Right-hemispheric activation approaches to neglect rehabilitation poststroke

Unilateral neglect is a common neurological syndrome resulting from right-hemisphere strokes and has important prognostic value for functional outcome. This article identifies three approaches to neglect rehabilitation that are based on right-hemispheric activation mechanisms: (a) the lateralized task approach, (b) the controlled sensory stimulation approach, and (c) the limb activation approach. Their theoretical bases, experimental findings, and practical implications for neglect remediations are discussed. Meta-analytic procedures were used to critically review and statistically combine the results from potentially relevant studies, including 9 group design studies and 22 single-subject studies. An overall mean effect size r of .77 was found for the group design studies. For the studies with individual subjects as units of analysis, an overall mean r of .89 was obtained. This review provided empirical support for intervention in cases of unilateral neglect on the basis of brain activation mechanisms. Some appropriate areas for further research include evaluating treatment efficacy against functional criteria, refining intervention procedures in keeping with the advances in brain activation research, and identifying the optimal conditions for promoting generalized training.