Durfee Alexandra Zezinka, Hillis Argye E
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (A.Z.D., A.E.H.).
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD (A.E.H.).
Stroke. 2023 Jan;54(1):10-19. doi: 10.1161/STROKEAHA.122.041710. Epub 2022 Dec 21.
Unilateral spatial neglect (USN) is a common and disabling cognitive consequence of stroke wherein individuals demonstrate decreased response to contralesional information. Here, we provide an updated narrative review of studies that shed light on the neural mechanisms and predictors of recovery of USN. Additionally, we report a rapid review of randomized controlled trials focusing on USN intervention, both nonpharmacological and pharmacological, published in the last 5 years. Randomized controlled trials are reviewed within the context of systematic reviews and meta-analyses of USN interventions published within the same time frame. The quality of randomized controlled trials of treatment is higher compared to quality reported in previous reviews and meta-analyses. However, remaining weaknesses in participant demographic reporting, as well as small, heterogenous samples, render generalizability and cross-study interpretation a challenge. Nevertheless, evidence regarding neural mechanisms underlying USN recovery and regarding the effectiveness of targeted USN interventions is accumulating and strengthening, setting the foundation for future investigations into patient-specific factors that may influence treatment response. We identify gaps and provide suggestions for future USN intervention research.
单侧空间忽视(USN)是中风常见且致残的认知后果,在此情况下个体对患侧对侧信息的反应会降低。本文中,我们对有关USN恢复的神经机制和预测因素的研究进行了更新的叙述性综述。此外,我们还对过去5年发表的聚焦于USN干预(包括非药物和药物干预)的随机对照试验进行了快速综述。随机对照试验是在同一时间范围内发表的USN干预的系统评价和荟萃分析的背景下进行综述的。与之前综述和荟萃分析中报告的质量相比,治疗的随机对照试验质量更高。然而,参与者人口统计学报告方面仍然存在不足,以及样本量小且异质性大,使得普遍性和跨研究解释成为一项挑战。尽管如此,关于USN恢复的神经机制以及针对性USN干预有效性的证据正在积累和加强,为未来对可能影响治疗反应的患者特异性因素的研究奠定了基础。我们找出了差距,并为未来的USN干预研究提供了建议。