Reported quality of randomized controlled trials in neglect rehabilitation

Effects of body-oriented intervention after stroke on cognitive function, body awareness, and quality of life: A systematic review

BACKGROUND

Some cognitive functions can be affected by a stroke as it causes sensory, perceptual, and visual deficits, contributing to a loss of body awareness and changes in one's body image and leading to a decrease in the quality of life (QoL). This systematic review aims to identify and systematize scientific evidence of body-oriented intervention (BOI) effects in adult and elderly patients after a stroke on cognitive function, body awareness, and QoL.

METHODS

The research was carried out in: Pubmed, Science Direct, Cochrane, Web of Science, Psycinfo, Scopus, Portal Regional da BVS, and PEDro. To assess the methodological quality of the studies, the PEDro scale was used, and best evidence synthesis (BES) was performed on the data.

RESULTS

The study included 11 high-quality randomized controlled trials involving 590 participants. The trials investigated BOIs' effects, focusing on creative arts and mind-body and evaluating cognitive functions, body awareness, and QoL. BOIs were evidenced to induce positive effects, limited to strong ones, on several cognitive outcomes and QoL indicators, with more benefits than, or similar amounts of benefits to, other therapies.

CONCLUSIONS

BOIs have been shown to be a valid therapy in stroke recovery as there is limited to strong evidence that they improve several cognitive functions and QoL, with similar benefits to or more benefits than other therapies. In the future, it is important to study the outcomes that were not explored by the included studies or that have hardly been investigated, such as those related to body awareness.

Effect of stimulation-driven attention in virtual reality balloon search training of patients with left unilateral spatial neglect after stroke: A randomized crossover study

Patients with unilateral spatial neglect (USN) commonly experiences stimulus-driven attention deficit characterized by unexpected stimuli detection. We investigated whether virtual reality (VR) balloon search training with the screen background shifted to left space could improve stimulus-driven attention in patients with USN. The participants were divided into two groups: immediate VR group (n = 14) and delayed VR group (n = 14). The immediate VR group first received VR balloon search training, followed by control training, for two weeks each. Delayed VR group received the same training in reverse order. Outcomes were changes in scores on Catherine Bergego Scale (CBS) and reaction time on the modified Posner task (MPT). There was significant improvement in CBS score change after VR balloon retrieval training (all F > 2.71; P < 0.002). In the invalid condition of MPT, significant improvements were shown after VR balloon search training in left-sided reaction time (improvement of stimulation-driven attention). This study shows that VR balloon search training can improve neglect symptoms by using an intensive intervention lasting 2 weeks.

A Comparison of Three Common Rehabilitation Interventions Used to Improve Cardiovascular Fitness after Stroke: An Overview of the Literature

Background

One of the most frequent consequences of stroke is a reduction in heart function. After a stroke, one of the main aims of physiotherapy practice is to improve cardiovascular fitness (CVF). This paper is aimed at identifying the best effective intervention of improving the cardiovascular fitness (CVF) after stroke while focusing on body weight-supported treadmill training (BWSTT), over gait training (OGT), and therapeutic exercise.

Methods

Different electronic databases were searched until July 2022. Controlled randomized trials examining the effects of BWSTT, OGT, and therapeutic exercise to improve CVF on an ambulatory person with stroke, written in English and reporting cardiovascular fitness or at least one of its indicators, such as peak oxygen consumption (VO₂), gait speed, gait energy expenditure, and functional independence measure for locomotion (FIM-L), were included. The quality of the methodology was evaluated using the Physiotherapy Evidence Database (PEDro) scale.

Results

The research yielded 3854 relevant studies, of which 22 met the eligibility criteria. The primary indicators of the CVF, VO₂ and energy expenditure, were used to examine the CVF in only three studies, while the rest used other indicators of the CVF. There was a lack of sufficient evidence to establish the superiority of one intervention over another. However, it appears that utilizing BWSTT to improve the CVF after stroke is effective.

Conclusion

Physiotherapy has the potential to enhance the CVF of stroke patients. However, effective interventions and long-term effects remain debatable.

Current trends in the treatment of patients with post-stroke unilateral spatial neglect: a scoping review

PURPOSE

The purpose of this scoping review was to explore the current treatment approaches for patients with post-stroke unilateral spatial neglect.

