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

1 comment:

  1. This is so interesting. I learned a lot. Bless all therapist who help people with this challenge