The effects of the dopamine agonist rotigotine on hemispatial neglect following stroke TENS and optokinetic stimulation in neglect therapy after cerebrovascular accident: a randomized controlled study. The use of Optokinetic Stimulation in Rehabilitation of the Hemineglect Disorder Theta-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect A single blinded randomised controlled pilot trial of prism adaptation for improving self-care in stroke patients with neglect The prognostic value of domain-specific cognitive abilities in acute first-ever stroke Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with Unilateral Spatial Neglect Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect The Effect of Virtual Reality Training on Unilateral Spatial Neglect in Stroke Patients Left-hand somatosensory stimulation combined with visual scanning training in rehabilitation for post-stroke hemineglect: A randomised, double-blind study Repetitive transcranial magnetic stimulation to hemispatial neglect in patients after stroke: an open-label pilot study. The effect of voluntary trunk rotation and half-field eye-patching for patients with unilateral neglect in stroke: a randomized controlled trial Effectiveness of Prism Adaptation in Neglect Rehabilitation: A Controlled Trial Study The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Reported quality of randomized controlled trials in neglect rehabilitation Occupational therapy treatment with right half-field eye-patching for patients with subacute stroke and unilateral neglect: A randomised controlled trial Is Visual Scanning Better Than Mental Practice in Hemispatial Neglect? Results from a Pilot Study Prism Adaptation Therapy Enhances Rehabilitation of Stroke Patients With Unilateral Spatial Neglect The effects of visuomotor feedback training on the recovery of hemispatial neglect symptoms: assessment of a 2-week and follow-up intervention The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Stimulating visual exploration of the neglected space in the early stage of stroke by hemifield eye-patching: a randomized controlled trial in patients with right brain damage. Acute neglect rehabilitation using repetitive prism adaptation: a randomized placebo-controlled trial. Reliability of the PEDro scale for rating quality of randomized controlled trials. Unilateral neglect syndrome rehabilitation by trunk rotation and scanning training. Development of a behavioral test of visuospatial neglect. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Rehabilitation of hemispatial neglect: A randomized study using either arm activation or visual scanning training.
Hemispatial neglect following right-hemisphere stroke is a common and disabling disorder , for which there is currently no effective pharmacological treatment . Dopamine agonists have been shown to play a role in selective attention and working memory , two core cognitive components of neglect . Here , we investigated whether the dopamine agonist rotigotine would have a beneficial effect on hemispatial neglect in stroke patients . A double-blind , r and omized , placebo-controlled ABA design was used , in which each patient was assessed for 20 testing sessions , in three phases : pretreatment ( Phase A1 ) , on transdermal rotigotine for 7–11 days ( Phase B ) and post-treatment ( Phase A2 ) , with the exact duration of each phase r and omized within limits . Outcome measures included performance on cancellation ( visual search ) , line bisection , visual working memory , selective attention and sustained attention tasks , as well as measures of motor control .  Sixteen right-hemisphere stroke patients were recruited , all of whom completed the trial .  Performance on the Mesulam shape cancellation task improved significantly while on rotigotine , with the number of targets found on the left side increasing by 12.8 % ( P = 0.012 ) on treatment and spatial bias reducing by 8.1 % ( P = 0.016 ) . This improvement in visual search was associated with an enhancement in selective attention but not on our measures of working memory or sustained attention . The positive effect of rotigotine on visual search was not associated with the degree of preservation of prefrontal cortex and occurred even in patients with significant prefrontal involvement . Rotigotine was not associated with any significant improvement in motor performance . This proof-of-concept study suggests a beneficial role of dopaminergic modulation on visual search and selective attention in patients with hemispatial neglect following stroke BACKGROUND In a r and omized controlled type Ib study , the effectiveness of three different forms of therapy for the treatment of visual neglect was assessed by comparing therapy outcomes in three groups of patients after cerebrovascular accidents . METHODS A control group received only st and ard exploration training , whilst the second and third group received exploration training combined with either contralateral transcutaneous electrical nerve stimulation ( TENS ) or optokinetic stimulation ( OKS ) respectively . RESULTS It was found that exploration training alone result ed in no improvement