Abstract
A systematic review of the effectiveness of rehabilitation for persons with unilateral neglect (UN) after stroke was conducted by searching the computerized databases from 1997 through 2012. Randomized controlled trials (RCTs) of neglect treatment strategies for stroke patients which used the Behavioral Inattention Test (BIT) as the primary outcome measure were eligible for inclusion. Out of 201 studies initially identified, 12 RCTs covering 277 participants were selected for analysis. All had the same weakness of low power with smaller samples and limitation in the blinding of the design. Prism Adaptation (PA) was the most commonly used intervention while continuous Theta-burst stimulation (cTBS) appeared to be a new approach. Meta-analysis showed that for immediate effects, the BIT conventional subscore had a significant and large mean effect size (ES = 0.76; 95% CI 0.28–1.23; p = 0.002) whereas the BIT total score showed a modestly significant mean ES (ES = 0.55; 95% CI 0.16–0.94; p = 0.006). No significant mean ES in sensitivity analysis was found for long-lasting effects across all BIT outcomes. PA appeared to be the most effective intervention based on the results of pooled analysis. More rigorous studies should be done on repetitive transcranial magnetic stimulation (rTMS) before it can be concluded that it is a promising treatment for UN.
Highlights
Unilateral neglect (UN) is a heterogeneous perceptual disorder that often follows stroke, especially after right hemisphere lesion
SELECTION CRITERIA We included all Randomized controlled trials (RCTs) that sought to identify the effectiveness of any type of rehabilitation intervention in UN in adult stroke patients diagnosed by clinical examination and/or classical neuropsychological tests
After careful evaluation by the reviewers, we identified 25 clinical trials (Wiart et al, 1997; Robertson et al, 2002; Harvey et al, 2003; Pizzamiglio et al, 2004; Katz et al, 2005; Fong et al, 2007; Nys et al, 2008; Schroder et al, 2008; Ertekin et al, 2009; Luukkainen-Markkula et al, 2009; Polanowska et al, 2009; Serino et al, 2009; Song et al, 2009; Tsang et al, 2009; Saevarsson et al, 2010; Turton et al, 2010; Ferreira et al, 2011; Kamada et al, 2011; Kim et al, 2011; Làdavas et al, 2011; Mizuno et al, 2011; Welfringer et al, 2011; Gorgoraptis et al, 2012; Ianes et al, 2012; Koch et al, 2012) to be included in the final assessment
Summary
Unilateral neglect (UN) is a heterogeneous perceptual disorder that often follows stroke, especially after right hemisphere lesion. Its most typical feature is failure to report or respond to stimuli presented from the contralateral space, including visual, somatosensory, auditory, and kinesthetic sources. Sufferers may even fail to perceive their own body parts (Mesulam, 1999). The reported incidence varies from 10 to 82% following right- and from 15 to 65% following left-hemisphere stroke (Plummer et al, 2003). Lesion site, the nature and timing of the assessment, and lack of agreement on assessment methods are all responsible for the variability in these reported rates (Stone et al, 1991; Azouvi et al, 2002). UN has a significant negative impact associated with functional recovery at home discharge (Jehkonen et al, 2006; Mutai et al, 2012)
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