Rehabilitation of unilateral neglect: Evidence-based medicine

In the last decades, several rehabilitation methods have been developed to improve spatial neglect. These can be classified according to their theoretical basis: (i) enhance awareness of neglect behaviour through a top-down mechanism; (ii) low-level bottom-up sensory stimulation; (iii) modulation of inhibitory processes; (iv) increase arousal.

The purpose of this study was to provide an overview of the evidence on the effectiveness of rehabilitation procedures for unilateral neglect.

A systematic search was performed to look for all randomised controlled trials aimed at reducing left spatial neglect that included a functional assessment. In addition, recent review papers and meta-analyses were analysed.

Thirty-seven randomized controlled trials were found (12 bottom-up; 12 top-down; 1 interhemispheric competition; 12 combination of approaches) that included 1027 patients with neglect. Although there are some encouraging results, overall, the level of evidence remains low. Poor methodological quality and small sample sizes are major limitations in many published trials.

There is a need for well-conducted, large-scale randomised controlled trials that incorporate blinded assessments, evaluation of the generalization to activities of daily living and long-term follow-up.