on both st and ard neglect tests ( NTs ) and everyday-relevant measures of reading and writing performance . In contrast , the groups receiving TENS or OKS showed significant improvements in both sets of measures with the difference that for the TENS group the improvement in NT scores at the end of therapy had disappeared 1-week later . However , both treatments result ed in significant improvements in reading and writing which were still present upon retesting 1-week after the end of therapy . CONCLUSION Both methods can be recommended for neglect therapy and are superior to exploration therapy alone The aim of this study was to investigate whether it is possible to strengthen the rehabilitation of spatial hemineglect by combining st and ard training for spatial scanning with optokinetic stimulation . A simple r and omized design was used : one group of neglect patients was treated with a combination of the two techniques , and a second group received only the st and ard treatment . Both treatments were given for six consecutive weeks and produced significant improvements . However , addition of the optokinetic stimulation did not improve the patients ' performance . Also , none of the independent variables ( i.e. , presence/absence of hemianopia ) predicted the positive effect occasionally observed in individual patients Objective : Cortico-cortical circuits originating from the posterior parietal cortex ( PPC ) of the intact left hemisphere ( LH ) may become hyperexcitable in patients with hemispatial neglect due to a right hemispheric ( RH ) stroke . Methods : In the current r and omized , double-blind , sham-controlled study , we investigated safety and efficacy of continuous theta-burst stimulation ( cTBS ) in 10 sessions over 2 weeks applied over the intact PPC of the LH in subacute ischemic stroke patients .  Severity of neglect was assessed through the st and ardized Behavioral Inattention Test ( BIT ) . We also measured , by means of bifocal transcranial magnetic stimulation ( TMS ) , how cTBS modified the excitability of the parieto-frontal functional connections in the intact LH . Results : We found that 2 weeks of cTBS , but not sham cTBS , were effective in improving neglect symptoms as measured by BIT score . BIT scores improved by 16.3 % after 2 weeks of cTBS and 22.6 % at 1 month follow-up . We also found that hyperexcitability of LH parieto-frontal circuits was reduced following treatment with real but not sham cTBS . Conclusion : These findings suggest that a 2-week course of cTBS over the LH PPC may be a potential effective strategy in accelerating recovery from visuospatial neglect in subacute stroke patients , possibly counteracting the hyperexcitability of LH parieto-frontal circuits . Classification of evidence : This study provides Class III evidence that left posterior parietal cortex theta-burst stimulation improves hemispatial neglect for up to 2 weeks after treatment Prism adaptation has been shown to alleviate the symptoms of unilateral spatial neglect following stroke in single case and small group studies . The purpose s of this single blinded pilot r and omised controlled trial were to determine the feasibility of delivering prism adaptation treatment in a clinical ly valid sample and to assess its impact on self-care . Thirty seven right hemisphere stroke patients with unilateral spatial neglect were r and omised into either prism adaptation ( using 10 dioptre , 6 degree prisms ) or sham treatment ( using plain glasses ) groups . Treatment was delivered each weekday for two weeks . Pointing accuracy , without vision of the finger , was recorded each day before treatment . Outcome was measured , by blinded assessors , four days and eight weeks after the end of treatment using the Catherine Bergego Scale ( CBS ) and the conventional neuropsychological tests from the Behavioural Inattention Test ( BIT ) . Thirty four patients received treatment : 16 with prisms , 18 sham .  Mean compliance was 99 % and 97 % , respectively . Over the treatment days only the prism treated group showed increased leftward bias in open loop pointing to targets on a touch screen . However , despite the group level changes in pointing behaviour no overall effect of the treatment on self-care or BIT were found Objective : To evaluate the prognostic value of domain-specific cognitive abilities in acute stroke with respect to long-term cognitive and functional outcome in addition to neurologic and demographic predictors . Methods : The authors evaluated 168 patients within the first 3 weeks after first-ever stroke . The prevalence of neuropsychological impairment was calculated vs 75 matched healthy controls . The authors also recorded demographic data , vascular risk factors , lesion characteristics , and clinical factors at admission . Independent predictor variables associated with long-term cognitive impairment ( assessed with a follow-up neuropsychological examination ) and functional impairment ( assessed with the modified Barthel Index and the Frenchay Activities Index ) were identified with stepwise multiple logistic regression . Areas under receiver operator characteristic curves