METHODS

A three-step search strategy using the Johanna Briggs Institute (JBI) guidelines, was undertaken. PubMed, CINAHL, The Cochrane Central Register of Controlled Trial, SCOPUS, PROSPERO, JBI, Sport Discus, and Google Scholar databases were searched. Searches were limited to publications from January 1, 2008, to May 1, 2020. Critical appraisal was undertaken by two independent reviewers using a standardized critical appraisal instrument developed by JBI. Data were extracted using a study-specific charting table.

RESULTS

A total of 3,648 articles were identified, 311 full-text articles were screened and 86 articles were critically appraised, with 83 articles included in the review. Intervention approaches for post-stroke unilateral spatial neglect symptom amelioration were identified and categorized as prism adaptation and visual scanning, mental practice and mirror therapy, electrical stimulation and robotics, combination therapy, pharmacological therapy, and other interventions. Both positive and negative results across identified interventions were identified without specific reference to the phase of recovery.

CONCLUSION

This review provides insight into current interventions for post-stroke unilateral spatial neglect. A plethora of intervention studies have been explored to ameliorate neglect symptoms post-stroke.IMPLICATION FOR REHABILITATIONPrism adaptation (PA) and combination therapy are most commonly investigated intervention for unilateral spatial neglect (USN) and showed promise in ameliorating USN symptoms.No single treatment approach seems optimally superior in the rehabilitation of USN post-stroke.Evidence for the selection of treatment at a specific phase of recovery is not conclusive as both positive and negative outcome on neglect measure were observed across all treatment approaches without specific reference to the phase of recovery.Evidence for the long-term use of PA in USN rehabilitation appears to be modest.

Rehabilitation interventions of unilateral spatial neglect based on the functional outcome measure: A systematic review and meta-analysis

ABSTRACTThis review aimed to examine the bottom-up and top-down rehabilitation intervention effectiveness based on the functional outcome measure as immediate effect and long-term effect for unilateral spatial neglect conditions. The RCT studies were collected by searching in three databases J-Stage, PubMed, and PEDro from 2008 through 2018. The studies which used the following instruments: BI, CBS, FMA, and FIM, as the functional outcome with the PEDro score of six and above, were eligible for inclusion. A total of 492 participants in 13 studies included from 291 studies initially identified. The meta-analysis for overall ES revealed that BI and CBS had a significant mean of SMD = 0.65 (95% CI, 0.23-1.07; p = 0.003; I2 = 65%), and SMD = -0.23 (95% CI, -0.45 to -0.01; p = 0.04; I2 = 35%) respectively, while FMA and FIM had an insignificant mean of SMD = 0.14 (95% CI, -0.08-0.37; p = 0.22; I2 = 0%), and SMD = -0.22 (95% CI, -0.69-0.25; p = 0.37; I2 = 0%) respectively. Based on the results, although indicated the heterogeneity representation across studies, it showed that the top-down intervention approach of high-frequency rTMS was more effective in enhancing the functional abilities and ADL of unilateral spatial neglect patients on the immediate effects but not necessarily in the long-term effects.

The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults: A systematic review and meta-analysis

BACKGROUND

Neck pain is a prevalent condition that can adversely affect quality of life, productivity at work, and sleep quality. The aim of this systematic review and meta-analysis was to identify clinical trials assessing the effect of different types of pillows on neck pain, waking symptoms, neck disability, sleep quality, and spinal alignment.

METHODS

We systematically searched CINAHL Complete, Cochrane Library, EMBASE, Medline, Pubmed and Psychinfo databases from inception to September 2020. Two reviewers independently assessed the articles and evaluated the methodological quality using PEDro.

FINDINGS

Thirty-five articles fulfilled the inclusion criteria of the study. There were nine high-quality studies involving 555 participants. The meta-analysis revealed significant differences favouring the use of rubber pillows to reduce neck pain [standardized mean difference (SMD): -0.263; P < 0.001). Moreover, waking pain (SMD: -0.228; P < 0.001) and neck disability (SMD: -0.506; P = 0.020) were reduced while the satisfaction rate was enhanced (SMD: 1.144; P < 0.001) with pillow use. Pillow designs did not influence sleep quality (SMD = 0.047; P = 0.703) in patients with chronic neck pain.

