Effects of Repetitive Transcranial Magnetic Stimulation Combined With Sensory Cueing on Unilateral Neglect in Subacute Patients With Right Hemispheric Stroke

Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) Combined With Sensory Cueing (SC) on Unilateral Neglect in Subacute Patients With Right Hemispheric Stroke: A Randomized Controlled Study

The objective was to compare the effects of repetitive Transcranial Magnetic Stimulation (rTMS) combined with sensory cueing (SC), rTMS alone, and conventional rehabilitation on reducing unilateral neglect (UN) and improving hemiplegic arm functions and performance of activities of daily living (ADL). Sixty subacute patients with left UN after right-hemispheric stroke were randomly assigned to three groups; rTMS combined with SC, rTMS alone, and conventional rehabilitation. 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 four-week follow-up upon completion of training.

Inclusion Criteria:

• Diagnosis of right-hemispheric stroke
• Duration since onset of more than one week
• Presenting with unilateral neglect, confirmed by the conventional subtests of the BIT with cutoff scores of 129
• First-ever stroke, or unilateral neglect as the consequence of the last stroke
• Being aged 18 or over
• Mini Mental State Examination score of ≥17
• Giving written consent to participate.

Exclusion Criteria:

• Duration since onset of stroke of more than six months
• Medically unstable
• Epileptic seizures, unconsciousness, or intracranial hypertension
• Serious heart disease
• Gravid
• Severe aphasia so as to have difficulty understanding the therapists' instructions
• Metal implants in vivo