The effect of theta-burst stimulation on unilateral spatial neglect following stroke: a systematic review.

OBJECTIVE:: To evaluate the effectiveness of theta-burst stimulation for the treatment of stroke-induced unilateral spatial neglect. DATA SOURCES:: A systematic literature search was conducted from the inception of each database to 30 June 2018 using CINAHL, EMBASE, PubMed, PsycINFO, and Scopus. REVIEW METHODS:: Articles were included if theta-burst stimulation was used to treat neglect following a stroke. The additional a priori inclusion criteria were as follows: (1) ⩾3 adult (⩾18 years) participants, (2) ⩾50% stroke population, and (3) peer-reviewed journal articles published in English. Extracted data included study and treatment characteristics, results, and adverse events. RESULTS:: Nine studies met the inclusion criteria, generating a total of 148 participants. Eight studies evaluated a continuous stimulation protocol and one study investigated an intermittent stimulation protocol. Overall, both protocols significantly improved neglect severity when compared against placebo or active controls ( P < 0.05). Adding smooth pursuit training to theta-burst stimulation did not improve neglect relative to when the stimulation was delivered alone ( P > 0.05). There was inconsistent reporting of neglect terminology, outcome measures, and adverse events. The treatment characteristics were heterogeneous among the trials. CONCLUSION:: This systematic review found that theta-burst stimulation seems to improve post-stroke unilateral spatial neglect, but because the evidence is limited to a few small studies with varied and inconsistent protocols and use of terminology, no firm conclusion on effectiveness can be drawn.

The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis.

BACKGROUND: Virtual reality (VR) is becoming a popular alternative to traditional upper and lower limb rehabilitation following a stroke. OBJECTIVE: To conduct a systematic review and meta-analysis on the effectiveness of VR interventions for improving balance in a chronic stroke (≥6 months) population. DATA SOURCES: A literature search of Pubmed, Scopus, CINAHL, Embase, Psycinfo, and Web of Science databases was conducted. STUDY SELECTION: English randomized controlled trials published up to September 2015 assessing balance with VR in chronic stroke participants. DATA EXTRACTION: Mean and standard deviations from outcome measures were extracted. Pooled standard mean differences ± standard error were calculated for the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG). RESULTS: In total, 20 studies were selected which assessed the Nintendo® Wii Fit balance board (n = 7), treadmill training and VR (n = 7), and postural training using VR (n = 6). Significant improvements were found for VR interventions evaluating the BBS (n = 12; MD = 2.94 ± 0.57; p < 0.001) and TUG (n = 13; MD = 2.49 ± 0.57; p < 0.001). Sub-analyses revealed postural VR interventions had a significant effect on BBS (n = 5) and TUG (n = 3) scores (BBS: MD = 3.82 ± 0.79; p < 0.001 and TUG: MD = 3.74 ± 0.97; p < 0.001). VR and treadmill training (n = 5) had a significant effect on TUG scores (MD = 2.15 ± 0.89, p = 0.016). CONCLUSION: Overall, VR interventions compared to conventional rehabilitation had significant improvements. The meta-analyses also suggest that the Nintendo® Wii Fit balance board may not be effective, although further confirmatory studies are necessary. Results should be interpreted with caution due to differences in therapy intensities and effect sizes within the included studies.

Continuous Descending Modulation of the Spinal Cord Revealed by Functional MRI.

Spontaneous variations in spinal cord activity may arise from regulation of any of a number of functions including sensory, motor, and autonomic control. Here, we use functional MRI (fMRI) of healthy participants to identify properties of blood oxygenation-level dependent (BOLD) variations in the spinal cord in response to knowledge that either a noxious stimulus is impending, or that no stimulus is to be expected. Expectation of a noxious stimulus, or no stimulus, is shown to have a significant effect on wide-spread BOLD signal variations in the spinal cord over the entire time period of the fMRI acquisition. Coordination of BOLD responses between/within spinal cord and brainstem regions are also influenced by this knowledge. We provide evidence that such signal variations are the result of continuous descending modulation of spinal cord function. BOLD signal variations in response to noxious stimulation of the hand are also shown, as in previous studies. The observation of both continuous and reactive BOLD responses to emotional/cognitive factors and noxious peripheral stimulation may have important implications, not only for our understanding of endogenous pain modulation, but also in showing that spinal cord activity is under continuous regulatory control.