INTERPRETATION

The use of spring and rubber pillows are effective in reducing neck pain, waking symptoms, and disability and enhancing pillow satisfaction in patients with chronic neck pain. Moreover, there may be no change in the alignment of the cervical spine in the side-lying position, regardless of the use of rubber or feather pillows. Rather, the cervical alignment may be significantly impacted by the shape and height of the pillow.

Benefits of Pilates in Parkinson's Disease: A Systematic Review and Meta-Analysis

Pilates may be a beneficial method of exercise for people with Parkinson’s disease (PD). However, no studies have critically reviewed the scientific evidence in this regard. The purpose of this study was to conduct a systematic review and meta-analysis on the effectiveness of Pilates as a rehabilitation strategy for PD. A systematic search of the electronic databases PubMed, PEDro, Scopus, and SPORTDiscus was conducted to identify studies related to the effect of Pilates on PD. The search timeframe ranged from the inception of each database to March 2019. The search resulted in the identification of four randomized controlled trials (RCTs) and four non-RCT studies. The methodological quality of the investigations ranged from poor to fair. The descriptive analysis of the eight investigations showed that Pilates resulted in beneficial effects on fitness, balance and functional autonomy. A subsequent meta-analysis on the four RCTs indicated that Pilates was more effective than traditional training programmes in improving lower limb function. Pilates can be safely prescribed for people with mild-to-moderate PD. Preliminary evidence indicates that its practice could have a positive impact on fitness, balance and physical function. Its benefits on lower-body function appear to be superior to those of other conventional exercises. Future randomized studies with greater samples are needed to confirm these observations.

Therapeutic Intervention for Visuo-Spatial Neglect after Stroke: A Meta-Analysis of Randomized Controlled Trials

Objectives

The aims of this meta-analysis were to examine intervention methods of qualitatively, well-designed studies from the past 10 years for treating visuo-spatial neglect (VSN) in patients who had suffered a stroke, and to evaluate the combined effects of intervention.

Methods

Studies published between 2008 and 2017 on the theme of VSN were collected from PubMed, CINAHL, and MEDLINE, representative academic databases and search engines. The PEDro scale was used for evaluating the quality of methodology. The sample size, mean, and standard deviation of identified studies were used for meta-analysis.

Results

Eight studies were selected for analysis. The PEDro scores of the selected studies were ≥ 7, with 237 subjects analyzed. The results of intervention were classified into “mental function” and “activity and participation” based on the International Classification of Functioning, Disability and Health. The analyzed effect sizes for combined outcomes, mental function and, activity and participation, were 0.728 (medium effect size), 0.850 (large effect size), and 0.536 (medium effect size), respectively.

Conclusion

Intervention methods for treating VSN had a short-term effect on cognitive function (visual perception). In particular, non-invasive brain stimulation therapy showed a large effect size for VSN treatment.

[Effects of physical exercise in a population with systemic lupus erythematosus: A systematic review]

This systematic review was aimed at analysing the existing scientific evidence regarding the effects of physical exercise on the symptomatology, disease activity, and fitness level in a population with systemic lupus erythematosus. Following the PRISMA checklist, a search was carried out on PubMed, PEDro, and Sportdiscus databases. The PEDro and MINORS checklists were used in order to identify the methodological quality of the studies selected. A total of 14 studies were found, of which 10 were randomised controlled trials, and 4 were comparative studies. The performance of physical exercise led to significant improvements in fitness and fatigue. No adverse effects were registered. None of the studies found reported positive effects on the disease activity. The obtained results imply that the performance of physical exercise is safe for people with systemic lupus erythematosus, although its benefits are reduced mainly to improvements in their fitness and perceived level of fatigue.

The effectiveness of structured exercise in the south Asian population with type 2 diabetes: a systematic review

The impact of exercise interventions on south Asians with type 2 diabetes (T2DM), who have a higher T2DM incidence rate compared to other ethnic groups, is inconclusive. This study aimed to systematically review the effect of exercise interventions in south Asians with T2DM. Five electronic databases were searched up to April 2017 for controlled trials investigating the impact of exercise interventions on south Asian adults with T2DM. The PEDro scale was used to assess the quality of the included studies. Eighteen trials examining the effect of aerobic, resistance, balance or combined exercise programs met the eligibility criteria. All types of exercise were associated with improvements in glycemic control, blood pressure, waist circumference, blood lipids, muscle strength, functional mobility, quality of life or neuropathy progression. The majority of included studies were of poor methodological quality. Few studies compared different types or dose of exercise. In conclusion, this review supports the benefits of exercise for south Asians with T2DM, although it was not possible to identify the most effective exercise prescription. Further studies of good methodological quality are required to determine the most effective dosage and type of exercise to manage T2DM in this population.

