Abstract
Aim : To review the literature on unilateral visuospatial inattention/neglect following stroke, concentrating on the areas of the brain involved, methods of assessment and therapeutic options. Methods : A literature-based survey was conducted using relevant articles and practical experience to elicit current theories of inattention and to discover whether any evidence-based treatment strategies exist. As there are numerous testing approaches for inattention, evidence was also sought for the most appropriate and accurate assessment tool(s). Results: The star cancellation, line bisection and random shape cancellation tests appeared to be the most sensitive for detecting neglect; however, a range of tests is necessary in order to detect severity.Therapeutic options may include scanning techniques and visuo-motor cueing into the affected side, prism adaptation and limb activation to increase awareness of the affected side and reduce inhibition by the healthy hemisphere. Motor and functional recovery of stroke patients with neglect seems to be improved by targeted treatment. Conclusion: Neglect is an important predictor of poor functional recovery and therefore treatment remains a high priority. However, more research is needed to better define which treatment options are the most effective.
Highlights
Unilateral visual inattention (VI) or neglect is an umbrella term to describe perceptual, attentional, motor and sensory defects
Patients often miss or omit letters from one side of the vision chart. Those patients with marked neglect often turn their head and body to the unaffected side; that is, in left neglect they turn towards the right and may demonstrate a large abnormal head posture of face turn right with their eyes deviated in extreme right gaze, simulating a gaze palsy
Patients may perform better on one test but have marked VI on another;[29] this may be a reflection of the type of neglect or their attentional status at the time or the stage of the assessment
Summary
Unilateral visual inattention (VI) or neglect is an umbrella term to describe perceptual, attentional, motor and sensory defects. Many patients are totally unaware of or deny any ill-effects of their stroke This is termed anosognosia and is common following dominant parietal lobe lesions with hemi-paresis. This results in a belief that their perception of space is entirely normal, and making patients aware of the deficit can be extremely difficult. The limbic system forms a representation of the external environment; it targets specific stimuli and searches these stimuli through visual scanning.[8] As the parietal lobe is largely responsible for creating this sensory representation and targeting stimuli an interruption to any of its connections, rather than a lesion in a specific anatomical area, may result in damage to the attentional system and cause neglect.[8]. The neglect syndrome rather than overall stroke severity is an important predictor of poor functional recovery,[15,16] and therapy treatment for neglect remains a high priority
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