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Meta-Analysis
. 2021 Jul 1;7(7):CD003586.
doi: 10.1002/14651858.CD003586.pub4.

Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury

Verity Longley  1 , Christine Hazelton  2 , Calvin Heal  3 , Alex Pollock  2 , Kate Woodward-Nutt  4 , Claire Mitchell  5 , Gorana Pobric  6 , Andy Vail  7 , Audrey Bowen  6
Affiliations
Meta-Analysis

Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury

Verity Longley et al. Cochrane Database Syst Rev. .

Abstract

Background: People with spatial neglect after stroke or other brain injury have difficulty attending to one side of space. Various rehabilitation interventions have been used, but evidence of their benefit is unclear.

Objectives: The main objective was to determine the effects of non-pharmacological interventions for people with spatial neglect after stroke and other adult-acquired non-progressive brain injury.

Search methods: We searched the Cochrane Stroke Group Trials Register (last searched October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; last searched October 2020), MEDLINE (1966 to October 2020), Embase (1980 to October 2020), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1983 to October 2020), and PsycINFO (1974 to October 2020). We also searched ongoing trials registers and screened reference lists.

Selection criteria: We included randomised controlled trials (RCTs) of any non-pharmacological intervention specifically aimed at spatial neglect. We excluded studies of general rehabilitation and studies with mixed participant groups, unless separate neglect data were available.

Data collection and analysis: We used standard Cochrane methods. Review authors categorised the interventions into eight broad types deemed to be applicable to clinical practice through iterative discussion: visual interventions, prism adaptation, body awareness interventions, mental function interventions, movement interventions, non-invasive brain stimulation, electrical stimulation, and acupuncture. We assessed the quality of evidence for each outcome using the GRADE approach.

Main results: We included 65 RCTs with 1951 participants, all of which included people with spatial neglect following stroke. Most studies measured outcomes using standardised neglect assessments. Fifty-one studies measured effects on ADL immediately after completion of the intervention period; only 16 reported persisting effects on ADL (our primary outcome). One study (30 participants) reported discharge destination, and one (24 participants) reported depression. No studies reported falls, balance, or quality of life. Only two studies were judged to be entirely at low risk of bias, and all were small, with fewer than 50 participants per group. We found no definitive (phase 3) clinical trials. None of the studies reported any patient or public involvement. Visual interventions versus any control: evidence is very uncertain about the effects of visual interventions for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 55 participants) (standardised mean difference (SMD) -0.04, 95% confidence interval (CI) -0.57 to 0.49); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Prism adaptation versus any control: evidence is very uncertain about the effects of prism adaptation for spatial neglect based on measures of persisting functional ability in ADL (2 studies, 39 participants) (SMD -0.29, 95% CI -0.93 to 0.35); measures of immediate functional ability in ADL; persisting standardised neglect assessments; and immediate neglect assessments. Body awareness interventions versus any control: evidence is very uncertain about the effects of body awareness interventions for spatial neglect based on measures of persisting functional ability in ADL (5 studies, 125 participants) (SMD 0.61, 95% CI 0.24 to 0.97); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Mental function interventions versus any control: we found no trials of mental function interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of mental function interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Movement interventions versus any control: we found no trials of movement interventions for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of body awareness interventions on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments. Non-invasive brain stimulation (NIBS) versus any control: evidence is very uncertain about the effects of NIBS on spatial neglect based on measures of persisting functional ability in ADL (3 studies, 92 participants) (SMD 0.35, 95% CI -0.08 to 0.77); measures of immediate functional ability in ADL; persisting standardised neglect assessments; immediate neglect assessments; and adverse events. Electrical stimulation versus any control: we found no trials of electrical stimulation for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of electrical stimulation on spatial neglect based on immediate neglect assessments. Acupuncture versus any control: we found no trials of acupuncture for spatial neglect reporting on measures of persisting functional ability in ADL. Evidence is very uncertain about the effects of acupuncture on spatial neglect based on measures of immediate functional ability in ADL and immediate neglect assessments.

Authors' conclusions: The effectiveness of non-pharmacological interventions for spatial neglect in improving functional ability in ADL and increasing independence remains unproven. Many strategies have been proposed to aid rehabilitation of spatial neglect, but none has yet been sufficiently researched through high-quality fully powered randomised trials to establish potential or adverse effects. As a consequence, no rehabilitation approach can be supported or refuted based on current evidence from RCTs. As recommended by a number of national clinical guidelines, clinicians should continue to provide rehabilitation for neglect that enables people to meet their rehabilitation goals. Clinicians and stroke survivors should have the opportunity, and are strongly encouraged, to participate in research. Future studies need to have appropriate high-quality methodological design, delivery, and reporting to enable appraisal and interpretation of results. Future studies also must evaluate outcomes of importance to patients, such as persisting functional ability in ADL. One way to improve the quality of research is to involve people with experience with the condition in designing and running trials.

