What Is Left Neglect?

Article by Moody Neuro

Injury to the brain’s right hemisphere can cause left neglect. The condition is also known as left side neglect, unilateral neglect or hemispatial neglect. It is one of the oddest symptoms of brain injury and can be one of the most troublesome.

“Left neglect” is a term describing a deficit in awareness that occurs following an injury to the brain’s right side. Because of the injury, the brain has difficulty paying attention to items falling into the left hemisphere.

Left Neglect Symptoms

Left neglect or hemispatial neglect generally manifests most clearly in difficulties with visually noticing items on the left side. For example, survivors with left neglect may bump into door frames on their left side or miss eating food on the left side of plates. It often appears as if they’re blind to items on the left, but this isn’t a true vision issue — it’s an attention issue.

The brain isn’t attending to information generated from the person’s left side. The survivor can have perfect visual skills. However, the message their brain is providing is that the left side of their world essentially doesn’t exist, resulting in left visual neglect.

Left neglect doesn’t involve just visual components. It can also manifest as a lack of attention to sound or touch on the left side. For example, survivors may report they can’t hear as well from their left ear, despite audiological testing demonstrating perfect hearing.

Survivors may fail to notice left hands getting stuck in the wheels of their wheelchairs, and they may injure that hand. In severe cases, survivors may not recognize their own left limbs as being parts of their bodies. They may ask something like, “Whose arm is in my bed?”

Fine variations in damage suffered to slightly different parts of the right side of the brain lead to notably distinct manifestations of left neglect, which makes each survivor’s experiences differ.

Common Left Neglect Symptoms and Signs

Here are a few signs that rehabilitation professionals commonly see when diagnosing cases of left neglect or hemispatial neglect:

The patient eats food only on the right side of plates and doesn’t notice food on the left side. Often the patient complains that they’re not being fed enough. They believe people are serving them half-sized portions — the brain is ignoring food to the left.
The patient bumps against objects with the left side of their body or wheelchair. For example, the patient may catch the left side of a door frame as they enter or exit a room. Patients who are just beginning to understand their left neglect and have yet to become proficient in scanning techniques will often have bruising along their left limbs.
The patient doesn’t face people to their left, even when speaking to them. The patient may begin a conversation face to face, but their gaze drifts to the right during the conversation.
The patient applies makeup to, shaves or washes only the right side of their face.
The patient misses words on the left side of a page. This can cause them to complain that the reading material doesn’t make sense because they don’t realize they’re reading words only on the right side of the page.
The patient can’t find rooms located on the left side of a hallway. Sometimes a patient will claim a room has “moved” or “disappeared” because they can’t find it.
The patient will start all activities on the right side and not make it all the way to the left. For example, a patient may play Connect Four and place chips only on the right half of the board. They may squeeze all their writing onto the right side of a page and leave the left side blank. When drawing a picture, they may leave the page’s left side blank.
The patient complains that they’re losing hearing in the left ear, even though testing shows no hearing loss.
In extreme cases, a patient may not recognize a left arm or leg as being their own body part. When they see the limb but don’t recognize it, they may make a complaint, such as that a stranger has joined them in bed.

Left Neglect Difficulties

Left-sided neglect symptoms may result in considerable difficulties that can cause serious safety issues. For example, a survivor may not notice a boiling pot of water sitting on the stove on their left side and bump into the pot, causing serious burns from spilled boiling water.

Similarly, a survivor may not notice cars on their left and attempt to cross a busy street at a bad moment, which puts them at risk of being hit. It’s not uncommon for survivors with left neglect to have constant bruising on the left side of their bodies due to bumping into items.

To make the issue even more complex, many survivors with left neglect may have issues with impulse control or be very easily distracted. This substantially compounds the dangers and difficulties that survivors with left neglect have to deal with.

Some survivors may be missing vision on the left side — a condition known as a field cut (see below) that adds an actual visual problem on top of attentional issues. Even when survivors are completely aware of their left neglect, in the absence of treatment, difficulties and errors will persist.

Remember: The brain is unconsciously telling the survivor to ignore the left side, and the neglect is unintentional. Because the brain creates this false message, survivors feel like everything is normal and as if they’re attending to the left as well as they would have before their injury.

[Related: Tips for Improving Attention]

Left Neglect vs. Field Cut

Multiple distinct symptoms of brain injury can present in remarkably similar ways.