were used to compare the predictive value of three models , i.e. , a st and ard medical model , a purely cognitive model , and a model consisting of both medical and cognitive predictors . Results : Thirty-one percent of patients showed long-term cognitive impairment . Basic and instrumental ADL disturbances remained present in 19 % and 24 % of patients . Domain-specific cognitive functioning predicted cognitive and functional outcome better than any other variable . Moreover , the prediction of instrumental ADL functioning improved when cognitive predictors were added to the st and ard medical model ( p < 0.05 ) . Impairments in abstract reasoning and executive functioning were independent predictors of long-term cognitive impairment . Inattention and perceptual disorders were more important in predicting long-term functional impairment . Conclusion : Domain-specific cognitive abilities in the early phase of stroke are excellent independent predictors of long-term cognitive and functional outcome Purpose . The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect ( USN ) as a result of a right hemisphere stroke , and to compare it to a st and ard computer visual scanning training . Method . Participants included 19 patients with right hemisphere stroke in two groups , 11 in an experimental group were given computer desktop-based Virtual Reality ( VR ) street crossing training and 8 in a control group who were given computer based visual scanning tasks , both for a total of twelve sessions , 9 hours total , over four weeks . Measures included : 1 . St and ard USN assessment s , paper and pencil and ADL checklist ; 2 . Test on the VR street program ; and 3 . Actual street crossing videotaped . Testing was performed pre and post intervention . Results . The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks . They improved more on the VR test and they did better on some measures of the real street crossing . Conclusions . Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN , and further development of the program A large proportion of right-hemisphere stroke patients show hemispatial neglect — a neurological deficit of perception , attention , representation , and /or performing actions within their left-sided space , inducing many functional debilitating effects on everyday life , and responsible for poor functional recovery and ability to benefit from treatment . The frequent parietal locus of the lesion producing neglect reflects the impairment of coordinate transformation used by the nervous system to represent extrapersonal space . Given that adaptation to a visual distortion can provide an efficient way to stimulate neural structures responsible for the transformation of sensorimotor coordinates , the aim of our study was to investigate the effect of prism adaptation on various neglect symptoms , including the pathological shift of the subjective midline to the right . All patients exposed to the optical shift of the visual field to the right were improved on their manual body-midline demonstration and on classical neuropsychological tests . Unlike other physiological manipulations used to improve neglect , this improvement lasted for at least two hours after prism removal and thus could be useful in rehabilitation programmes . The positive effect found for both sensorimotor and more cognitive spatial functions suggests that they share or depend on a common level of space representation linked to multisensory integration Objective To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients . Method Twenty-four stroke patients ( 14 males and 10 females , mean age=64.7 ) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited . All patients were r and omly assigned to either the virtual reality ( VR ) group ( n=12 ) or the control group ( n=12 ) . The VR group received VR training , which stimulated the left side of their bodies . The control group received conventional neglect therapy such as visual scanning training . Both groups received therapy for 30 minutes a day , five days per week for three weeks . Outcome measurements included star cancellation test , line bisection test , Catherine Bergego scale ( CBS ) , and the Korean version of modified Barthel index ( K-MBI ) . These measurements were taken before and after treatment . Results There were no significant differences in the baseline characteristics and initial values between the two groups . The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment . The changes in line bisection test score and the K-MBI in the VR group were not statistically significant . Conclusion This study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients The aim of this r and omised , double-blind study was to investigate the therapeutic effectiveness of left-h and electrical stimulation for patients with post-stroke left visuo-spatial neglect . This approach was hypothesised to enhance activation of the right hemisphere attention system and to improve visual exploration of extrapersonal space .  