Trial registration: ClinicalTrials.gov NCT02401724 NCT02526238 NCT02695927 NCT03141996 NCT00989430 NCT02213640 NCT02680171 NCT03168360 NCT03317860 NCT03402906 NCT03451708 NCT03458611 NCT03854487 NCT03887962 NCT04080999 NCT04227132 NCT04273620.

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Conflict of interest statement

Verity Longley: none known. Christine Hazelton: payment for a fellowship: my time on this review has been funded in part by a non‐clinical lectureship funded by the Stroke Association. Work as a health professional: clinical work as an Optometrist, Glasgow Caledonian University ‐ only a very small amount of this clinical work touches on the topic of interest in this review. Calvin Heal: none known. Alex Pollock: none known. Kate Woodward‐Nutt: none known. Claire Mitchell: none known. Gorana Pobric: none known. Andy Vail: none known. Audrey Bowen: grants and contracts: (1) funding for this review update, NIHR NETSCC Incentive Funding; (2) funding for primary research on the topic of this review (e.g. the SPATIAL feasibility study), NIHR RfPB, awarded to SRFT NHS Trust rather than to my University as per NIHR arrangements. Payment for a fellowship: fellowship for Dr Longley under my mentorship, NIHR Development and Skills Enhancement Award, awarded to MMU, where Dr Longley secured an academic post. Published opinions in medical journals, the public press, broadcast and social media relevant to interventions in the work: I have published journal papers and book chapters, and I have edited national guidelines that include the topic of this review (e.g. ICSWP National Clinical Guideline for Stroke 2016, awarded to SRFT NHS Trust rather than to my University as per NIHR arrangements). If you were involved in conducting a study that is eligible for inclusion in this review, what was the funding source for that study? Bowen A (CI), et al. A feasibility study of prisms and therapy in attention loss after stroke (SPATIAL feasibility). NIHR RfPB 249K, 2018‐2020.

