title: Rehabilitation of unilateral neglect: Evidence-based medicine.
abstract: BACKGROUND
  In the last decades, several rehabilitation methods have been developed to improve spatial neglect. These can be classified according to their theoretical basis: (i) enhance awareness of neglect behaviour through a top-down mechanism; (ii) low-level bottom-up sensory stimulation; (iii) modulation of inhibitory processes; (iv) increase arousal.
  
  
  OBJECTIVE
  The purpose of this study was to provide an overview of the evidence on the effectiveness of rehabilitation procedures for unilateral neglect.
  
  
  METHODS
  A systematic search was performed to look for all randomised controlled trials aimed at reducing left spatial neglect that included a functional assessment. In addition, recent review papers and meta-analyses were analysed.
  
  
  RESULTS
  Thirty-seven randomized controlled trials were found (12 bottom-up; 12 top-down; 1 interhemispheric competition; 12 combination of approaches) that included 1027 patients with neglect. Although there are some encouraging results, overall, the level of evidence remains low. Poor methodological quality and small sample sizes are major limitations in many published trials.
  
  
  CONCLUSIONS
  There is a need for well-conducted, large-scale randomised controlled trials that incorporate blinded assessments, evaluation of the generalization to activities of daily living and long-term follow-up.
authors.affiliation: AP-HP, hôpital Raymond-Poincaré, service de médecine physique et de réadaptation, 92380 Garches, France; EA 4047 HANDIReSP, université de Versailles-Saint-Quentin, 78180 Montigny-Le-Bretonneux, France. Electronic address: Philippe.azouvi@rpc.aphp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Azouvi
authors.affiliation: Service de médecine physique et de réadaptation, rééducation neurologique, hôpital Henry-Gabrielle, CHU de Lyon, 69230 Saint-Genis-Laval, France; Université de Lyon, université Lyon 1, 69100 Villeurbanne, France; Centre de recherche en neuroscience de Lyon (CRNL), équipe IMPACT, Inserm, U1028, CNRS, UMR5292, 69675 Bron, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jacquin-Courtois
authors.affiliation: Service de médecine physique et de réadaptation, rééducation neurologique, hôpital Henry-Gabrielle, CHU de Lyon, 69230 Saint-Genis-Laval, France; Université de Lyon, université Lyon 1, 69100 Villeurbanne, France; Centre de recherche en neuroscience de Lyon (CRNL), équipe IMPACT, Inserm, U1028, CNRS, UMR5292, 69675 Bron, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Luauté
mesh_terms: D006801:Humans; D010468:Perceptual Disorders / Q000209:etiology / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications
keywords: Rehabilitation; Stroke; Unilateral neglect