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Ann Phys Rehabil Med. 2017 Jun;60(3):191-197. doi: 10.1016/ Epub 2016 Dec 13.

Rehabilitation of unilateral neglect: Evidence-based medicine.

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AP-HP, hôpital Raymond-Poincaré, service de médecine physique et de réadaptation, 92380 Garches, France; EA 4047 HANDIReSP, université de Versailles-Saint-Quentin, 78180 Montigny-Le-Bretonneux, France. Electronic address:
Service de médecine physique et de réadaptation, rééducation neurologique, hôpital Henry-Gabrielle, CHU de Lyon, 69230 Saint-Genis-Laval, France; Université de Lyon, université Lyon 1, 69100 Villeurbanne, France; Centre de recherche en neuroscience de Lyon (CRNL), équipe IMPACT, Inserm, U1028, CNRS, UMR5292, 69675 Bron, France.



In the last decades, several rehabilitation methods have been developed to improve spatial neglect. These can be classified according to their theoretical basis: (i) enhance awareness of neglect behaviour through a top-down mechanism; (ii) low-level bottom-up sensory stimulation; (iii) modulation of inhibitory processes; (iv) increase arousal.


The purpose of this study was to provide an overview of the evidence on the effectiveness of rehabilitation procedures for unilateral neglect.


A systematic search was performed to look for all randomised controlled trials aimed at reducing left spatial neglect that included a functional assessment. In addition, recent review papers and meta-analyses were analysed.


Thirty-seven randomized controlled trials were found (12 bottom-up; 12 top-down; 1 interhemispheric competition; 12 combination of approaches) that included 1027 patients with neglect. Although there are some encouraging results, overall, the level of evidence remains low. Poor methodological quality and small sample sizes are major limitations in many published trials.


There is a need for well-conducted, large-scale randomised controlled trials that incorporate blinded assessments, evaluation of the generalization to activities of daily living and long-term follow-up.


Rehabilitation; Stroke; Unilateral neglect

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