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, 95 (10), 1423-32

Motor and Visuospatial Attention and Motor Planning After Stroke: Considerations for the Rehabilitation of Standing Balance and Gait

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Motor and Visuospatial Attention and Motor Planning After Stroke: Considerations for the Rehabilitation of Standing Balance and Gait

Sue Peters et al. Phys Ther.

Abstract

Attention and planning can be altered by stroke, which can influence motor performance. Although the influence of these factors on recovery from stroke has been explored for the upper extremity (UE), their impact on balance and gait are unknown. This perspective article presents evidence that altered motor and visuospatial attention influence motor planning of voluntary goal-directed movements poststroke, potentially affecting balance and gait. Additionally, specific strategies for rehabilitation of balance and gait poststroke in the presence of these factors are discussed. Visuospatial attention selects relevant sensory information and supports the preparation of responses to this information. Motor attentional impairments may produce difficulty with selecting appropriate motor feedback, potentially contributing to falls. An original theoretical model is presented for a network of brain regions supporting motor and visuospatial attention, as well as motor planning of voluntary movements. Stroke may influence this functional network both locally and distally, interfering with input or output of the anatomical or functional regions involved and affecting voluntary movements. Although there is limited research directly examining leg function, evidence suggests alterations in motor and visuospatial attention influence motor planning and have a direct impact on performance of gait and balance. This model warrants testing comparing healthy adults with individuals with stroke.

Figures

Figure 1.
Figure 1.
The dorsal and ventral streams include the occipital cortex and the posterior parietal cortex (PPC) and inferior temporal cortex (ITC), respectively. The dorsal frontoparietal network includes the PPC and the prefrontal cortex (PFC). The ventral frontoparietal network includes the inferior frontal gyrus (IFG) and the temporoparietal junction (TPJ). Motor attention includes the primary sensory cortex (S1) and the PPC. The PPC is important for the dorsal visual stream (part of visuospatial attention), the dorsal frontoparietal network, and motor attention.
Figure 2.
Figure 2.
The prefrontal cortex (PFC) selects a movement-related goal while sensory signals from the dorsal stream and primary sensory cortex (S1) converge on the posterior parietal cortex (PPC). The PPC narrows (or converges) the attentionally selected signals pertaining to the goal, based on visuospatial and motor attentional priorities. The supplementary motor area (SMA) and premotor cortex (PMc) areas receive this information and generate a motor plan based on the attention-filtered sensory signals and movement goals. The PPC is important for the dorsal visual stream (part of visuospatial attention), the dorsal frontoparietal network, and motor attention.

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