. METHOD: This study was a prospective, single-blinded, randomized controlled trial. Eighteen hemiplegic patients due to brain lesions were randomly assigned to: (1) robot-assisted upper limb training and conventional upper limb physical therapy for 30 min a day, respectively (Robot group); or (2) conventional upper limb physical therapy for 30 min twice a day (Conventional group). All interventions were provided for 2 weeks, 5 times a week. Each patient was evaluated at pre- and post-treatment by the Fugl-Meyer assessment-upper extremity (FMA-UE), Jebsen hand function test (JHFT), grip power, modified Barthel index-upper extremity (MBI-UE), line bisection test, and Albert test. RESULTS: The Robot group showed significant improvement in FMA-UE (pre: 13.22 +/- 14.20, post: 21.67 +/- 15.84; p = 0.018), MBI-UE (pre: 14.33 +/- 7.42, post: 16.56 +/- 6.95; p = 0.041), and line bisection test (pre: 25.15 +/- 34.48, post: 14.93 +/- 28.38; p = 0.043). The Conventional group showed significant improvement only in MBI-UE (pre: 9.22 +/- 6.06, post: 15.56 +/- 6.19; p = 0.008). The improvement in MBI-UE was larger in the Conventional group than Robot group (6.33 +/- 3.28 vs. 2.22 +/- 2.49; p = 0.014). CONCLUSION: This study suggests that short-term robot-assisted upper limb training may improve upper limb function in hemiplegic patients. However, proper physical therapy may be needed to transfer improved upper limb function to activity of daily living. In addition, goal-directed reaching tasks using a robot are expected to be a treatment option for hemineglect.
Brain ; Extremities ; Hand ; Hand Strength ; Hemiplegia ; Humans ; Perceptual Disorders ; Prospective Studies ; Rehabilitation ; Robotics ; Upper Extremity*

OBJECTIVE: To investigate the effectiveness of an upper limb rehabilitation robot therapy on hemispatial neglect in stroke patients. METHODS: Patients were randomly divided into an upper limb rehabilitation robot treatment group (robot group) and a control group. The patients in the robot group received left upper limb training using an upper limb rehabilitation robot. The patients sat on the right side of the robot, so that the monitor of the robot was located on the patients' left side. In this position, patients could focus continuously on the left side. The control group received conventional neglect treatment, such as visual scanning training and range of motion exercises, administered by occupational therapists. Both groups received their respective therapies for 30 minutes a day, 5 days a week for 3 weeks. Several tests were used to evaluate treatment effects before and after the 3-week treatment. RESULTS: In total, 38 patients (20 in the robot group and 18 in the control group) completed the study. After completion of the treatment sessions, both groups showed significant improvements in the Motor-Free Visual Perception Test 3rd edition (MVPT-3), the line bisection test, the star cancellation test, the Albert's test, the Catherine Bergego scale, the Mini-Mental State Examination and the Korean version of Modified Barthel Index. The changes in all measurements showed no significant differences between the two groups. CONCLUSION: This present study showed that the upper limb robot treatment had benefits for hemispatial neglect in stroke patients that were similar to conventional neglect treatment. The upper limb robot treatment could be a therapeutic option in the treatment of hemispatial neglect after stroke.
Exercise ; Humans ; Perceptual Disorders* ; Range of Motion, Articular ; Rehabilitation* ; Robotics ; Stroke* ; Upper Extremity* ; Visual Perception