The work presented here represents the views of the authors and not necessarily those of the funding bodies.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
1.1
1.1. Analysis
Comparison 1: Visual interventions versus any control, Outcome 1: Activities of daily living: persisting effects
1.2
1.2. Analysis
Comparison 1: Visual interventions versus any control, Outcome 2: Activities of daily living: immediate effects
1.3
1.3. Analysis
Comparison 1: Visual interventions versus any control, Outcome 3: Neglect outcomes: persisting effects
1.4
1.4. Analysis
Comparison 1: Visual interventions versus any control, Outcome 4: Neglect outcomes: immediate effects
2.1
2.1. Analysis
Comparison 2: Prism adaptation versus any control, Outcome 1: Activities of daily living: persisting effects
2.2
2.2. Analysis
Comparison 2: Prism adaptation versus any control, Outcome 2: Activities of daily living: immediate effects
2.3
2.3. Analysis
Comparison 2: Prism adaptation versus any control, Outcome 3: Neglect outcomes: persisting effects
2.4
2.4. Analysis
Comparison 2: Prism adaptation versus any control, Outcome 4: Neglect outcomes: immediate effects
3.1
3.1. Analysis
Comparison 3: Body awareness interventions versus any control, Outcome 1: Activities of daily living: persisting effects
3.2
3.2. Analysis
Comparison 3: Body awareness interventions versus any control, Outcome 2: Activities of daily living: immediate effects
3.3
3.3. Analysis
Comparison 3: Body awareness interventions versus any control, Outcome 3: Neglect outcomes: persisting effects
3.4
3.4. Analysis
Comparison 3: Body awareness interventions versus any control, Outcome 4: Neglect outcomes: immediate effects
3.5
3.5. Analysis
Comparison 3: Body awareness interventions versus any control, Outcome 5: Discharge destination (home)
3.6
3.6. Analysis
Comparison 3: Body awareness interventions versus any control, Outcome 6: Adverse events
4.1
4.1. Analysis
Comparison 4: Mental function interventions versus any control, Outcome 1: Activities of daily living: persisting effects
4.2
4.2. Analysis
Comparison 4: Mental function interventions versus any control, Outcome 2: Activities of daily living: immediate effects
4.3
4.3. Analysis
Comparison 4: Mental function interventions versus any control, Outcome 3: Neglect outcomes: persisting effects
4.4
4.4. Analysis
Comparison 4: Mental function interventions versus any control, Outcome 4: Neglect outcomes: immediate effects
4.5
4.5. Analysis
Comparison 4: Mental function interventions versus any control, Outcome 5: Adverse events
5.1
5.1. Analysis
Comparison 5: Movement intervention versus any control, Outcome 1: Activities of daily living: persisting effects
5.2
5.2. Analysis
Comparison 5: Movement intervention versus any control, Outcome 2: Activities of daily living: immediate effects
5.3
5.3. Analysis
Comparison 5: Movement intervention versus any control, Outcome 3: Neglect outcomes: persisting effects
5.4
5.4. Analysis
Comparison 5: Movement intervention versus any control, Outcome 4: Neglect outcomes: immediate effects
5.5
5.5. Analysis
Comparison 5: Movement intervention versus any control, Outcome 5: Adverse events
6.1
6.1. Analysis
Comparison 6: NIBS versus any control, Outcome 1: Activities of daily living: persisting effects
6.2
6.2. Analysis
Comparison 6: NIBS versus any control, Outcome 2: Activities of daily living: immediate effects
6.3
6.3. Analysis
Comparison 6: NIBS versus any control, Outcome 3: Neglect outcomes: persisting effects
6.4
6.4. Analysis
Comparison 6: NIBS versus any control, Outcome 4: Neglect outcomes: immediate effects
6.5
6.5. Analysis
Comparison 6: NIBS versus any control, Outcome 5: Adverse events
7.1
7.1. Analysis
Comparison 7: Electrical stimulation versus any control, Outcome 1: Activities of daily living: persisting effects
7.2
7.2. Analysis
Comparison 7: Electrical stimulation versus any control, Outcome 2: Activities of daily living: immediate effects
7.3
7.3. Analysis
Comparison 7: Electrical stimulation versus any control, Outcome 3: Neglect outcomes: persisting effects
7.4
7.4. Analysis
Comparison 7: Electrical stimulation versus any control, Outcome 4: Neglect outcomes: immediate effects
8.1
8.1. Analysis
Comparison 8: Acupuncture versus any control, Outcome 1: Activities of daily living: persisting effects
8.2
8.2. Analysis
Comparison 8: Acupuncture versus any control, Outcome 2: Activities of daily living: immediate effects
8.3
8.3. Analysis
Comparison 8: Acupuncture versus any control, Outcome 3: Neglect outcomes: persisting effects
8.4
8.4. Analysis
