Evaluation of the impact of bottom-up and top-down approaches on daily activities in people with neglet – a systematic review

Abstract

BACKGROUND: Currently there is no consensus on which are the characteristics of rehabilitation approaches (bottom-up or top-down) most effective in the rehabilitation of ADLs in people with Neglet Syndrome (NS). AIM: To characterize the approaches (bottom-up or top-down) with more impact on ADLs in adults and elderly with NS. METHODS: This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendation. A bibliographic search was carried out in PubMed, Web of Science, PEDro and Cochrane databases. Experimental studies were considered in which at least one technique of the bottom-up and top-down approaches was used. The Joanna Briggs Institute Critical Appraisal Checklist for RCTs tool was used to assess the methodological quality of the studies. The following combination of keywords was used: Negligence Syndrome OR Unilateral Syndrome OR Negligence (...) AND Activities OF Daily OR Daily Life (...) AND Treatment OR Intervention OR Technique (...). RESULTS: 16 studies were included, which 9 include techniques from the bottom-up approach, 6 include techniques from the top-down approach and 1 article includes two techniques, each belonging to each approach. The techniques of the bottom-up approach that increased independence in the ADLs were Visuomotor Feedback Training, Smooth Pursuit Eye Movement Training and the combination of Eye Patching with Constraint-induced Therapy. In the top-down approach, the techniques with the same results were Visual Scanning, Mental Practice, Continuous Theta Burst Stimulation and Transcranial Direct Current Stimulation. CONCLUSION: Both bottom-up and top-down approaches increase independence in ADLs. Each approach contains techniques with a significant positive impact on ADLs such as Visuomotor Feedback Training and Continuous Theta Burst Stimulation. The present work also allowed a critical analysis to the classification of the approaches in bottom-up and top-down, since they are not different to the category of rehabilitation mechanisms.