case_images: PMC11747466_01
case_images: Brain computed tomography (CT) after the patient's third stroke. (A) No significant atrophy of the cerebrum, (B) infarction of the medial right occipital lobe, and (C) infarction of the left genu of the internal capsule (red circles).
case_images: fresc-05-1462978-g001.jpg
case_images: PMC11747466_01_fresc-05-1462978-g001.jpg
case_images: F1
case_images: Figure 1 shows the brain computed tomography (CT) image of the patient. Brain CT conducted after his third stroke showed no significant cerebral atrophy (Figure 1A). Figures 1B,C show cerebral infarction in the right occipital lobe and left internal capsule, respectively.
case_images: Timeline of the case, including the patient's stroke history, step-by-step approach implemented in response to symptom improvement, and progress in the line cancellation test.
case_images: fresc-05-1462978-g002.jpg
case_images: PMC11747466_01_fresc-05-1462978-g002.jpg
case_images: F2
case_images: The case timeline (Figure 2) outlines the patient's history, step-by-step approach implemented in response to symptom improvement, and progress made in the line cancellation test.
case_images: In the first few sessions, the therapist initially placed all the musical instruments (tone bars) in the patient's right recognizable space. (A) The therapist gradually moved the instruments to his left side, crossing his midline in a stepwise manner. (B) A floor tom drum, small drum, cymbal, and triangle hanging from a drip pole (as an example) were placed in a semicircle in front of the patient. (C) The desk bell exercise with a few bells arranged in the lower left space.
case_images: fresc-05-1462978-g003.jpg
case_images: PMC11747466_01_fresc-05-1462978-g003.jpg
case_images: F3
case_images: Tonal and percussion instruments were used, for which each tone could be independently spatially rearranged and played one at a time (Figure 3). Once the patient became familiar with the tone sequence, the therapist gradually shifted the bars to the left, crossing his midline (Figure 3A). At 3 months, the therapist introduced an exercise with a floor tom drum and other instruments placed in a semicircle in front of the patient (Figure 3B) and a left-right alternating strike exercise with two paddle drums held and moved by the therapist. The therapist increased the difficulty of the visual search by changing the arrangement from a horizontal row to shifting each bell backward or forward and placing a few bells in the lower left space (Figure 3C).
case_images: Progress over the intervention and follow-up phases. The green line shows the patient's progress in the line cancellation test, demonstrating improvement in left hemispatial neglect. The blue line represents the Mini-Mental State Examination (MMSE) results over time, which shows stable cognitive function.
case_images: fresc-05-1462978-g004.jpg
case_images: PMC11747466_01_fresc-05-1462978-g004.jpg
case_images: F4
case_images: Improvement was observed in the line cancellation test (score = 19, Figure 4). Follow-up evaluations at 1, 3, and 6 months with scores of 7, 8, and 1, respectively, showed no decline in progress (Figure 4). Figure 4 shows the patient's progress on the line cancellation test and MMSE over the intervention and follow-up phases.