Comparison 8: Acupuncture versus any control, Outcome 4: Neglect outcomes: immediate effects
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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    1. Vatanparasti S, Kazemnejad A, Yoonessi A, Oveisgharan S. The effect of continuous theta-burst transcranial magnetic stimulation combined with prism adaptation on the neglect recovery in stroke patients. Journal of Stroke & Cerebrovascular Diseases 2019;28(11):1-8. - PubMed
Volkening 2016 {published data only}
    1. Volkening K, Kerkhoff G, Keller I. Effects of repetitive galvanic vestibular stimulation on spatial neglect and verticality perception - a randomised sham-controlled trial. Neuropsychological Rehabilitation 2016;7:1-18. - PubMed
Welfringer 2011 {published data only}
    1. Welfringer A, Leifert-Fiebach G, Babinsky R, Brandt T. Visuomotor imagery as a new tool in the rehabilitation of neglect: a randomised controlled study of feasibility and efficacy. Disability and Rehabilitation 2011;33:2033-43. - PubMed
Wiart 1997 {published and unpublished data}
    1. Wiart L, Bon Saint Come A, Debellaix X, Petit H, Joseph PA, Mazaux JM, et al. Unilateral neglect syndrome rehabilitation by trunk rotation and scanning training. Archives of Physical Medicine and Rehabilitation 1997;78:424-9. - PubMed
Wilkinson 2014 {published data only}
    1. Wilkinson D, Zubko O, Sakel M, Coulton S, Higgins T, Pullicino P. Galvanic vestibular stimulation in hemi-spatial neglect. Frontiers in Integrative Neuroscience 2014;8(4):1-12. - PMC - PubMed
Wu 2013 {published data only}
    1. Wu C-Y, Wang T-N, Chen Y-T, Lin K-C, Chen Y-A, Li H-T, et al. Effects of constraint-induced therapy combined with eye patching on functional outcomes and movement kinematics in poststroke neglect. American Journal of Occupational Therapy 2013;67:236-45. - PubMed
Yang 2015 {published data only}
    1. Yang W, Liu T-T, Song X-B, Zhang Y, Li Z-H, Cui Z-H, et al. Comparison of different stimulation parameters of repetitive transcranial magnetic stimulation for unilateral spatial neglect in stroke patients. Journal of the Neurological Sciences 2015;359:219-25. - PubMed
Yang 2015 10Hz {published data only}
    1. Yang W, Liu T-T, Song X-B, Zhang Y, Li Z-H, Cui Z-H, et al. Comparison of different stimulation parameters of repetitive transcranial magnetic stimulation for unilateral spatial neglect in stroke patients. Journal of the Neurological Sciences 2015;359:219-25. - PubMed
Yang 2015 1Hz {published data only}
    1. Yang W, Liu T-T, Song X-B, Zhang Y, Li Z-H, Cui Z-H, et al. Comparison of different stimulation parameters of repetitive transcranial magnetic stimulation for unilateral spatial neglect in stroke patients. Journal of the Neurological Sciences 2015;359:219-25. - PubMed
Yang 2015 cTBS {published data only}
    1. Yang W, Liu T-T, Song X-B, Zhang Y, Li Z-H, Cui Z-H, et al. Comparison of different stimulation parameters of repetitive transcranial magnetic stimulation for unilateral spatial neglect in stroke patients. Journal of the Neurological Sciences 2015;359:219-25. - PubMed
Yang 2017 {published data only}
    1. Yang NY, Fong KN, Li-Tsang CW, Zhou D. Effects of repetitive transcranial magnetic stimulation combined with sensory cueing on unilateral neglect in subacute patients with right hemispheric stroke: a randomized controlled study. Clinical Rehabilitation 2017;31(9):1154-63. - PubMed
    1. Zhang RG, Liu SX, Wang FY, Ma XC, Yang YH. Treatment of unilateral neglect using repetitive transcranial magnetic stimulation (rTMS) and sensory cueing (SC) in stroke patients. Journal of Sichuan University, Medical Science Edition 2017;48(2):309‐13. - PubMed
Yi 2016 {published data only}
    1. Yi YG, Chun MH, Do KH, Sung EJ, Kwon YG, Kim DY. The effect of transcranial direct current stimulation on neglect syndrome in stroke patients. Annals of Rehabilitation Medicine 2016;40(2):223-9. - PMC - PubMed
Yi 2016 anodal {published data only}
    1. Yi YG, Chun MH, Do KH, Sung EJ, Kwon YG, Kim DY. The effect of transcranial direct current stimulation on neglect syndrome in stroke patients. Annals of Rehabilitation Medicine 2016;40(2):223-9. - PMC - PubMed
Yi 2016 cathodal {published data only}
    1. Yi YG, Chun MH, Do KH, Sung EJ, Kwon YG, Kim DY. The effect of transcranial direct current stimulation on neglect syndrome in stroke patients. Annals of Rehabilitation Medicine 2016;40(2):223-9. - PMC - PubMed
Zeloni 2002 {published data only}
    1. Zeloni G, Farne A, Baccini M. Viewing less to see better. Journal of Neurology Neurosurgery and Psychiatry 2002;73:195-8. - PMC - PubMed