Use of antidepressants in dentistry: A systematic review

OBJECTIVE

Previous research has suggested that antidepressants can be used in oral health care. The aim of this systematic review was to search for scientific evidence of the efficacy of the use of antidepressants in dentistry.

MATERIALS AND METHODS

The clinical question was as follows (PICO question): dentistry patients (Patients); antidepressants (Intervention); no use or placebo or other drug (Comparison); and efficacy in oral health problems (Outcome). An electronic search was conducted in seven databases, as well as a manual search without restriction regarding language and date of publication. Two independent reviewers selected studies based on eligibility criteria, extracted data and assessed methodological quality based on the PEDro scale. The PROSPERO record is number CRD42016037442.

RESULTS

A total of 15 randomized controlled trials were associated with the use of antidepressants to control chronic or acute pain in dentistry, among other conditions such as bruxism and burning mouth syndrome. The most commonly used drug in clinical trials was amitriptyline (more than 50% of studies).

CONCLUSIONS

Antidepressants may be effective in dentistry for acute and chronic pain, but there is a large amount of methodological heterogeneity among the evaluated studies. In summary, there is rationality for the indication of this class of medicine in dentistry in specific clinical situations.

Strategies to translate knowledge related to common musculoskeletal conditions into physiotherapy practice: a systematic review

BACKGROUND

Many physiotherapists underuse evidence-based practice guidelines or recommendations when treating patients with musculoskeletal disorders, yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines.

OBJECTIVES

To evaluate the effectiveness of various knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues.

DATA SOURCES

A computerized literature search of MEDLINE, CINHAL and ProQuest of systematic reviews (from inception until May 2016) and primary research studies (from January 2010 until June 2016).

STUDY SELECTION AND ELIGIBILITY CRITERIA

Eligibility criteria specified articles evaluating interventions for translating knowledge into physiotherapy practice.

DATA EXTRACTION AND DATA SYNTHESIS

Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Of a total of 13014 articles located and titles and abstracts screened, 34 studies met the inclusion criteria, including three overlapping publications, resulting in 31 individual studies.

RESULTS

Knowledge translation interventions appear to have resulted in a positive change in physiotherapist beliefs, attitudes, skills and guideline awareness. However, no consistent improvement in clinical practice, patient and economic outcomes were observed.

LIMITATIONS

The studies included had small sample sizes and low methodological quality. The heterogeneity of the studies was not conducive to pooling the data.

CONCLUSIONS AND IMPLICATION OF KEY FINDINGS

The intensity and type of knowledge translation intervention seem to have an effect on practice change. More research targeting financial, organizational and regulatory knowledge translation interventions is needed.

Rehabilitation of unilateral neglect: Evidence-based medicine

BACKGROUND

In the last decades, several rehabilitation methods have been developed to improve spatial neglect. These can be classified according to their theoretical basis: (i) enhance awareness of neglect behaviour through a top-down mechanism; (ii) low-level bottom-up sensory stimulation; (iii) modulation of inhibitory processes; (iv) increase arousal.

OBJECTIVE

The purpose of this study was to provide an overview of the evidence on the effectiveness of rehabilitation procedures for unilateral neglect.

METHOD

A systematic search was performed to look for all randomised controlled trials aimed at reducing left spatial neglect that included a functional assessment. In addition, recent review papers and meta-analyses were analysed.

RESULTS

Thirty-seven randomized controlled trials were found (12 bottom-up; 12 top-down; 1 interhemispheric competition; 12 combination of approaches) that included 1027 patients with neglect. Although there are some encouraging results, overall, the level of evidence remains low. Poor methodological quality and small sample sizes are major limitations in many published trials.

CONCLUSION

There is a need for well-conducted, large-scale randomised controlled trials that incorporate blinded assessments, evaluation of the generalization to activities of daily living and long-term follow-up.