For example, a brain-injured survivor’s failure to take medication could be due to a memory deficit that leads them to simply forget their medication, or the missed medication could be due to an attention deficit that causes them to be too distracted to take the medication.

The survivor missed taking the medication in each case, but they missed taking it for distinctly different reasons. A similar issue comes to light when looking at postinjury visual deficits. Did a survivor fail to notice information to their left due to left neglect or a field cut?

[Related: Visual and Verbal Memory]

What Is a Field Cut?

Overall, a field cut is the simpler of the two conditions to understand. Similar to left neglect or hemispatial neglect, brain injury (often stroke) causes a field cut.

With a field cut, survivors have permanently lost the ability to perceive a portion of the field of vision. That area of the field formerly available has been “cut” away.

Because of their injury, the survivor is now in effect partially blind. In medical terms, this loss of vision is often called “hemianopsia.” A survivor with a field cut has had actual visual loss in their left visual field and thus misses seeing information on their left side.

Field Cut Treatment

In the case of a field cut, most survivors do reasonably well after becoming sufficiently aware of the condition. After enough practice, they’ll naturally turn and make extra effort to look for the information in their blind spots.

Left Neglect Treatment, Therapy and Recovery

Although left neglect is certainly an issue of attention, it can’t be treated with stimulant medications like Ritalin, which rehabilitation professionals generally can rely on to improve more typical attention deficits.

Can left side neglect be reversed? Survivors can certainly get much better, although this takes dedication and time. Goals for left side neglect include retraining the brain to recognize the missing field of vision.

Survivors must engage in specific therapies and learn compensatory techniques to help make attentional deficits more manageable. Even with treatment, survivors must practice and carry over left neglect strategies into home life to avoid regressing in their performance.

Left neglect or hemispatial neglect can affect a survivor’s ability to engage in activities requiring both tabletop and environmental scanning. Rehabilitation professionals can observe left neglect effects on tabletop tasks when survivors miss words or numbers on the left side of a page.

Some examples of left neglect effects in terms of environmental scanning are survivors missing potholes on the left side of a street or a car parked on the left side of a parking lot. For such reasons, driving with left neglect is inadvisable.

For a survivor with left neglect, improvement requires awareness as well as daily scanning exercises and consistent visual aid use. Over time, survivors can improve. Below, we’ve listed a few common rehabilitation exercises for left side neglect.

Prism Adaptation

A number of methods can help survivors compensate for left neglect. One method is known as prism adaptation.

Under the care of rehabilitation professionals, patients engage in an activity while wearing strong prism glasses that pull visual items from the left into a more central attentional domain. This visual change forces them to compensate for the effects of the prism to accurately complete the activity.

After the activity, some patients with left neglect notice an aftereffect. The brain continues to pull visual items from the left to their attention, even without wearing the glasses.

Limb Activation Therapy

Professionals also use limb activation therapy to aid survivors with left neglect.

The focus is to get survivors to actively use their left limbs in the space surrounding the body’s left side. This engages the brain’s spatial and motor maps for those domains. The method is very helpful to patients, but they often encounter substantial difficulties.

Unfortunately, this method has limitations. It’s common for survivors to also have difficulty moving anything on the left side of their bodies (such as targeted paralysis or semi-paralysis, one of the most common symptoms of stroke or brain injury). However, research has shown that even passive movement of the left side can help improve issues stemming from left neglect.

Scanning Therapy

Honing scanning techniques is one of the most frequently used methods to treat patients with left neglect. Therapists teach patients methods by which to ensure they’ve scanned the entire visual field.

In scanning therapy, therapists often instruct patients to pretend as if the head is a lighthouse. They direct patients to turn their heads fully from one side to the other while scanning an environment, like how a lighthouse turns its light. Therapists generally teach patients that if they’re scanning the environment and haven’t seen their left shoulder, they probably haven’t scanned as far to the left as needed.

When involved in tabletop activities, therapists teach patients to scan to their left hand or elbow. Patients can practice this type of scanning in several ways. Therapists may ask them to scan for and identify letters or lights on a board or to scan and find features in a parking lot.

Therapists often teach patients to highlight the left side of a page or place a bright bookmark to a page’s left side to institute a cue. This cue helps them recognize when they’ve scanned all the way to the left. If patients haven’t seen the highlighted area or bookmark, they know they haven’t made it as far to the left as they should.

[Related: Visual Scanning Using Menus]

Patients learn to always start their scanning from the left and then move slowly to the right. Patients with left neglect are less likely to miss items if they begin the scanning process on the left and proceed to the right than if they do the reverse.

