The effectiveness of different treatment modalities for the rehabilitation of unilateral neglect in stroke patients: A systematic review

Abstract

Patients suffering from unilateral neglect syndrome (UNS) are not able to respond to stimuli administered to the side of the body opposite to the lesion. UNS is most commonly seen after right-hemisphere lesions. Patients with UNS experience more problems with activities of daily living and recovery after stroke is delayed. To investigate which treatment modalities can alleviate the symptoms of UNS after stroke and to determine their effectiveness. Databases PubMed, Web of knowledge and PEDro have been searched. Quality assessment was conducted using the 9-item Delphi list. Data extraction was performed by the first author. Effect sizes have been calculated using Cohen's d. 15 RCT's have been included. Most studies used add-on therapies. Almost all studies found improvements in both groups, but only 7 trials showed statistically significant between group differences in favor of the experimental group. Large effect sizes were found in only four studies. All the interventions discussed in this review can reduce the symptoms of UNS. However, TENS, optokinetic stimulation, somatosensory electrostimulation, mirror therapy and virtual reality training seem to be the most effective treatment methods (d > 0,80). Future research should focus on producing studies of higher methodological quality with larger sample sizes.