References to studies excluded from this review

Akinwuntan 2010 {published data only}
    1. Akinwuntan A, Devos H, Verheyden G, Baten G, Kiekens C, Feys H, et al. Retraining moderately impaired stroke survivors in driving-related visual attention skills. Topics in Stroke Rehabilitation 2010;17(5):328-36. - PubMed
Al Mahasneh 1991 {published data only}
    1. Al Mahasneh SM. Nursing Interventions to Reduce Unilateral Neglect in Right Hemisphere Stroke Patients [Dissertation]. Ann Arbor, Michigan: University of Michigan, 1991.
Angeli 2004 {published data only}
    1. Angeli V. Recovery of oculo-motor bias in neglect patients after prism adaptation. Neuropsychologia 2004;42(9):1223-34. - PubMed
Bar‐Haim 2011 {unpublished data only}
    1. Bar-Haim Erez A, Soroker N, Averbuch S. Phasic alerting combined with visual search training: a novel therapeutic approach for unilateral spatial neglect. Data on file.
Beis 1999 {published and unpublished data}
    1. Beis J-M, Andre JM, Baumgarten A, Challier B. Eye patching in unilateral spatial neglect: efficacy of two methods. Archives of Physical Medicine and Rehabilitation 1999;80:71-6. - PubMed
Butter 1992 {published data only}
    1. Butter C, Kirsch N. Combined and separate effects of eye patching and visual stimulation on unilateral neglect following stroke. Archives of Physical Medicine and Rehabilitation 1992;73:1133-9. - PubMed
Carter 1980 {published data only}
    1. Carter L, Caruso J, Languirand M, Berard M. Cognitive skill remediation in stroke and non-stroke elderly. Clinical Neuropsychology 1980;2(3):109-13.
Chen 2014 {published data only}
    1. Chen P, Goedert K, Shah P, Foundas A, Barrett A. Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment. Brain Imaging and Behavior 2014;8(3):346-58. - PMC - PubMed
Cubelli 1993 {published data only}
    1. Cubelli R, Inzaghi MG, De Tanti A. The rehabilitation of unilateral spatial neglect: experimental verification of its effectiveness [La rieducazione della negligenza spaziale unilaterale: verifica sperimentale della sua efficacia]. Europa Medicophysica 1993;29:111-21.
Diller 1974 {published data only}
    1. Diller L, Ben Yishay Y, Gerstman LJ, Goodki R, Gordon W, Weinberg J. Studies in cognition and rehabilitation in hemiplegia. In: Rehabilitation Monograph No. 50. New York: New York University, 1974.
EEG‐NF 2009 {published data only}
    1. Smithard D. A novel neurofeedback-based intervention to reduce neglect and improve function in stroke patients. UK Clinical Research Network Portfolio Database, 2012 (http://public.ukcrn.org.uk/search/).
    1. Smithard D. Electroencephalogram-neurofeedback (EEG-NF) to improve neglect in stroke patients. Current Controlled Trials, 2009 (http://www.controlled-trials.com/).
Facchin 2019 {published data only}
    1. Facchin AE, Sartori CL, De Galeazzi A, Beschin N. Effect of prism adaptation on neglect hemianesthesia. Cortex 2019;113:298-311. - PubMed
Frassinetti 2002 {published data only}
    1. Frassinetti A, Angeli V, Meneghello F, Avanzi S, Ladavas E. Long-lasting amelioration of visuospatial neglect by prism adaptation. Brain 2002;125:608-23. - PubMed
Gordon 1985 {published data only}
    1. Gordon W, Hibbard M, Egelko S, Diller L. Perceptual remediation in patients with right brain damage: a comprehensive programme. Archives of Physical Medicine and Rehabilitation 1985;66:353-9. - PubMed
Harvey 2003 {published data only}
    1. Harvey M, Hood B, North A, Robertson IH. The effects of visuomotor feedback training on the recovery of hemispatial neglect symptoms: assessment of a 2-week and follow-up intervention. Neuropsychologia 2003;41:886-93. - PubMed
Harvey 2010 {published and unpublished data}
    1. Harvey M, Muir K, Rossit S. Long term improvements in activities of daily living in patients with hemispatial neglect. Behavioural Neurology 2010;23:249-51. - PMC - PubMed
Jacquin‐Courtois 2010 {published data only}
    1. Jacquin-Courtois S, Rode G, Pavani F, O'Shea J, Giard MH, Boisson D, et al. Effect of prism adaptation on left dichotic listening deficit in neglect patients: glasses to hear better? Brain 2010;133(3):895-908. - PubMed
Kang 2009 {published data only}
    1. Kang SH, Kim DY, Seo KM, Kwang C-A, Yoo JY, Sung SY, et al. A computerized visual perception rehabilitation programme with interactive computer interface using motion tracking technology – a randomized controlled, single-blinded, pilot clinical trial study. Clinical Rehabilitation 2009;23:434-44. - PubMed
Keller 2006 {published data only}
    1. Keller I, Beer AL, Kerkhoff G. Optokinetic stimulation in visual neglect [Optokinetische stimulation bei visuellem neglect]. Neurologie und Rehabilitation 2003;9(6):272-9.
Keller 2009 {published data only}
    1. Keller I, Lefin-Rank G, Lösch J, Kerkhoff G. Combination of pursuit eye movement training with prism adaptation and arm movements in neglect therapy: a pilot study. Neurorehabilitation and Neural Repair 2009;23(1):58-66. - PubMed
Kerkhoff 2005 {unpublished data only}
    1. Kerkhoff G, Keller I, Ritter V, Marquandt C. Repetitive optokinetic stimulation induces lasting recovery from visual neglect. Restorative Neurology and Neuroscience 2006;24:357-68. - PubMed
    1. Kerkhoff G. Personal communication 2005.
Kerkhoff 2012b {published data only}
    1. Kerkhoff G, Keller I, Artinger F, Hildebrandt H, Marquardt C, Reinhart S, et al. Recovery from auditory and visual neglect after optokinetic stimulation with pursuit eye movements - transient modulation and enduring treatment effects. Neuropsychologia 2012;50(6):1164-77. - PubMed
Klos 2005 {unpublished data only}
    1. Klos T. Personal communication, 2005.
Ladavas 2013 {published data only}
    1. Ladavas E, Giulietti S, Avenanti A, Bertini C, Lorenzini E, Quinquinio C, et al. a-tDCS on the ipsilesional parietal cortex boosts the effects of prism adaptation treatment in neglect. Restorative Neurology and Neuroscience 2015;33(5):647-62. - PubMed
Lesniak 2013 {published data only}
    1. Lesniak M, Polanowska K, Seniów J. Repeated anodal tDCS coupled with cognitive training for patients with severe traumatic brain injury - a pilot RCT. Clinical Neurophysiology 2013;124(10):179-80. - PubMed
Lincoln 1985 {published data only}
    1. Lincoln N, Whiting S, Cockburn J, Bhavnani G. An evaluation of perceptual retraining. International Rehabilitation Medicine 1985;7:99-110. - PubMed
Loverro 1988 {published data only}
    1. Loverro J, Reding M. Bed orientation and rehabilitation outcome for patients with stroke hemianopsia or visual neglect. Journal of Neurologic Rehabilitation 1988;2:147-50.
Nakamura 2015 {published data only}
