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Noninvasive Brain Stimulation Improves Hemispatial Neglect After Stroke: A Systematic Review and Meta-Analysis

  • Ana Paula S. Salazar
    Correspondence
    Corresponding author Ana Paula S. Salazar, MSc, Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245 Sarmento Leite Street, 90050170 Porto Alegre RS, Brazil.
    Affiliations
    Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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  • Patrícia G. Vaz
    Affiliations
    Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Centro Universitário Ritter dos Reis (UniRitter), Laureate International Universities, Porto Alegre, Brazil
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  • Ritchele R. Marchese
    Affiliations
    Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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  • Cinara Stein
    Affiliations
    Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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  • Camila Pinto
    Affiliations
    Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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  • Aline S. Pagnussat
    Affiliations
    Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Published:August 09, 2017DOI:https://doi.org/10.1016/j.apmr.2017.07.009

      Abstract

      Objective

      To evaluate the effectiveness of noninvasive brain stimulation (NIBS)—repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)—on hemispatial neglect and performance in activities of daily living (ADL) after stroke.

      Data Sources

      MEDLINE (PubMed), EMBASE, Cochrane CENTRAL, Scopus, SciELO, and Physiotherapy Evidence Database were searched from database inception to December 2016.

      Data Selection

      Randomized controlled trials or crossover trials focused on determining the effects of tDCS or rTMS combined or not combined with other therapies for hemispatial neglect after stroke.

      Data Extraction

      Methodological characteristics of the studies, number of participants, comparison groups, interventions, and outcomes were extracted.

      Data Synthesis

      Ten trials comprising 226 participants had data that were suitable for the meta-analysis. Meta-analysis showed that NIBS combined with other therapies significantly improves hemispatial neglect (standardized mean difference [SMD]=–1.91; 95% confidence interval [CI], –2.57 to –1.25; I2=71%). A sensitivity analysis showed that rTMS (SMD=–2.16; 95% CI, –3.00 to –1.33; I2=76%) and tDCS (SMD=–1.07; 95% CI, –1.76 to –0.37; I2=0%) had positive effects on hemispatial neglect. Furthermore, both excitatory (SMD=–2.34; 95% CI, –3.56 to –1.12; I2=65%) and inhibitory (SMD=–1.69; 95% CI, –2.49 to –0.88; I2=75%) stimulations were effective.

      Conclusions

      This meta-analysis reveals moderate-quality evidence for the effectiveness of NIBS protocols combined with other therapies on hemispatial neglect and performance in ADL after stroke.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), a-tDCS (anodal tDCS), CI (confidence interval), cTBS (continuous TBS), NIBS (noninvasive brain stimulation), PEDro (Physiotherapy Evidence Database), rTMS (repetitive transcranial magnetic stimulation), SMD (standardized mean difference), TBS (theta burst stimulation), tDCS (transcranial direct current stimulation)
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