Motor imagery reinforces brain compensation of reach-to-grasp movement after cervical spinal cord injury

Individuals with cervical spinal cord injury (SCI) that causes tetraplegia are challenged with dramatic sensorimotor deficits. However, certain rehabilitation techniques may significantly enhance their autonomy by restoring reach-to-grasp movements. Among others, evidence of motor imagery (MI) benefits for neurological rehabilitation of upper limb movements is growing. This literature review addresses MI effectiveness during reach-to-grasp rehabilitation after tetraplegia. Among articles from MEDLINE published between 1966 and 2015, we selected ten studies including 34 participants with C4 to C7 tetraplegia and 22 healthy controls published during the last 15 years. We found that MI of possible non-paralyzed movements improved reach-to-grasp performance by: (i) increasing both tenodesis grasp capabilities and muscle strength; (ii) decreasing movement time (MT), and trajectory variability; and (iii) reducing the abnormally increased brain activity. MI can also strengthen motor commands by potentiating recruitment and synchronization of motoneurons, which leads to improved recovery. These improvements reflect brain adaptations induced by MI. Furthermore, MI can be used to control brain-computer interfaces (BCI) that successfully restore grasp capabilities. These results highlight the growing interest for MI and its potential to recover functional grasping in individuals with tetraplegia, and motivate the need for further studies to substantiate it.

Assessment and rehabilitation of neglect using virtual reality: a systematic review

After experiencing a stroke in the right hemisphere, almost 50% of patients showed Unilateral Spatial Neglect (USN). In recent decades, Virtual Reality (VR) has been used as an effective tool both for the assessment and rehabilitation of USN. Indeed, this advanced technology allows post-stroke patients to interact with ecological and engaging environments similar to real ones, but in a safe and controlled way. To provide an overview of the most recent VR applications for the assessment and rehabilitation of USN, a systematic review has been carried out. Since 2010, 13 studies have proposed and tested innovative VR tools for USN. After a wide description of the selected studies, we discuss the main features of these VR tools in order to provide crucial indications for future studies, neurorehabilitation interventions, and clinical practice.

Mechanical diagnosis and therapy has similar effects on pain and disability as 'wait and see' and other approaches in people with neck pain: a systematic review

QUESTIONS

In people with neck pain, does Mechanical Diagnosis and Therapy (MDT) reduce pain and disability more than 'wait and see'? Does MDT reduce pain and disability more than other interventions? Are any differences in effect clinically important?

DESIGN

Systematic review of randomised trials with meta-analysis.

PARTICIPANTS

People with neck pain.

INTERVENTION

MDT.

OUTCOME MEASURES

Pain intensity and disability due to neck pain in the short (< 3 months), intermediate (< 1 year) and long term (≥ 1 year).

RESULTS

Five trials were included. Most comparisons demonstrated mean differences in effect that favoured MDT over wait-and-see controls or other interventions, although most were statistically non-significant. For pain, all comparisons had a 95% confidence interval (CI) with lower limits that were less than 20 on a scale of 0 to 100, which suggests that the difference may not be clinically important. For disability, even the upper limits of the 95% CI were below this threshold, confirming that the differences are not clinically important. In all of the trials, some or all of the treating therapists did not have the highest level of MDT training.

CONCLUSION

The additional benefit of MDT compared with the wait-and-see approach or other therapeutic approaches may not be clinically important in terms of pain intensity and is not clinically important in terms of disability. However, these estimates of the effect of MDT may reflect suboptimal training of the treating therapists. Further research could improve the precision of the estimates and assess whether the extent of training in MDT influences its effect.

Visual Scanning Training for Neglect after Stroke with and without a Computerized Lane Tracking Dual Task

Neglect patients typically fail to explore the contralesional half-space. During visual scanning training, these patients learn to consciously pay attention to contralesional target stimuli. It has been suggested that combining scanning training with methods addressing non-spatial attention might enhance training results. In the present study, a dual task training component was added to a visual scanning training (i.e., Training di Scanning Visuospaziale - TSVS; Pizzamiglio et al., 1990). Twenty-nine subacute right hemisphere stroke patients were semi-randomly assigned to an experimental (N = 14) or a control group (N = 15). Patients received 30 training sessions during 6 weeks. TSVS consisted of four standardized tasks (digit detection, reading/copying, copying drawings, and figure description). Moreover, a driving simulator task was integrated in the training procedure. Control patients practiced a single lane tracking task for 2 days a week during 6 weeks. The experimental group was administered the same training schedule, but in weeks 4-6 of the training, the TSVS digit detection task was combined with lane tracking on the same projection screen, so as to create a dual task (computerized visual reaction time task designed for training). Various neglect tests and driving simulator tasks were administered before and after training. No significant group and interaction effects were found that might reflect additional positive effects of dual task training. Significant improvements after training were observed in both groups taken together on most assessment tasks. Ameliorations were generally not correlated to post-onset time, but spontaneous recovery, test-retest variability, and learning effects could not be ruled out completely, since these were not controlled for. Future research might focus on increasing the amount of dual task training, the implementation of progressive difficulty levels in driving simulator tasks, and further exploration of relationships between dual task training and daily functioning.