    1. Nakamura J, Kita Y, Ikuno K, Kojima K, Okada Y, Shomoto K. Influence of the stimulus parameters of galvanic vestibular stimulation on unilateral spatial neglect. NeuroReport 2015;26(8):462-6. - PubMed
Niemeier 1998 {published data only}
    1. Niemeier JP. The Lighthouse Strategy: use of a visual imagery technique to treat visual inattention in stroke patients. Brain Injury 1998;12(5):399-406. - PubMed
Osawa 2010 {published data only}
    1. Osawa A, Maeshima S. Family participation can improve unilateral spatial neglect in patients with acute right hemispheric stroke. European Neurology 2010;63:170-5. - PubMed
Paolucci 1996 {published and unpublished data}
    1. Antonucci G, Guariglia C, Judica A, Magnotti L, Paolucci S, Pizzamiglio L, et al. Effectiveness of neglect rehabilitation in a randomised group study. Journal of Clinical and Experimental Neuropsychology 1995;17(3):383-9. - PubMed
    1. Paolucci S, Antonucci G, Guariglia C, Magnotti L, Pizzamiglio L, Zoccolotti P. Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: a cross-over study. Journal of Neurology 1996;243:308-14. - PubMed
Patole 2015 {published data only}
    1. Patole RR, Kulkarni VN, Rairikar SA, Shyam AK, Sancheti PK. Effect of task specific treatment in patients with unilateral neglect. Indian Journal of Physiotherapy and Occupational Therapy 2015;9(1):74-7.
Pizzamiglio 2004 {published data only}
    1. Pizzamiglio L, Fasotti L, Jehkonen M, Antonucci G, Magnotti L, Boelen D, et al. The use of opto-kinetic stimulation in rehabilitation of the hemi-neglect disorder. Cortex 2004;40:441-50. - PubMed
Rossetti 1998 {published and unpublished data}
    1. Rossetti Y, Rode G, Pisella L, Farne A, Li L, Boisson D, et al. Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect. Nature 1998;395(6698):166-9. - PubMed
Rossetti 2005 {unpublished data only}
    1. Rossetti Y. Personal communication, 2005.
Rossi 1990 {published data only}
    1. Rossi P, Kheyfets S, Reding M. Fresnel prisms improve visual perception in stroke patients with homonymous hemianopia or unilateral visual neglect. Neurology 1990;40:1597-9. - PubMed
Schindler 2002 {published data only}
    1. Schindler I, Kerkhoff G, Karnath H-O, Keller I, Goldenberg G. Neck muscle vibration induces lasting recovery in spatial neglect. Journal of Neurology, Neurosurgery and Psychiatry 2002;73:412-9. - PMC - PubMed
Schmidt 2013 {published data only}
    1. Schmidt L, Keller I, Utz KS, Artinger F, Stumpf O, Kerkhoff G. Galvanic vestibular stimulation improves arm position sense in spatial neglect: a sham-stimulation-controlled study. Neurorehabilitation and Neural Repair 2013;27(6):497-506. - PubMed
Serino 2006 {published data only}
    1. Serino A, Angeli V, Frassinetti F, Ladavas E. Mechanisms underlying neglect recovery after prism adaptation. Neuropsychologia 2006;44:1068-78. - PubMed
Serino 2009 {published data only}
    1. Serino A, Barbiani M, Rinaldesi ML, Ladavas E. Effectiveness of prism adaptation in neglect rehabilitation: a controlled trial study. Stroke 2009;40:1392-8. - PubMed
Svaerke 2019 {published data only}
    1. Svaerke KW, Omkvist KV, Havsteen IB, Christensen HK. Computer-based cognitive rehabilitation in patients with visuospatial neglect or homonymous hemianopia after stroke. Journal of Stroke & Cerebrovascular Diseases 2019;28(11):1-9. - PubMed
Tham 1997 {published data only}
    1. Tham K, Tegner R. Video feedback in the rehabilitation of patients with unilateral neglect. Archives of Physical Medicine and Rehabilitation 1997;78:410-3. - PubMed
Toglia 2009 {published data only}
    1. Toglia J, Cermak SA. Dynamic assessment and prediction of learning potential in clients with unilateral neglect. American Journal of Occupational Therapy 2009;63(5):569-79. - PubMed
Trudell 2003 {published data only}
    1. Trudell C, Bodian L, Demaio JH, Cheskes BE, Reding M. Comparison of hemi-field fresnel prisms versus patching for visual neglect after stroke. Archives of Physical Medicine and Rehabilitation 2003;84:A9.
Turgut 2018 {published data only}
    1. Turgut N, Möller L, Dengler K, Steinberg K, Sprenger A, Eling P, et al. Adaptive cueing treatment of neglect in stroke patients leads to improvements in activities of daily living: a randomized controlled, crossover trial. Neurorehabilitation & Neural Repair 2018;32(11):988-98. - PubMed
Vaes 2016 {published data only}
    1. Vaes N, Nys G, Lafosse C, Dereymaeker L, Oostra K, Hemelsoet D, et al. Rehabilitation of visuospatial neglect by prism adaptation: effects of a mild treatment regime. A randomised controlled trial.. Neuropsychological Rehabilitation 2016;28(6):899-918. - PubMed
Van Kessel 2013 {published data only}
    1. Van Kessel ME, Geurts ACH, Brouwer WH, Fasotti L. Visual scanning training for neglect after stroke with and without a computerized lane tracking dual task. Frontiers in Human Neuroscience 2013;7:358. - PMC - PubMed
Van Os 1991 {published data only}
    1. Van Os ES, Driessen M-J, Wagenaar RC. Visual scanning training in stroke patients. Nederlands Tijdschrift voor Ergotherapie 1991;19:47-53.
Van Puymbroeck 2014 {published data only}
    1. Van Puymbroeck M, Allsop J, Miller KK, Schmid AA. Improvements in ICF components in individuals with chronic stroke following a yoga-based intervention. American Journal of Recreation Therapy 2014;95(10):24.
Webster 2001 {published data only}
    1. Webster JS, McFarland PT, Rapport LJ, Morrill B, Roades LA, Abadee PS. Computer-assisted training for improving wheelchair mobility in unilateral neglect patients. Archives of Physical Medicine and Rehabilitation 2001;82:769-75. - PubMed
Weinberg 1977 {published data only}
    1. Weinberg J, Diller L, Gordon W, Gerstman L, Lieberman A, Lakin P, et al. Visual scanning training effect on reading-related tasks in acquired right brain damage. Archives of Physical Medicine and Rehabilitation 1977;58:479-86. - PubMed
Weinberg 1979 {published data only}
    1. Weinberg J, Diller L, Gordon W, Gerstman L, Lieberman A, Lakin P, et al. Training sensory awareness and spatial organisation in people with right brain damage. Archives of Physical Medicine and Rehabilitation 1979;60:491-7. - PubMed
Weinberg 1982 {published data only}
    1. Weinberg J, Piasetsky E, Diller L, Gordon W. Treating perceptual organisation deficits in nonneglecting RBD stroke patients. Journal of Clinical Neuropsychology 1982;4(1):59-75. - PubMed
Young 1983 {published data only}
    1. Young G, Collins D, Hren M. Effect of pairing scanning training with block design training in the remediation of perceptual problems in left hemiplegics. Journal of Clinical Neuropsychology 1983;5(3):210-2. - PubMed

