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

Abstract

ObjectivesThe 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.MethodsStudies 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.ResultsEight 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.ConclusionIntervention 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.

Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect

“…The present results can be compared with common clinical interventions for neglect, which typically involve therapist‐administered “top‐down” self‐cueing strategies (eg, “look left”) that typically rely on adequate recall of the behavioral strategy (an approach that might not be conducive for patients with deficit awareness issues) 48 and experimental interventions, which have largely applied “bottom‐up” approaches (eg, optokinetic stimulation, repetitive transcranial magnetic stimulation, prism adaptation). Although a lack of shared methods in neglect research has prevented one‐to‐one comparisons between interventions (eg, 50 different outcome measures were used in a variety of combinations across 20 studies included in a recent meta analysis 79 ), notable improvements have been demonstrated across several therapies 45,79–83 . A recent review of intervention trials for neglect 80 found 7 of 15 randomized controlled trials with statistically significant between‐group differences in favor of the experimental group, but only 4 studies 84–87 that showed large effect sizes (Cohen's d > 0.80).…”