Rehabilitation Interventions for Unilateral Neglect after Stroke: A Systematic Review from 1997 through 2012

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.

Acupuncture for spinal cord injury and its complications: a systematic review and meta-analysis of randomized controlled trials

To evaluate the evidence supporting the effectiveness of acupuncture treatment for SCI and its complications, we conducted search across 19 electronic databases to find all of the randomized controlled trials (RCTs) that used acupuncture as a treatment for SCI and its complications. The methodological quality of each RCT was assessed using the Cochrane risk of bias tool and the PEDro scale. Sixteen RCTs, including 2 high-quality RCTs, met our inclusion criteria (8 for functional recovery from SCI, 6 for bladder dysfunction, and 2 for pain control). The meta-analysis showed positive results for the use of acupuncture combined with conventional treatments for the functional recovery in terms of motor ASIA scores and total FIM scores when compared to conventional treatments alone. Positive results were also obtained for the treatment of bladder dysfunction, in terms of the total efficacy rate, when comparing acupuncture to conventional treatments. However, 2 RCTs for pain control reported conflicting results. Our systematic review found encouraging albeit limited evidence for functional recovery, bladder dysfunction, and pain in SCI. However, to obtain stronger evidence without the drawbacks of trial design and the quality of studies, we recommend sham-controlled RCTs or comparative effectiveness research for each condition to test the effectiveness of acupuncture.

Combined effects of sensory cueing and limb activation on unilateral neglect in subacute left hemiplegic stroke patients: a randomized controlled pilot study

Objective:

To compare the effects of contralesional sensory cueing and limb activation with that of sham control in the treatment of unilateral neglect after stroke.

Design:

A randomized, single-blinded, sham-controlled pilot study.

Setting:

Two rehabilitation hospitals.

Subjects:

Forty subacute left hemiplegic stroke inpatients with unilateral neglect.

Interventions:

Participants were assigned randomly to 1 of 2 groups. The experimental group wore a wristwatch cueing device over the hemiplegic arm for three hours a day, five days per week, for three weeks, and also underwent conventional rehabilitation. Patients were encouraged to move their hemiplegic arm five consecutive times after each prompt. The sham group underwent the same rehabilitation process, except they wore a sham device.

Main measures:

Neglect, arm motor performance, and overall functioning were assessed pre- and posttraining, and at follow-up.

Results:

There were no significant differences between groups in outcome measures except the neglect drawing tasks ( p = 0.034) (the mean gain score from baseline to follow-up assessment was 5.2 (3.7) in the experimental group and 1.9 (3.5) in the sham group), across three time intervals. The experimental group showed greater improvement in arm motor performance than did the sham group.

Conclusion:

The results did not confirm that sensory cueing and limb activation treatment is effective when compared with those receiving placebo to reduce unilateral neglect, but it might be useful for promoting hemiplegic arm performance in stroke patients.

Recent trends in rehabilitation interventions for visual neglect and anosognosia for hemiplegia following right hemisphere stroke

This article highlights the most recent findings regarding the rehabilitation interventions for the syndromes of visual neglect and anosognosia for hemiplegia that occur following right hemisphere stroke. We review papers published in the past 4 years pertaining to therapeutic approaches for these two syndromes in order to identify the trends in the development of effective interventions. Overall, it appears well recognized that visual neglect syndromes and awareness syndromes frequently co-occur and both include complex, multifaceted impairments leading to significant difficulties in daily life functioning following stroke. Thus, the interventions for these syndromes must be multifaceted in order to address the complex interplay of cognitive-behavioral-emotional components. There appears to be a trend for using combination therapeutic interventions that address these components.