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Rehabilitation of hemineglect is vexingly inadequate. Beyond its direct detrimental effect on visual-spatial function, hemineglect interferes with rehabilitation of cognitive and motor function.1 Interventions targeting this condition include relearning appropriate visuospatial scanning behaviors through practice and cuing, engaging the attentional system with exogenous sensory stimulation, and changing excitability at the level of the brain.2 This last approach is based on Kinsbourne's3 theory of hemispheric rivalry, which posits that contralateral attention is subserved by each hemisphere, and mutual transcallosal inhibition checks overactivity in the opposite hemisphere to keep attention evenly distributed. Unilateral stroke is thought to disrupt this balance by reducing inhibition from the lesioned hemisphere to the contralesional hemisphere, resulting in greater overactivity in the contralesional hemisphere which in turn increases inhibition to the lesioned hemisphere; the end result is an asymmetric attentional field manifested as hemineglect. Changing cortical excitability by noninvasive brain stimulation is an emerging approach that aims to restore the functional balance, by either increasing activity in the lesioned hemisphere or suppressing overactivity in the contralesional hemisphere. Repetitive transcranial magnetic stimulation (rTMS) has been recognized as a …
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