Advances in the Rehabilitation of Hemispatial Inattention

Purpose of ReviewThere continue to be a plethora of approaches to the rehabilitation of hemispatial inattention, from different forms of sensory stimulation (visual, auditory and somatosensory feedback), through all major modes of non-invasive brain stimulation to drug therapies. Here we summarise trials published in the years 2017-2022 and tabulate their effect sizes, with the aim of drawing on common themes that may serve to inform future rehabilitative studies.Recent FindingsImmersive virtual reality approaches to visual stimulation seem well tolerated, although they have yet to yield any clinically relevant improvements. Dynamic auditory stimulation looks very promising and has high potential for implementation. Robotic interventions are limited by their cost and are perhaps best suited to patients with a co-occurring hemiparesis. Regarding brain stimulation, rTMS continues to demonstrate moderate effects but tDCS studies have yielded disappointing results so far. Drugs, primarily aimed at the dopaminergic system, often demonstrate beneficial effects of a medium size, but as with many of the approaches, it seems difficult to predict responders and non-responders.Our main recommendation is that researchers consider incorporating single-case experimental designs into their studies as rehabilitation trials are likely to remain small in terms of patient numbers, and this is the best way to deal with all the factors that cause large between-subject heterogeneity.

Automated summary

The purpose of this review is to summarize the studies published from 2017 to 2022 on rehabilitation approaches for hemispatial inattention and identify common themes to guide future research. Immersive virtual reality approaches to visual stimulation are well tolerated but have not yet shown clinically relevant improvements. Dynamic auditory stimulation shows promise and has high potential for implementation. Robotic interventions are limited by cost and may be most suitable for patients with co-occurring hemiparesis. Regarding brain stimulation, rTMS has moderate effects while tDCS studies have yielded disappointing results so far. Drugs targeting the dopaminergic system often demonstrate moderate beneficial effects, but predicting responders and non-responders remains a challenge.