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.
abstract: 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.
  
  
  METHODS
  A single-blinded randomized controlled trial.
  
  
  METHODS
  A convalescent hospital.
  
  
  METHODS
  Sixty inpatients with left unilateral neglect after stroke.
  
  
  METHODS
  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 postintervention, and 6 weeks follow-up.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.|2 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, China.|3 Institute for Disaster Management and Reconstruction, Sichuan University, China.
authors.forename: Nicole Yh
authors.initials: NY
authors.lastname: Yang
authors.affiliation: 1 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
authors.forename: Kenneth Nk
authors.initials: KN
authors.lastname: Fong
authors.affiliation: 1 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
authors.forename: Cecilia Wp
authors.initials: CW
authors.lastname: Li-Tsang
authors.affiliation: 4 Department of Neurology, West China Hospital, Sichuan University, China.
authors.forename: D
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001132:Arm; D003463:Cues; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: Stroke; repetitive transcranial magnetic stimulation; sensory cueing; unilateral neglect