Neglect patients do not react to stimuli on one side of their body or their environment. For example, when eating, food on one side of the plate remains untouched. When putting on makeup or shaving, one side is missed, or when spoken to from the affected side, individuals will not react.

Patients suffering from neglect do not realize that their perception is limited. Stimuli from the environment are sent to the brain, but the brain fails to process this information correctly.

The brain controls the body crosswise: The right hemisphere controls the left side of the body, and the left hemisphere coordinates the right side of the body. Typically, neglect occurs following damage to the right half of the brain.

With a visual neglect, the patient’s eyes and head move towards the side of the brain that is damaged. Patients can miss objects, obstacles, persons or react too late. They might also have difficulties maintaining eye contact.

When suffering from an auditory or acoustic neglect, the patient no longer registers sounds or noise on the neglected side. The patient does not react when addressed from that side. This does not equal deafness. Hearing is intact, but the information is not processed correctly in the brain.

A motor neglect means that the patient is barely using, or not using at all, their muscles on the neglected side of the body. The vast majority of movements are carried out by the other half.

If a patient does not or only with delay respond to touch or pain on one side of the body, this is classified as a somatosensory neglect. This is particularly problematic if pain is not detected when being injured, e.g. fingers pinched in the spokes of a wheelchair. To some extent, patients perceive pain on the other side of the body.

If smelling is affected, the patient finds it difficult or impossible to perceive smells on the neglected side of the body. This is called an olfactory neglect.

A stroke is a new, challenging situation – for the entire family. A neglect can worsen the situation by the fact that those affected do not notice that they are missing or neglecting things.

In everyday life, relatives can support the independence and motivate those affected to be active. In the case of a neglect, it can be helpful to stimulate the affected side of the body, for example by handing the person objects, sitting or addressing that person from the neglected side.

A neglect can also make communication and interaction difficult. Affected individuals sometimes react inappropriately to conversations or situations and have difficulty maintaining eye contact. This can affect social life.

In day-to-day life, the family should encourage the patient to complete more and more tasks independently and to exercise. Understanding and interacting with the patient can improve the patient’s condition. Furthermore, family members should support rehabilitation exercises in coordination with the treating therapist. Where appropriate, family and patients can join self-help groups, either together or separately.

A 2021 study showed that robotic hand training can have a positive impact on neglect after a stroke.

The advantage of robotic rehabilitation equipment is that it allows for passive, active or assistive movement of the affected part of the body with a high number of repetitions. Whereas therapists typically had to provide continuous movement of the hand of a stroke patient, this task can now be carried out by technology under supervision of the therapist.

Movement stimulates neuroplasticity. The brain starts to form new connections to compensate for damaged areas. This can help reduce the impact of neglect.

Technology also allows for objective assessments in neglect therapy. The “wiping” exercise using Myro can quantify the extent of a neglect. Deficits can then be addressed specifically, and progress can be monitored.

Author: Michaela Partel

Sources:

Leitlinien für Diagnostik und Therapie in der Neurologie. Rehabilitation bei Störungen der Raumkognition, 2017

Neglect und assoziierte Störungen, 2018

Passive limb movements improve visual Neglect, 2001

The effects of robot-assisted left-hand training on hemispatial Neglect in older patients with chronic stroke: A pilot and randomized controlled trial, 2021

Effects of contralesional robot-assisted hand training in patients with unilateral spatial Neglect following stroke: a case series study, 2014