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Purpose: There is widespread acceptance that patients demonstrating neglect/hemi-inattention (HI) following right hemisphere stroke (RHS) underachieve functionally compared to their counterparts without neglect. However, empirical evidence for this view needs examination. The purpose of this review is to critically appraise relevant studies that compared outcomes from RHS patients with/without hemi-attention and suggest more robust follow-up research.Method: Twelve studies published in 1995–2013 were critically reviewed. Two independent reviewers appraised design features including sample representation, assessment and data analysis methods. Strengths and limitations were highlighted.Results: Results were largely inconsistent. Considerable heterogeneity within patient groups and across studies complicated interpretation. Evidence suggested average group disparity in scores between patients with and without HI at discharge but the cause of functional disparity could not be attributed specifically to HI from the data and modelling results available.Conclusion: The relationship between HI status and functional recovery warrants further investigation in studies with stronger methodology to ensure rigour and robustness in the results. Pending further research, HI status should not be regarded as a key predictor of functional recovery or rehabilitation potential in patients with RHSs. This group should continue to receive appropriate therapeutic intervention aimed at maximising their functional recovery post-stroke.Implications for RehabilitationFindings from this review demonstrate a paucity of evidence to support the presence of hemi-inattention as a key predictor of functional recovery in patients with right hemisphere stroke; as such, practitioners should take this into consideration when planning rehabilitation programmes of their patients.In the initial months following right hemisphere stroke, there are wide-ranging differences in the rate and amount of functional recovery in patients, with and without hemi-inattention. Practitioners should not limit the aspirations of their patients based on the presence or absence of hemi-inattention.This review has identified a number of measurement limitations in commonly employed assessment tools for hemi-inattention and overall functional recovery. As such, practitioners should take the limitations of specific measures into account when interpreting the results contextually and with respect to their patients’ situation. [ABSTRACT FROM AUTHOR]

Objective: In recent years it has emerged that the attentional disorder of visuo-spatial neglect can be overcome via artificial stimulation of the balance system. One means of achieving this is via galvanic vestibular stimulation (GVS), a simple procedure in which tiny, electrical currents are discharged to the part of the scalp overlying the vestibular nerves. Attempts to remediate neglect with GVS have utilized only a single session of stimulation and, although this can induce spontaneous recovery, symptoms resurface soon after stimulation. This study assessed whether repeated sessions induce longer carry-over. Methods: Two individuals diagnosed with neglect post-stroke received 5 days of sub-sensory, left anodal GVS. Performance was assessed via the letter and star cancellation tasks of the Behavioural Inattention Test on four occasions; 3 days before the start of stimulation, on the first and last day of stimulation and 3-days after stimulation. Results: Analyses of variance indicated that both participants missed significantly fewer targets in both tasks on the fifth day of stimulation compared to baseline. More so, this improvement was still evident at follow-up 3 days later. Conclusion: The results strengthen the need for a larger, sham-controlled trial to establish whether repeated GVS provides lasting relief from neglect. [ABSTRACT FROM AUTHOR]

The aim of the review was to determine, from a physiotherapeutic perspective, existing tools that assess neglect and whether there was support for the positive effect of physiotherapeutic interventions on neglect after stroke. The review was based on publicized randomized controlled studies and reviews about neglect and stroke. The databases PubMed (Medline), Ahmed, Cinahl, PeDRO and PsycINFO were queried from 1980 until March 2007. A checklist from the Swedish Council on Technology Assessment in Health Care (SBU) was used to evaluate the quality of randomized controlled studies; a model for analysis of systematic reviews from SBU was used for reviews. Specific training for the neglect syndrome was recommended. There was moderate evidence for spatio-motor cueing and scanning training towards the effected side. The literature also indicated that trunk rotation or repeated neck muscle vibrations when associated with an extensive training programme, mental imagery training, video feedback training and prism adaptation could be recommended for the rehabilitation of stroke patients with neglect. Treatment with Constraint-Induced Movement Therapy (CIMT) has shown some promising results. None of the tools designed to assess neglect evaluated physical performance. From a physiotherapeutic point of view, there is limited evidence for treatment of patients with neglect after stroke and the way neglect should be assessed. Scanning training and activation of the affected hemisphere with spatio-motor cueing can be effectual. Several assessment tools in combination are recommended. Further randomized controlled trials with larger samples concerning physiotherapeutic interventions are warranted, in order to evaluate new techniques targeting cognitive processes contributing to clinical manifestations of neglect. [ABSTRACT FROM AUTHOR]