Participants ( n = 40 ) in the study were in a relatively early stage of recovery from their first right hemisphere stroke , and were r and omly assigned to the experimental ( E ) or control ( C ) group . Group E received conventional visual scanning training combined with electrostimulation of the left h and , while Group C received scanning training with sham stimulation . Their visuo-spatial neglect was assessed twice , prior to the rehabilitation programme and on its completion , using cancellation tests and a letter-reading task . The effect of electrostimulation on hemineglect was assessed following a single administration and after a month-long rehabilitation programme . Although the immediate effect of stimulation was poor , after a month-long rehabilitation period we found significantly greater improvement in Group E patients than in Group C patients . Interestingly , the presence of hemisensory loss did not weaken the observed effect . Therefore , we cl aim that contralesional h and stimulation combined with visual scanning was a more effective treatment for hemineglect rehabilitation than scanning training alone OBJECTIVE To test whether multiple sessions of inhibitory low-frequency repetitive transcranial magnetic stimulation ( rTMS ) applied to the left parietal area can improve hemispatial neglect after stroke . DESIGN An open-label design . PATIENTS Seven consecutive patients with hemispatial neglect after right hemispheric stroke were compared with 7 retrospectively recruited control patients . METHODS Seven patients received a session of 1 Hz rTMS to the left parietal area immediately prior to occupational therapy for 10 days . Seven control patients received only behavioural therapy . RESULTS Baseline values of the line bisection test and the Albert test were comparable in the two groups . The stimulation group showed a greater improvement in the line bisection test than did the control group . However , no differences were found between the two groups according to the Albert test . CONCLUSION In this pilot study , low-frequency rTMS application to the non-affected left parietal area was found to be safe and to improve line bisection test , which suggests that non-invasive cortical stimulation has a potential role as an adjuvant strategy during cognitive rehabilitation training in patients with hemispatial neglect . A prospect i ve r and omized , sham-controlled study is required to determine the beneficial role of non-invasive cortical stimulation on hemispatial neglect Objective : To investigate the effectiveness of voluntary trunk rotation and half-field eye-patching to treat patients with unilateral neglect in stroke . Design : Pre — post , day 60 follow-up , single-blinded r and omized controlled trial . Setting : Single-centre inpatient rehabilitation hospital . Subjects : Sixty subacute patients with right hemisphere stroke having unilateral neglect within eight weeks post stroke consented to participate between November 2003 and July 2005 . They were r and omly assigned to three comparison groups . Interventions : Nineteen patients received daily experimental training in voluntary trunk rotation ( TR ) for 1 hour five times a week for 30 days . Twenty patients received the same kind of treatment together with half-field eye-patching ( TR + EP ) . Fifteen patients in the control group received conventional training with the same contact time . Main outcome measures : Patients were assessed on days 0 , 30 and 60 using the Behavioural Inattention Test , the Clock Drawing Test , and the Functional Independence Measure . Results : No significant differences between voluntary trunk rotation ( TR ) , voluntary trunk rotation and half-field eye-patching ( TR + EP ) and controls were found in functional performance and neglect measures at day 30 ( P = 0.042—0.994 ) and follow-up ( P = 0.052—0.911 ) at P = 0.005 using Bonferroni correction . Conclusions : The results of this study do not support the use of voluntary trunk rotation alone or with half-field eye-patching to improve functional performance or reduce unilateral neglect in subacute patients with stroke Background and Purpose — This study was conducted to investigate the effectiveness on neglect recovery of a 2-week treatment based on prism adaptation ( PA ) in comparison to an analogous visuomotor training performed without prisms , ie , neutral pointing ( NP ) . Methods — Twenty neglect patients were divided into 2 matched groups , one was su bmi tted to PA ( PA group ) and the other to NP ( NP group ) for 10 daily sessions over a period of 2 weeks . After the end of NP treatment , the patients in the NP group were also su bmi tted to PA treatment . Neglect was assessed before and after each treatment and 1 month after the end of the PA treatment . Results — Visuospatial abilities improved after both PA and NP treatment ; however , the improvement was significantly higher in the patients in the PA group than in the patients in the NP group . Moreover , when the patients in the NP group were su bmi tted to PA , they further improved up to the level reached by patients in the PA group , ie , to nonpathological scores . Long-lasting beneficial effects of PA were confirmed 1 month from the end of treatment . Conclusion — The leftward recalibration of