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)To read this article in full you will need to make a payment
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References
- The impact of recovery of visuo-spatial neglect on motor recovery of the upper paretic limb after stroke.PLoS One. 2014; 9: e100584
- Non-invasive brain stimulation in neglect rehabilitation: an update.Front Hum Neurosci. 2013; 7: 248
- Hemispatial neglect: subtypes, neuroanatomy, and disability.Neurology. 2004; 62: 749-756
- Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke.Stroke. 1999; 30: 1196-1202
- The anatomy underlying acute versus chronic spatial neglect: a longitudinal study.Brain. 2011; 134: 903-912
- An integrative review of factors associated with falls during post-stroke rehabilitation.J Nurs Scholarsh. 2010; 42: 395-404
- Rehabilitation interventions for unilateral neglect after stroke: a systematic review from 1997 through 2012.Front Hum Neurosci. 2013; 7: 187
- Limb activation ameliorates body-related deficits in spatial neglect.Front Hum Neurosci. 2012; 6: 188
- Stroke rehabilitation using noninvasive cortical stimulation: hemispatial neglect.Expert Rev Neurother. 2012; 12: 983-991
- Hemi-spatial neglect rehabilitation using non-invasive brain stimulation: or how to modulate the disconnection syndrome?.Ann Phys Rehabil Med. 2015; 58: 251-258
- Repetitive transcranial magnetic stimulation and transcranial direct current stimulation in motor rehabilitation after stroke: an update.Ann Phys Rehabil Med. 2015; 58: 220-224
- Orientational bias model of unilateral neglect: evidence from attentional gradients within hemispace.in: Robertson I. Marshall J. Unilateral neglect: clinical and experimental studies. Erlbaum, Hillsdale1993: 63-86
- Effect of high- and low-frequency repetitive transcranial magnetic stimulation on visuospatial neglect in patients with acute stroke: a double-blind, sham-controlled trial.Arch Phys Med Rehabil. 2013; 94: 803-807
- The effect of transcranial direct current stimulation on neglect syndrome in stroke patients.Ann Rehabil Med. 2016; 40: 223-229
- Theta-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect.Neurology. 2012; 78: 24-30
- Effect of combination of transcranial direct current stimulation and feedback training on visuospatial neglect in patients with subacute stroke: a pilot randomized controlled trial.J Phys Ther Sci. 2015; 27: 2759-2761
- Effects of repetitive transcranial magnetic stimulation on arm function and decreasing unilateral spatial neglect in subacute stroke: a randomized controlled trial.Clin Rehabil. 2016; 30: 649-656
- The effects of repetitive transcranial magnetic stimulation on unilateral neglect of acute stroke patients: a randomised controlled trial.Hong Kong Physiother J. 2015; 33: 53-58
- Long-term effects of continuous theta-burst stimulation in visuospatial neglect.J Int Med Res. 2015; 43: 196-203
- Comparison of different stimulation parameters of repetitive transcranial magnetic stimulation for unilateral spatial neglect in stroke patients.J Neurol Sci. 2015; 359: 219-225
- Low-frequency transcranial magnetic stimulation for visual spatial neglect: a pilot study.J Rehabil Med. 2009; 41: 162-165
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Int J Surg. 2010; 8: 336-341
- Reliability of the PEDro scale for rating quality of randomized controlled trials.Phys Ther. 2003; 83: 713-721
- Scales to assess the quality of randomized controlled trials: a systematic review.Phys Ther. 2008; 88: 156-175
- GRADE guidelines: 3. Rating the quality of evidence.J Clin Epidemiol. 2011; 64: 401-406
- Line bisection and unilateral visual neglect in patients with neurologic impairment.Neurology. 1980; 30: 509-517
- Improving the sensitivity of the Barthel Index for stroke rehabilitation.J Clin Epidemiol. 1989; 42: 703-709
- Cochrane handbook for systematic reviews of interventions.5th ed. John Wiley & Sons, Chichester2011
- Statistical power analysis for the behavioral sciences.2nd ed. Lawrence Erlbaum Associates, Hillsdale1988
- Intermittent theta burst stimulation modulates resting-state functional connectivity in the attention network and promotes behavioral recovery in patients with visual spatial neglect.Neuroreport. 2016; 27: 1261-1265
- Effects of repetitive transcranial magnetic stimulation combined with sensory cueing on unilateral neglect in subacute patients with right hemispheric stroke: a randomized controlled study.Clin Rehabil. 2017; 31: 1154-1163
- Theta burst stimulation reduces disability during the activities of daily living in spatial neglect.Brain. 2012; 135: 3426-3439
- Improvement of visual scanning after DC brain polarization of parietal cortex in stroke patients with spatial neglect.Neurosci Lett. 2008; 448: 171-174
- Effects of dual transcranial direct current stimulation on post-stroke unilateral visuospatial neglect.Neurosci Lett. 2013; 554: 94-98
- Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS.Nat Clin Pract Neurol. 2007; 3: 383-393
- Use of theta-burst stimulation in changing excitability of motor cortex: a systematic review and meta-analysis.Neurosci Biobehav Rev. 2016; 63: 43-64
- Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans.Neurology. 2001; 57: 1899-1901
- Non-invasive brain stimulation improves paretic limb force production: a systematic review and meta-analysis.Brain Stimul. 2016; 9: 662-670
- Mechanisms underlying transcranial direct current stimulation in rehabilitation.Ann Phys Rehabil Med. 2015; 58: 214-219
- Neuroplasticity and its applications for rehabilitation.Am J Ther. 2011; 18: 70-80
- Transcranial magnetic stimulation combined with upper-limb training for improving function after stroke: a systematic review and meta-analysis.J Neurol Sci. 2016; 369: 149-158
- Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke.Front Psychiatry. 2012; 3: 88
- Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke.Cochrane Database Syst Rev. 2016; 3: CD009645
- Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect.Arch Phys Med Rehabil. 1999; 80: 379-384
- Recovery of functional status after right hemisphere stroke: relationship with unilateral neglect.Arch Phys Med Rehabil. 2001; 82: 322-328
- Activity among long-term stroke survivors. A study based on an ICF-oriented analysis of two established ADL and social activity instruments.Disabil Rehabil. 2016; 38: 2028-2037
- Reliability (inter-rater agreement) of the Barthel Index for assessment of stroke survivors: systematic review and meta-analysis.Stroke. 2013; 44: 462-468
- Safety of transcranial direct current stimulation: evidence based update 2016.Brain Stimul. 2016; 9: 641-661
- Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research.Clin Neurophysiol. 2009; 120: 2008-2039
Article info
Publication history
Published online: August 09, 2017
Footnotes
Clinical Trial Registration No.: PROSPERO CRD42016053049.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine