[Top-down and bottom-up approaches for the treatment of unilateral spatial neglect in stroke patients: A systematic review]

Abstract

Objective: To evaluate the effectiveness of top-down and bottom-up approaches in the rehabilitation of unilateral spatial neglect in stroke patients.

Methodology: We carried out a systematic review of randomized controlled trials from January of 2013 to March of 2017. The following databases were searched: Scopus, Science Direct, Web of Science, Pubmed and CINHAL. The methodological quality, level of scientific evidence and the strength of recommendation were evaluated.

Results: We included 13 studies (294 subjects): nine studies (188 patients) carried out therapies with a bottom-up approach such us eye patching, virtual reality, optokinetic stimulation, transcranial magnetic stimulation and prism adaption; three studies (94 patients) evaluated therapies with a top-down approach such us visual scanning, sensory feedback and mental practice; one study incorporated both approaches. Nine of these studies showed improvements in spatial neglect scales; five of these used bottom-up approaches, another three used top-down approaches and the remaining study combined both approaches. Disability was evaluated by nine studies, and only three reported improvements. Three studies reported significant improvements in motor function in the intervention groups.

Conclusions: Top-down and bottom-up approaches could improve unilateral spatial neglect, disability and motor function in patients with stroke.

Keywords: Disability; Discapacidad; Función motora; Ictus; Motor function; Perceptual disorders; Rehabilitación; Rehabilitation; Stroke; Trastornos de percepción.