| Abstract [eng] |
Stroke is the second leading cause of death and third leading cause of disability worldwide. Cognitive impairment post stroke commonly occurs in patients with the manifestation ranging from impairment in memory, to attention, to executive function to processing speed. Thess effects can impair a patients live for years. Visuospatial neglect (USN) occurrs in around 20–82% of stroke patients. USN impairs functional recovery process and has a severely negative impact on Activities of daily living (ADL). Despite many years of research and its severe negative effects, no single intervention has proven to be the gold standard, highlighting the need for a comprehensive comparative overview. The aim of this narrative literature review was to provide this comprehensive overview and compare the effectiveness of the most commonly researched visuospatial neglect rehabilitation techniques. To do so the objectives were 1st to evaluate the effectiveness of prism adaptation (PA), virtual reality (VR) assisted rehabilitation, mirror therapy, robot assisted therapy, transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS). 2nd compare effectiveness across modalities and 3rd identify key methodological limitations and formulate recommendations for future research. A structured literature search was conducted in PubMed using MeSH term consisting of visuospatial neglect, stroke and most common rehabilitation interventions. Studies published between January 2015 and December 2025 which included adult stroke patient with USN were included. Included designs comprised randomized controlled trials, observational studies, systematic reviews, meta-analyses, and case reports with five or more participants. A narrative synthesis approach was adopted to accommodate the heterogeneity of interventions, outcome measures, and study designs. 18 sources were included. Overall TMS demonstrated the most consistent and robust evidence of improvement across line bisection test, star cancellation test, and ADL. tDCS showed moderate evidence of benefits. VR assisted rehabilitation proved to be at least equivalent effectiveness when comparing with conventional therapy. Robot assisted therapy showed task specific improvements in line bisection, but they did not consistently generalize to broader functional outcomes. PA yielded mixed short-term effectiveness with no confirmed long-term benefit. Mirror therapy showed no significant effect on USN. However, all modalities show severe limitations due to limitation in small sample sizes, heterogeneous protocols, and insufficient long term follow ups. Therefore, future research should prioritize large multicenter randomized trials, standardized outcome measures including functional scales and integrate neuroimaging. |
