Abstract
Eye patching (EP; monocular or right hemifield) has been proposed to improve visuospatial attention to the ignored field in patients with hemispatial neglect. The aim of this paper is to review the literature on the effects of EP in hemispatial neglect after stroke in order to convey evidence-based recommendations to clinicians in stroke rehabilitation. Thirteen intervention studies were selected from the Medline, EMBASE, Scopus, Cochrane Library, CINAHL, PsychINFO, EBRSR, and Health Star databases. Methodological quality was defined according to the Physiotherapy Evidence Database. Overall, seven studies used monocular EP, five used right hemifield patching, and one compared right monocular with right hemifield patching. Seven studies compared normal viewing to monocular or hemifield patching conditions. Six studies included a period of treatment. As to the monocular EP, four studies reported positive effects of right monocular patching. One study showed an improvement in hemispatial neglect with left monocular patching. Two studies found no superiority of right vs. left monocular patching. One study found no effects of right monocular patching. As to the right hemifield EP, one study showed improvements in neglect after right hemifield patching. Three studies found that right hemifield patching combined with another rehabilitation technique was more effective than that treatment alone. One study found no differences between right hemifield patching combined with another treatment and that treatment alone. One study found the same effect between right hemifield patching alone and another rehabilitation technique. Our results globally tend to support the usefulness of right hemifield EP in clinical practice. In order to define a level of evidence with the standard rehabilitation evidence rating tools, further properly powered randomized controlled trials or meta-analysis are needed.
Highlights
Hemispatial neglect is a common syndrome after stroke in which patients fail to report or respond or be aware of stimuli located contralateral to a brain lesion (Heilman and Valenstein, 1979; Kwon et al, 2012)
Seven studies investigated the effects of right monocular Eye patching (EP) (Butter and Kirsch, 1992; Soroker et al, 1994; Serfaty et al, 1995; Walker et al, 1996; Barrett et al, 2001; Khurshid et al, 2009; Wu et al, 2013) and five assessed the effects of right hemifield EP (Arai et al, 1997; Zeloni et al, 2002; Fong et al, 2007; Tsang et al, 2009; Ianes et al, 2012)
One study investigated the effect of right monocular EP and that of right hemifield EP (Beis et al, 1999)
Summary
Hemispatial neglect is a common syndrome after stroke in which patients fail to report or respond or be aware of stimuli located contralateral to a brain lesion (Heilman and Valenstein, 1979; Kwon et al, 2012). The incidence of hemispatial neglect varies between 8 and 95% in individuals with stroke (Bowen et al, 1999), with a reasonable estimate of 23% (Pedersen et al, 1997). These epidemiological discrepancies are thought to result from inconsistencies in defining hemispatial neglect, differences in the timing of examination after stroke, the use of different tests to detect visual hemispatial neglect, and the use of small and insensitive test batteries in the available literature (Ogden, 1985; Stone et al, 1991). Diagnosis must exclude that these behavioral abnormalities arise from a primary sensory or motor deficit such as hemianopia or paralysis (Heilman and Valenstein, 1979)
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