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Updated: May 10, 2026
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Randomized, Triple-Blind, and Parallel-Controlled Trial of Transcranial Direct Current Stimulation for Cognitive Rehabilitation after Stroke
Published on: June 6, 2025
Cognitive rehabilitation for spatial neglect following stroke
Audrey Bowen1, Christine Hazelton, Alex Pollock
1Stroke and Vascular Research Centre, Clinical Sciences Building, University of Manchester, Salford, UK. audrey.bowen@manchester.ac.uk.
The Cochrane Database of Systematic Reviews
|July 2, 2013
Summary
Cognitive rehabilitation for unilateral spatial neglect in stroke patients lacks proven effectiveness for long-term functional independence. While immediate improvements in neglect assessments were observed, high-quality studies show no significant benefit.
Area of Science:
- Neurorehabilitation
- Cognitive Psychology
- Stroke Recovery
Background:
- Unilateral spatial neglect is a common post-stroke deficit affecting attention to one side of space.
- Existing rehabilitation interventions for spatial neglect have limited evidence supporting their efficacy.
Purpose of the Study:
- To evaluate the effectiveness of cognitive rehabilitation for improving functional independence and neglect in stroke patients.
- To assess immediate and long-term outcomes, including discharge destination, falls, balance, mood, and quality of life.
- To compare cognitive rehabilitation against standard care or attention control interventions.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) specifically targeting spatial neglect in stroke patients.
- Searched multiple databases (Cochrane Stroke Group, MEDLINE, EMBASE, CINAHL, PsycINFO) up to June 2012.
- Independent selection, data extraction, and quality assessment by two reviewers; categorization of interventions as 'top-down' or 'bottom-up'.
Main Results:
- Included 23 RCTs with 628 participants; only 11 studies had adequate allocation concealment and four had low risk of bias.
- Meta-analyses showed no statistically significant effect of cognitive rehabilitation on persisting activities of daily living (ADL) or neglect assessments.
- A statistically significant immediate effect favoring cognitive rehabilitation was found for neglect assessments, but this was lost in high-quality studies; attention control subgroup showed some benefit.
Conclusions:
- The overall effectiveness of cognitive rehabilitation for reducing neglect and increasing independence in stroke patients remains unproven.
- Current evidence does not support or refute specific rehabilitation approaches for spatial neglect.
- Limited evidence suggests potential immediate benefits on neglect tests, warranting further high-quality RCTs with appropriate controls and long-term follow-up.
