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TITLE
Effects of Repetitive Transcranial Magnetic Stimulation Combined with Sensory Cueing on Unilateral Neglect in Subacute Patients with Right Hemispheric Stroke: A Randomized Controlled Study
AUTHORS
Yang NY; Fong KN; Li-Tsang CW; Zhou D. Institution Yang, Nicole Yh. 1 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR. Yang, Nicole Yh. 2 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, China. Yang, Nicole Yh. 3 Institute for Disaster Management and Reconstruction, Sichuan University, China. Fong, Kenneth Nk. 1 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR. Li-Tsang, Cecilia Wp. 1 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR. Zhou, D. 4 Department of Neurology, West China Hospital, Sichuan University, China.
SOURCE
Clinical Rehabilitation. 31(9):1154-1163, 2017 Sep.
OBJECTIVE
To compare the effects of rTMS combined with sensory cueing, rTMS alone, and conventional rehabilitation on unilateral neglect, hemiplegic arm functions and performance of activities of daily living.
DESIGN
A single-blinded randomized controlled trial.
SETTING
A convalescent hospital.
SUBJECTS
Sixty inpatients with left unilateral neglect after stroke.
INTERVENTIONS
Patients were randomly assigned to three groups: rTMS combined with sensory cueing, rTMS, and conventional rehabilitation alone. rTMS at 1 Hz was applied over P5 of the contralesional hemisphere while vibration cueing was emitted using a wristwatch device on the hemiplegic arm, five days per week for two weeks. The first two groups received the same dosage of conventional rehabilitation on top of their experimental interventions. Blinded assessments were administered at baseline, 2 weeks post-intervention, and 6 weeks follow-up.
MAIN MEASURES
Neglect and arm motor performance.
RESULTS
Both rTMS combined with sensory cueing (99.6+/-33.0) and rTMS alone (88.2+/-28.7) significantly reduced unilateral neglect than conventional rehabilitation (72.7+/-33.1) when measured using the conventional subtests of the Behavioural Inattention Test, but the combination was better than rTMS alone. Hemiplegic arm functions and activities of daily living improved in all patients across the three groups but no significant differences were found between the groups.
CONCLUSION
The combination of inhibitory P5-rTMS with sensory cueing was better than either rTMS or conventional rehabilitation alone in producing a stronger and long-lasting improvement in unilateral neglect, but the improvement was not associated with improved arm function or independence in activities of daily living.
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