[Treatment of Unilateral Neglect using Repetitive Transcranial Magnetic Stimulation (rTMS) and Sensory Cueing (SC) in Stroke Patients]

Abstract

Objectives: To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and sensory cueing (SC) for improving hemi-spatial attention deficits related to unilateral neglect, upper limb function and independence of stroke patients.

Methods: An assessor-blinded randomized controlled trial (RCT) was conducted. Eligible stroke patients were treated with rTMS (n =17) or rTMS combined with SC (n =16) in addition to conventional rehabilitation measures. rTMS was applied with low frequency (1 Hz) over the posterior parietal cortex (P5) of the lefthemisphere, 90% resting motor threshold, 900 pulses each session, one session per day, and 5 d per week for 2 weeks. SC was emitted using a wristwatch device attached to the hemiplegic arm for 2 weeks with a cumulative wear time of 3 h per day. The severity of unilateral neglect [behavioral inattention test conventional subtests (BITC), Catherine Bergego scale (CBS)], activity of daily living [modified Barthel index (MBI)], and upper limb function [Fugl-Meyer assessment (FMA), action research arm test (ARAT)] of the patients were measured pre- and post-interventions (immediately after 2 weeks' treatment) by an occupational therapist.

Results: BIT-C was relieved significantly over time in both groups. But rTMS+SC had greater improvement than rTMS alone (P <0.05). No significant differences was found between the two groups in other outcomes (CBS, FMA, ARAT).

Conclusion: rTMS combined with SC is better than rTMS alone for treating unilateral neglect in stroke patients.

Keywords: Repetitive transcranial magnetic stimulation; Sensory cueing; Stroke; Unilateral neglect.