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

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.

• Authors: Ana Paula S Salazar, Patrícia G Vaz, Ritchele R Marchese, Cinara Stein, Camila Pinto, Aline S Pagnussat
• Journal: Archives of physical medicine and rehabilitation (Arch Phys Med Rehabil) Vol. 99 Issue 2 Pg. 355-366.e1 (02 2018) ISSN: 1532-821X [Electronic] United States
• PMID: 28802812 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Topics

• Activities of Daily Living
• Humans
• Perceptual Disorders (etiology, therapy)
• Recovery of Function
• Stroke (complications)
• Stroke Rehabilitation (methods)
• Transcranial Direct Current Stimulation
• Transcranial Magnetic Stimulation