sensorimotor reference frames induced by PA is effective to obtain proper neglect recovery , although visuomotor training based on pointing might partially improve neglect symptoms QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis The aim of this study is to assess the reported quality of r and omized controlled trials ( RCTs ) on the effectiveness of neglect rehabilitation using a st and ardized scale . A search of seven electronic data bases was carried out . Selected articles were scored using the PEDro scale and classified as high or low quality study both with the original cut off of 6 and a modified cut off of 5 . A linear regression analysis between year of publication and quality rate was used to test whether the quality of the studies improved with time . A total of 18 RCTs were selected . Six articles ( 33.3 % ) and 10 articles ( 55.56 % ) were classified as having high quality when the original cut off or the modified cut off of the PEDro scale were used , respectively . Analysis shows no time-related changes in PEDro scores . The results show that reported quality is moderate for RCTs in neglect rehabilitation Purpose . The right half-field eye-patching technique has been reported to be effective in reducing unilateral neglect ( UN ) and improving functional ability in stroke patients . This study investigated the efficacy of conventional treatment with right half-field eye patching in treating subacute stroke patients with UN  , using a r and omised controlled trial . Method . Thirty-five in patients with subacute stroke were recruited and r and omised into intervention and control groups . The patients in the intervention group received 4 weeks of conventional occupational therapy with modified right half-field eye-patching . Those in the control group received 4 weeks of conventional treatment only . Assessors , who were blind to the treatments , assessed the groups using the Behavioural Inattention Test ( BIT ) and the Functional Independence Measure ( FIM ) on admission and at 4 weeks . Results . Patients treated with right half-field eye-patching had significantly ( p = 0.046 ) higher BIT gain ( mean = 25.06 , SD = 30.81 ) than those treated with the conventional treatment ( mean = 8.29 , SD = 10.35 ) . There was no significant difference ( p = 0.467 ) in FIM gain between patients in both groups . Conclusions . Right half-field eye-patching improved stroke patients ' impairment level in terms of UN , but the potential benefits in impairment tests were not confirmed by improvements in function Abstract Objective : We compared visual scanning and mental practice and explored the effects of these techniques on specific hemispatial neglect tests and activities of daily living in chronic hemispatial neglect patients . Methods : Ten right-h and ed patients with hemispatial neglect caused by right hemisphere ischemic strokes were r and omly allocated to 1 of 2 study groups : visual scanning ( n = 5 ) , mental practice ( n = 5 ) . Five additional patients were included in a control group . Three evaluations for hemispatial neglect and the FIM were carried out in the intervention groups : pretreatment , at the end of the intervention period , and 3 months after that intervention period . Control patients were evaluated twice within a 2-month interval . Results : There was a significant difference among the 3 groups in Behavioral Inattention Test ( BIT ) score changes ( P = .047 ) and in FIM self-care item score changes ( P = .035 ) , the visual scanning protocol being responsible for these differences both in BIT ( P = .008 ) and in FIM self-care item scores ( P = .016 ) . The positive functional effects of visual scanning were partially retained at the end of the follow-up period . Conclusions : Visual scanning should probably be considered preferable to mental practice protocol s in the treatment of hemispatial neglect patients Background and objective . Unilateral spatial neglect ( USN ) can interfere with rehabilitation processes and lead to poor functional outcome . The purpose of this study was to determine whether prism adaptation ( PA ) therapy improves USN and functional outcomes in stroke patients in the subacute stage . Methods . A multicenter , double-masked , r and omized , controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN assessed with the Behavioral Inattention Test ( BIT ) , the Catherine Bergego Scale ( CBS ) , and activities of daily living ( ADL ) as evaluated with the Functional Independence Measure ( FIM ) . A total of 38 USN patients with right-brain damage were divided into prism ( n = 20 ) and control ( n = 18 ) groups . Patients were divided into mild and severe USN groups according to BIT behavioral test ( mild ≥ 55 and severe<55 ) . The prism group performed repetitive pointing with prism glasses that induce rightward optical shift twice daily , 5 days per week , for 2 weeks , whereas the control group performed similar pointing training with neutral glasses . Results . The FIM improved significantly more in the prism group . In mild USN patients , there was significantly greater improvement of BIT and FIM in the prism group . Conclusions . PA therapy can significantly improve ADL in patients with subacute stroke In patients suffering from left unilateral neglect , their right-biased attention to the phenomenal world can be ameliorated , short-term , by making motor responses to left-right extended objects ( rods ) that immediately reveal to them that their phenomenal world is in fact skewed . In this study the extent to which more intensive experiences of this type produced enduring and useful improvements in neglect , was assessed by first examining the effect of a 3-day experimenter-administered practice of rod lifting , then by examining the effects of a self-administered practice for a further 2-week period and a further 1 month post-training . Despite the fact that by the time the patients were able to undergo the intervention they had progressed to the chronic neglect stage , significant improvements of the intervention over the control group were found for a third of the tests given after the 3-day practice . Additionally , at the 1-month follow-up the intervention group again showed significantly better results in 46 % of the direct neglect tests . As far as we are aware this is the first time that significant long-term improvements have been shown in a rehabilitation approach with neglect patients with a mean time of more than 12 months post-stroke and visuomotor feedback training can thus be seen as a most encouraging paradigm for future attempts Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists BACKGROUND It has been well established that the presence of neglect is a predictor of poor functional outcome after stroke . Most rehabilitation studies on neglect have been performed with at least two months post-stroke . However , a recent series of stroke management indications highlight the importance of early rehabilitation treatment and evidence regarding neglect rehabilitation in the early phase after stroke is needed . AIM To evaluate the effectiveness of right half-field patches in treating neglect in patients during the early phase of stroke . DESIGN R and omized controlled trial . SETTING Acute care setting in an urban general hospital . POPULATION Eighteen patients with left unilateral neglect recruited among 56 patients consecutively admitted with right hemispheric stroke . METHODS The patients were evaluated at pre-treatment , post-treatment , and at a 7-day follow-up . The experimental group received right half-field patch treatment ( n=10 ) for approximately 8 hours a day for 15 consecutive days . The control group received visual scanning training ( n=8 ) for 40 minutes every weekday in a 15 day period . RESULTS Both groups significantly improved their performance in all outcome measures . No difference in the amount of improvement between the two groups was found . CONCLUSION Right half-field eye patching could be a promising technique for treating visual spatial neglect during the early stages of stroke . CLINICAL REHABILITATION IMPACT The eye-patching technique may represent an easily applicable and inexpensive method for neglect rehabilitation in the early stage after stroke PURPOSE At present , prism adaptation is probably the most promising rehabilitation procedure for hemi-neglect . However , r and omised controlled trials are lacking and no data are available on the effectiveness of prism adaptation  in the treatment of acute neglect . METHODS We followed sixteen neglect patients using a r and omised controlled design in which six patients received four-day-in-a-row placebo treatment ( CG ) and ten patients received four-day-in-a row experimental treatment with 10 degrees rightward deviating prisms ( EG ) during their stay on the stroke unit . We examined whether patients in the EG improved faster than the CG by administering three neglect tasks ( Schenkenberg Line Bisection , Letter Cancellation , Gainotti Scene Copying ) immediately before and after each treatment . Second , we examined whether patients in the EG demonstrated a better long-term outcome at one month post-treatment ( Behavioural Inattention Test ) . RESULTS Patients in the EG improved faster on spatial tasks ( line bisection , cancellation ) than the CG but not on visuo-construction . Patients in the EG showed no differences with the CG in neglect outcome at one month post-treatment . CONCLUSIONS Four consecutive prism sessions produced beneficial effects in patients with acute neglect . However ,  prism effects were either short-term , or placebo treatment with repeated pointing and /or repeated neglect testing was more helpful than we anticipated . Our results emphasize the importance of a placebo condition and a follow-up in rehabilitation studies BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE Assessment of a new rehabilitation method for  unilateral neglect syndrome ( UNS ) , using a specific device ( Bon Saint Come 's device ) that associates exploratory reconditioning with voluntary trunk rotation . DESIGN Study 1 , r and omized control trial during 2 months ; study 2 , nonr and omized control trial during 2 months . SETTING Neurorehabilitation units in private and public center . PATIENTS In study 1 , 22 