Cognitive rehabilitation for spatial neglect following stroke

• Published in: Cochrane database of systematic reviews 2013-07, Vol.2013 (7), p.CD003586-CD003586
• Main Authors: Bowen, Audrey, Hazelton, Christine, Pollock, Alex, Lincoln, Nadina B
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Cognitive Behavioral Therapy; Heart & circulation; Humans; Neurology; Perceptual Disorders - etiology; Perceptual Disorders - rehabilitation; PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE; Randomized Controlled Trials as Topic; Sensation Disorders - etiology; Sensation Disorders - rehabilitation; Space Perception; Stroke - complications; Stroke Rehabilitation
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD003586.pub3

Unilateral spatial neglect causes difficulty attending to one side of space. Various rehabilitation interventions have been used but evidence of their benefit is lacking. To assess whether cognitive rehabilitation improves functional independence, neglect (as measured using standardised assessments), destination on discharge, falls, balance, depression/anxiety and quality of life in stroke patients with neglect measured immediately post-intervention and at longer-term follow-up; and to determine which types of interventions are effective and whether cognitive rehabilitation is more effective than standard care or an attention control. We searched the Cochrane Stroke Group Trials Register (last searched June 2012), MEDLINE (1966 to June 2011), EMBASE (1980 to June 2011), CINAHL (1983 to June 2011), PsycINFO (1974 to June 2011), UK National Research Register (June 2011). We handsearched relevant journals (up to 1998), screened reference lists, and tracked citations using SCISEARCH. We included randomised controlled trials (RCTs) of cognitive rehabilitation specifically aimed at spatial neglect. We excluded studies of general stroke rehabilitation and studies with mixed participant groups, unless more than 75% of their sample were stroke patients or separate stroke data were available. Two review authors independently selected studies, extracted data, and assessed study quality. For subgroup analyses, review authors independently categorised the approach underlying the cognitive intervention as either 'top-down' (interventions that encourage awareness of the disability and potential compensatory strategies) or 'bottom-up' (interventions directed at the impairment but not requiring awareness or behavioural change, e.g. wearing prisms or patches). We included 23 RCTs with 628 participants (adding 11 new RCTs involving 322 new participants for this update). Only 11 studies were assessed to have adequate allocation concealment, and only four studies to have a low risk of bias in all categories assessed. Most studies measured outcomes using standardised neglect assessments: 15 studies measured effect on activities of daily living (ADL) immediately after the end of the intervention period, but only six reported persisting effects on ADL. One study (30 participants) reported discharge destination and one study (eight participants) reported the number of falls.Eighteen of the 23 included RCTs compared cognitive rehabilitation with any control intervention (placebo, a