Technologies for the three-dimensional assessment and treatment of unilateral spatial neglect in individuals with stroke: a systematic review

Unilateral spatial neglect (USN) is a failure to respond or orient to stimuli in contralesional space, not explained by primary sensory or motor deficits. It affects up to two-thirds of right hemisphere stroke survivors and significantly impacts rehabilitation and functional outcomes. Recent advances in three-dimensional (3D) technologies, such as virtual reality (VR) and robotics, offer promising tools for assessment and treatment, providing realistic scenarios and precise clinical stimulation. This systematic review explores the current use of 3D technologies in USN, focusing on their features, level of development, and reported outcomes. A structured search of four databases using the PICO format identified 37 relevant studies out of 2891. The most frequently employed technologies were immersive and non-immersive VR, augmented and mixed reality, and robotics. However, these tools are still in early experimental phases. Among the studies, 15 addressed assessment, 17 focused on treatment, and 5 were technical in nature. Key challenges include methodological variability and the lack of standardized protocols. Due to the heterogeneity of technologies and outcomes, a meta-analysis was not feasible. Future studies should adopt rigorous designs to validate these approaches and support their integration into clinical practice.