consecutive patients with UNS result ing from recent stroke ( < 3 months ) were r and omly assigned to an Experimental Group ( 11 patients ) or to a Control Group ( 11 patients ) . The 2 groups were very similar in terms of general and neurological data . In study 2 , 5 consecutive patients with chronic UNS result ing from an old stroke ( > 6 months ) showing the same characteristics were included . INTERVENTION In study 1 , patients in Group E followed the experimental program 1 hour a day for 1 month ( 20 hours ) and Group C followed usual neurorehabilitation during the same time . In study 2 , every patient followed the experimental program 1 hour a day for 1 month ( 20 hours ) . MAIN OUTCOME MEASURES Assessment in both studies was done at day 0 , day 30 , and day 60 using a battery of UNS tests ( Albert , Scheckenberg , bell ) and an activities of daily living ( ADL ) test ( the Functional Independence Measure [ FIM ] ) . Mean scores of each test were compared between the 2 groups with the Wilcoxon nonparametric test . RESULTS In study 1 all UNS test results and the FIM improved significantly more in Group E than in Group C. In Group E , UNS disappeared in 5 patients and improved in 6 . In Group C , UNS disappeared in 1 patient , improved in 4 , and was unchanged in 6 . In Study 2 , UNS remitted in 2 patients , improved in 2 patients , and was unchanged in 1 . CONCLUSION The Bon Saint Come method seems to significantly improve recent and chronic UNS , as well as ADL function . These encouraging results could have result ed from a synergistic effect of spatial reconditioning and voluntary trunk rotation . It must be assessed by a new study with more patients The Rivermead Behavioral Inattention Test ( RBIT ) , consisting of nine items sampling activities of daily living , was administered to 28 patients after unilateral right ( 20 ) or left ( 8) cerebrovascular accidents , and to 14 non-brain-damaged controls . All patients were tested on two parallel forms of the RBIT with order of presentation balanced and on at least two of six conventional tests of visual neglect . Control subjects were tested on either form 1 or form 2 of the RBIT .  Interrater reliability of scoring was tested on seven subjects chosen at r and om . Using control scores to determine the cutoff point between visual inattention and noninattention , 14 patients ( 50 % ) showed evidence of visuospatial neglect on the RBIT .  Correlation between the two forms of the test was 0.83 . The RBIT also correlated well with five of the conventional tests . Interrater reliability was 100 % . The RBIT appears to be a valid and reliable test of visuospatial neglect and one which is likely to provide more information about everyday problems than existing measures of neglect This paper describes PEDro , the Physiotherapy Evidence Data base . PEDro is a web-based data base of r and omized controlled trials and systematic review s in physiotherapy . It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro . The data base contains bibliographic details and abstract s of most English- language r and omized trials and systematic review s in physiotherapy , and of many trials and review s in other language s. Trials on the data base are rated on the basis of their method ological quality so that users of the data base can quickly identify trials of high quality . Trials and systematic review s are extensively indexed to facilitate search ing . PEDro provides an important information re source to support evidence -based clinical practice PURPOSE Hemispatial neglect , a failure to orient to the contralateral side of the lesion , is a disabling disorder after stroke . Previously arm activation combined with visual training or visual scanning training were found effective in rehabilitation of hemispatial neglect . The aim of this study was to determine whether left arm activation alone could be sufficient to produce a long lasting amelioration of neglect comparable to the effect obtained with traditional visual scanning training . METHODS Twelve neglect patients less than six months from stroke were r and omized either into 20 - 30 hours of left arm activation training or 10 hours of traditional visual scanning training as a part of a comprehensive rehabilitation program . All patients received 48~hours of therapy during the 3-week rehabilitation . RESULTS Visual neglect of the arm activation group recovered significantly in the conventional subtests of the Behavioural Inattention Test both post-rehabilitation and at 6-months follow-up . The improvement of the visual scanning training group was almost significant at the end of the rehabilitation and significant by the follow-up . The behavioural neglect observed in the Catherine Bergego Scale was alleviated nearly significantly at the post-rehabilitation in both groups . The effect was maintained in the arm activation group at 6-months . CONCLUSION The arm activation training appears beneficial even without supplementary visual neglect rehabilitation , although the traditional visual scanning training may have further effects in cognition
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