References to studies awaiting assessment

Cazzoli 2015 {published data only}
    1. Cazzoli D, Rosenthal CR, Kennard C, Zito GA, Hopfnere S, Muri RM, et al. Theta burst stimulation improves overt visual search in spatial neglect independently of attentional load. Cortex 2015;73:317-29. - PubMed
Chan 2013 {published data only}
    1. Chan DYK, ManDWK. Unilateral neglect in stroke: a comparative study. Topics in Geriatric Rehabilitation: 2013;29(2):126-34.
Hauer 2007 {published and unpublished data}
    1. Hauer B, Qirbach A. Unilateral neglect: prism adaptation as an economic and effective therapy? [Unilateraler Neglect: Prismenadaptation als ökonomische und effefktive Therapie?]. Zeitschrift für Neuropsychologie 2007;18(3):171-81.
Marandola 2020 {published data only}
    1. Marandola MM, Jimenez-Martin I, Rodriguez-Yanez M, Arias-Rivas S, Santamaria-Calavid M, Castillo J. Constraint-induced movement therapy in the rehabilitation of hemineglect after a stroke. Revista de Neurologia 2020;70(4):119-26. - PubMed
Park 2021 {published data only}
    1. Park JH. The effects of robot-assisted left-hand training on hemispatial neglect in older patients with chronic stroke. Medicine (Baltimore) 2021;100(9):e24781. - PMC - PubMed
Saevarsson 2010 {published data only}
    1. Saevarsson S, Kristjánsson Á, Halsband U. Strength in numbers: combining neck vibration and prism adaptation produces additive therapeutic effects in unilateral neglect. Neuropsychological Rehabilitation 2010;20(5):704–24. - PMC - PubMed
Toglia 2020 {published data only}
    1. Toglia J, Chen P. Spatial exploration strategy training for spatial neglect: a pilot study. Neuropsychological Rehabilitation 2020;online:1. - PMC - PubMed
Vilimovsky 2021 {published data only}
    1. Vilimovsky T, Chen P, Hoidekrova K, Petioky J, Harsa P. Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: a randomized pilot and feasibility trial. PLoS ONE 2021;16(1):1-17. - PMC - PubMed
Zigiotto 2020 {published data only}
    1. Zigiotto L, Damora A, Albini F, Casati C, Scrocco G, Mancuso M, et al. Multisensory stimulation for the rehabilitation of unilateral spatial neglect. Neuropsychological Rehabilitation 2020;online:1. - PubMed

