Thursday, September 3, 2015

Look Left: Compensating for Hemispatial Neglect (Part 2 of 2)

Hemispatial neglect, also known as left neglect, results most commonly from brain injury to the right cerebral hemisphere and causes visual neglect of the left hand side of space. When half of your visual field is lost, half of the world is gone.  The consequences of neglect can range from humorous to devastating, but one thing is certain, compensation will be necessary during the recovery process. Here are a few tips from the pros.

Compensating for Neglect

Left Sided Neglect and Mobility

Persons with neglect are at a higher risk for accident, injury and fall. Take precautions to increase safety and awareness.

Image result for wheelchair tray

Use a wheelchair tray or trough when seated;  use a sling or other positioning device when walking

  • prevents subluxation of the shoulder
  • prevents injury to the arm, hand, elbow
  • keeps the limb visible 
  • increases body awareness

Outline doorways with bright tape 

  • increases environmental awareness
  • provides a point of reference when seeking the left visual field
  • prevents collision and injury with door frames
  • increases safety
  • reduces risk for fall

Clear the way

  • eliminate necessary obstacles on the left side
  • provide clear, clutter free paths
  • offer verbal and visual cues as needed

Stand or walk next to the person on their affected side
  • encourages them to look and scan to the left
  •  enables you to steer them away from obstacles
  • increases safety- reduces risk of colliding, tripping or falling

Left Sided Neglect and Meal Time

Not only will persons with visual neglect eat only half of the food on their plate, they will not be aware of things on the left side of the table. It is important to consider the entire dining environment.  Small changes can make a big difference.

  • Place napkin, utensils, beverages and yummy deserts on the left side of the table
  • Rotate the plate during the meal to ensure all food is consumed
  • Sit on the person's left side to draw their attention that way
  • Use hand over hand techniques to facilitate use of left hand, when appropriate
  • Give verbal and tactile cues as needed
  • Tape a line down the center of the table or tray where the meal is being served
  • Avoid distractions and eliminate clutter

Left Sided Neglect and Activities of Daily Living

Neglecting half of the body can be problematic when considering hygiene and dressing. Compensatory strategies to the rescue!

  • Dress, shave or wash the left side of the body first and then the right
  • Encourage the use of the left hand as much as possible
  • Label drawers to indicate contents within
  • Place all necessary items to complete the task to the left
  • Use a mirror to provide feedback
  • Provide verbal and tactile cues as needed
  • Eliminate distractions
  • Reduce clutter
  • Limit choices

Additionally, there is a tremendous variety of adaptive equipment to make life easier for the person with hemiplegia and associated visual neglect. Occupational therapists are the experts here and can assist with selecting appropriate devices or pieces of equipment

Try to let the person do as much as they can for themselves. It may be easier and save time for you to do the task, but the person will become less independent unless they try to do tasks on their own. 

Left Sided Neglect and the Environment

Retraining an individual to attend to the left side of their world takes time and persistence. Consistent attention to the left, even during leisure activities or when visiting with a friend, can speed the recovery process.

Place frequently used items or objects on the left
  • remote control
  • glasses
  • water
  • phone
Position bed to encourage looking toward  windows and doorways

Position TV or radio on the left 

Sit on the left side of the person

To avoid startle, approach from the right

Left Sided Neglect and Reading or Writing

Reading and writing abilities can be significantly limited by changes in the visual field. External cues and simple modifications are helpful.

  • Draw a brightly colored line down the left side of the page- cue to use as a reference point for finding the left margin
  • Use a ruler, index card or blank piece of paper to follow the lines of text
  • Number the lines in order to follow proper sequence and avoid skipping
  • Follow along using a finger
  • Use enlarged print or double spacing 
  • Cue and prompt as needed

Neglect affects all aspects of a person's life. Encourage families and caregivers to learn more about ways they can assist in recovery. Incorporating compensatory strategies during the rehabilitation process can increase awareness, safety and ultimately, independence. 

Helping a person will not necessarily change the world, but it will change the world for that person. 

Monday, August 31, 2015

Look Left: The Basics of Hemispatial Neglect (Part 1 of 2)

Hemispatial neglect, also known as left neglect, results most commonly from brain injury to the right cerebral hemisphere and causes visual neglect of the left hand side of space. Although it most often affects visual perception, neglect in other forms of perception can can also be found, either alone or in combination, with visual neglect. 

No matter the reason or the result, witnessing neglect in a stroke survivor is a mind blowing experience. They teach us about it in school, but when you experience it first hand, you're almost guaranteed to be amazed.

I clearly remember a woman I was working with at a rehab hospital in Houston. She had visual and perceptual neglect of the left side of her body.  Not only did we have trouble getting her to see the things on the left of midline, she literally did not recognize the left side of her body. 

I was working with her during a therapeutic lunch meal, trying to get her to eat the food on both sides of her plate, when the neglect became apparent.

Ms. P: What is that?
Me:  That's your arm. 
Ms. P:  No it's not.
Me:  Yes, ma'am, it is. It is your left arm.
Ms. P:  That's not my arm. That arm is fat and ugly.
Me:  It's a little puffy, but it is your arm.
Ms. P: Get that thing out of here. It's disgusting. 
Me:  But it's your arm, we can't get rid of it.
Ms. P:  Well, you're a smart girl, I'm sure you can think of something. 

I thought she was joking, but it was no laughing matter for her...she wanted that arm gone or she was not going to eat.

Just this week, I had another run in with left neglect. I was so busy coaching the patient through his safe swallow strategies, I didn't notice, until the end of the meal, he had only eaten half of the food on his plate. It's almost a perfectly straight line down the middle of the plate...unbelievable

Quick, snap a picture!  This is good material for a blog!

So, if you've read this far, you've learned two of the signs of left neglect, but there are more...

Signs and Symptoms of Left Neglect

  • Frequently bumps into objects, furniture, door frames or people on the left
  • Unsure of footing while walking, with stumbling or tripping
  • Often startled by moving objects or people appearing suddenly on the left
  • May have bruises on left arm, shoulder, elbow or hand
  • Frequently loses place when reading and becomes frustrated when reading
  • Struggles to find or misjudges the start or end of a line of print in reading
  • Only writes or draws on the right half of the page
  • Problems in finding things on desks, counter tops, cabinets or closets
  • Fear or anxiety in walking through unfamiliar areas
  • Eats the food only on the right side of the plate
  • Little or no awareness a hemisphere deficit exists
  • Difficulty acknowledging the left side of the body
    • Comb only half of their hair
    • Put on only one sleeve of their shirt, or one leg of their pants
    • Wash only the right half of the body
    • A woman may apply makeup to only the right half of the face
    • A man may only shave the right half of his face

Model on the left. Patient's drawing on the right.

Left sided neglect

The stylish half beard

Okay, so now that we can identify hemispatial neglect, what are we going to do about it? Please check back for part 2 of this blog. I'll give you tips and tricks you can use to compensate for neglect or increase safety with mobility, during ADLs, at mealtime, when reading and writing.

Thanks for reading...hope it's a great week!

What we see depends mainly on what we look for.

Images courtesy of, and