Rehabilitation of neglect
Singh-Curry V., Husain M.
© Cambridge University Press 2008.The neglect syndrome is associated with a failure to attend to one side of space following unilateral brain injury, most commonly stroke. Neglect is a common disorder which can have a negative effect on long-term functional outcome. The syndrome is heterogenous, with different patients having varying combinations of underlying cognitive deficits. The pattern of cognitive deficits depends upon the areas of brain damaged - and those left intact. Both spatial and nonspatial mechanisms contribute to neglect and may represent different targets for treatments aimed at rehabilitating the condition. The neglect syndrome is a common disorder following unilateral brain injury, particularly prominent after right-hemisphere stroke. It consists of a striking failure to orient towards, report or act upon stimuli - objects, people and even the patient’s own body parts - in contralesional space (left side for individuals with right-hemisphere damage and vice versa). This lateralization may result from hemispheric asymmetries that exist for attention functions in the human brain. Many patients are also unaware of their deficits (anosognosia) making persistent neglect a disabling syndrome which is particularly difficult to rehabilitate (Robertson & Halligan, 1999). Thus neglect patients generally have poorer functional outcomes compared with other stroke patients with similar physical disabilities. Neglect is not a unitary disorder, but rather a syndrome. Patients may neglect the contralesional side of their own body (personal neglect), near space (peripersonal neglect) or distant space (extrapersonal neglect). Some patients are primarily deficient in attending to and perceiving objects in contralesional space, even though they may not have any primary sensory disorder. By contrast, others may show little spontaneous use of their contralesional limbs (motor neglect), despite being reasonably strong. Different patients may demonstrate different combinations of neglect behavior (Buxbaum et al., 2004), so clinical assessments often consist of a battery of tests (Figure 26.1), designed to take this variation into account (Parton et al., 2004).