References to ongoing studies

Elshout 2018 {published data only}
    1. Elshout JA, Nijboer TCW, Van Der Stigchel S. Is congruent movement training more effective than standard visual scanning therapy to ameliorate symptoms of visuospatial neglect? Study protocol of a randomised control trial. BMJ Open 2019;9(12):1-6. - PMC - PubMed
ISRCTN88395268 {published data only}http://www.isrctn.com/ISRCTN88395268
    1. ISRCTN88395268. A feasibility study for attention loss after stroke [A feasibility study of prisms and therapy in attention loss after stroke (SPATIAL feasibility)]. https://www.isrctn.com/ISRCTN88395268 (first received 8 January 2019).
Luvizutto 2017 {unpublished data only}RBR‐78jvzx
    1. Luvizutto GJ, Rizzati GRS, Fogaroli MO, Rodrigues RT, Ribeiro PW, Carvalho Nunes HR, et al. Treatment of unilateral spatial neglect after stroke using transcranial direct current stimulation (ELETRON trial): study protocol for a randomized controlled trial. Trials 2016;17(1):479. - PMC - PubMed
NCT00989430 {unpublished data only}
    1. NCT00989430. Prism adaptation therapy for spatial neglect [Prism adaptation therapy for spatial neglect: theoretical and practical outcomes]. https://clinicaltrials.gov/ct2/show/NCT00989430 (first received 5 October 2009).
NCT02213640 {unpublished data only}
    1. NCT02213640. Potentiation of the effects of prismatic adaptation by transcranial direct current stimulation (tDCS): evaluation of functional interest in negligence rehabilitation (PRIStiM1). https://clinicaltrials.gov/ct2/show/NCT02213640 (first received 11 August 2014).
NCT02680171 {unpublished data only}
    1. NCT02680171. Feasibility and effectiveness study of implementing prism adaptation as a treatment for spatial neglect after stroke [Feasibility and effectiveness study of implementing prism adaptation as a treatment for spatial neglect after right hemisphere stroke]. https://clinicaltrials.gov/ct2/show/NCT02680171 (first received 11 February 2016).
NCT03168360 {published data only}
    1. NCT03168360. Effect of intensive cognitive rehabilitation in subacute stroke patient. https://clinicaltrials.gov/ct2/show/NCT03168360 (first received 30 May 2017).
NCT03317860 {published data only}
    1. NCT03317860. Improving measurement and treatment of post-stroke neglect. https://clinicaltrials.gov/ct2/show/NCT03317860 (first received 23 October 2017).
NCT03402906 {published data only}
    1. NCT03402906. Family-clinician collaboration to improve neglect and rehabilitation outcome after stroke. https://clinicaltrials.gov/ct2/show/NCT03402906 (first received 18 January 2018).
NCT03451708 {published data only}
    1. NCT03451708. OKS for the treatment of hemispatial neglect [Optokinetic stimulation for the treatment of hemispatial neglect - safety and efficacy studies]. https://clinicaltrials.gov/ct2/show/NCT03451708 (first received 2 March 2018).
NCT03458611 {published data only}
    1. NCT03458611. Virtual Reality Attention Training in stroke patients (VRAT) [Virtual reality attention training in stroke patients]. https://clinicaltrials.gov/ct2/show/NCT03458611 (first received 8 March 2018).
NCT03854487 {published data only}
    1. NCT03854487. Effect of mirror therapy on unilateral neglect for patients after stroke. https://clinicaltrials.gov/ct2/show/NCT03854487 (first received 26 February 2019).
NCT03887962 {published data only}
    1. NCT03887962. Virtual environment rehabilitation for patients with motor neglect trial (VERMONT) [Trial of virtual reality biofeedback in patients with motor neglect from chronic pain or cerebrovascular disease]. https://clinicaltrials.gov/ct2/show/NCT03887962 (first received 25 March 2019).
NCT04080999 {published data only}
    1. NCT04080999. Repetitive transcranial magnetic stimulation in spatial attention after stroke (r-TMS) [Efficacy of repetitive transcranial magnetic stimulation (r-TMS) combined with conventional cognitive treatment on cognitive-behavioral symptoms of left hemispatial neglect in right-stroke patients within three months post-onset compared to conventional cognitive treatment only: a randomized controlled trial]. https://clinicaltrials.gov/ct2/show/NCT04080999 (first received 6 September 2019).
NCT04227132 {published data only}
    1. NCT04227132. Evaluation of an adaptive computerized training for rehabilitation of spatial neglect in stroke survivors (MULTITASK) [Modulation of visuospatial awareness during multi-tasking in right hemisphere stroke patients: towards novel behavioural and neurofunctional predictors of impairments and recovery of the attentional network]. https://clinicaltrials.gov/ct2/show/NCT04227132 (first received 13 January 2020).
NCT04273620 {published data only}
    1. NCT04273620. Combined optokinetic stimulation and cueing-based reading therapy to treat hemispatial neglect following stroke (OKS-READ) [Randomized controlled trial of combined optokinetic stimulation and cueing-based reading therapy to treat hemispatial neglect following stroke (OKS-READ study)]. https://clinicaltrials.gov/ct2/show/NCT04273620 (first received 18 February 2020).
NL8145 {published data only}
    1. NL8145. Modulating connectivity with non-invasive brain stimulation during spatial neglect rehabilitation. https://www.trialregister.nl/trial/8145 (first received 10 September 2019).
Olson 2020 {unpublished data only}
    1. Caloric vestibular stimulation for treatment of unilateral neglect. Ongoing study. Unknown. Contact author for more information.

Additional references

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References to other published versions of this review

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