Therapists may also place items to the left side of patients to force them to move, scan and use their left sides. They may place a glass of water to the left of a dinner plate or pass a pen to the left hand. All these seemingly small acts help improve scanning to the left. In addition, they help patients use the body’s left side in the left hemisphere of their space.

The goal is for robust scanning and increased use of the left side to become part of patients’ daily habits. Therapists may use other cues to help a patient better attend to the left.

For example, therapists may place bells on a patient’s left hand. They’ll hear the bells ring when their left hand falls from their wheelchair. This reminds them to pick up the hand.

Therapy With Friends and Family

Therapists can easily teach scanning skills to a survivor’s family and friends, who can be of great help to them in extending these techniques beyond an environment dedicated to therapy.

Family and friends can also help by identifying situations in which the survivor may be unaware of left neglect-related difficulties. All involved can then apply this knowledge to identify how left neglect could affect future situations.

For example, a family member may help a survivor in an airport recognize they’ve knocked over a fellow traveler’s bag. They can then help the survivor prepare to enter the plane without bumping into the left aisle seats.

Reinforced over time, this aided behavior will greatly improve the survivor’s solo interactions with the world.

Unfortunately, sometimes a survivor may suffer from both left neglect and a field cut. This combination can make successful functioning especially difficult, but with dedication and determination, left neglect and field cut patients can reach almost any rehabilitation goal.

Moody Neurorehabilitation Institute

We hope this article clarifies issues about left neglect/hemispatial neglect and field cut. Please leave a comment below with any questions, thoughts or ideas!

Learn how Moody Neuro can help with neuropsychology and counseling, speech and language disorders, physical therapy, outpatient rehabilitation assistance, community integration programs, occupational therapy and brain injury treatment services.

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Strokes are medical conditions that affect millions globally. In the United States, more than 795,000 people have a stroke each year, with about 610,000 cases being first or new strokes.

These can lead to a wide range of physical and cognitive impairments. Speech and language disorders are among the most common and most challenging consequences of strokes, occurring in about a third of stroke survivors.

Understanding Stroke-Induced Speech & Language Disorders

Stroke-induced speech and language disorders significantly impact communication abilities. Among these, aphasia, dysarthria, and apraxia of speech are prevalent. Understanding how they are diagnosed and their specific symptoms can aid in prompt and effective management.

Aphasia

Aphasia is a common outcome of stroke, manifesting as difficulty in speaking, understanding, reading, and writing. There are many different types of aphasia, depending on the affected brain area, and are categorized based on the symptoms present:

Expressive Aphasia (Broca’s Aphasia): Characterized by broken speech, limited vocabulary, and difficulty forming complete sentences. Patients often understand what is being said to them but struggle to verbalize responses.
Receptive Aphasia (Wernicke’s Aphasia): Patients can produce fluent speech but may lack meaning or include nonsensical words. They often have significant difficulty understanding spoken language.
Global Aphasia: A severe form of aphasia where individuals have extensive difficulties with both speech production and comprehension.
Anomic Aphasia: Individuals have difficulty finding words, particularly nouns and verbs, making their speech sound vague.

Dysarthria

Dysarthria is a speech disorder that affects 20-30% of stroke survivors. It occurs when stroke impacts the muscles responsible for speech, leading to slurred or slow speech that can be hard to understand. It is typically diagnosed through a physical examination and a series of speech evaluations conducted by a speech-language pathologist (SLP).

It is characterized by the following symptoms:

Slurred or slow speech that can be difficult to understand
Monotone or robotic-sounding speech
Difficulty controlling the volume of speech, which may be too loud or too soft
Challenges with the rhythm and flow of speech, including rapid speech that’s hard to interrupt or slow, drawn-out speech
Respiratory issues affecting the ability to speak loudly or for extended periods

Apraxia of Speech (AOS)

Apraxia of speech is a neurological disorder characterized by difficulty sequencing the movements needed for speech. This is caused by the impact of the stroke on the brain’s pathways involved in producing speech.

Patients with AOS know what they want to say but struggle to coordinate the muscle movements to articulate words correctly. This results in distorted speech, difficulty initiating speech, or the inability to accurately produce speech sounds or sequences of sounds.

How Long Is the Stroke Speech & Language Recovery Time?

According to one study on post-stroke speech and language therapy, approximately one-third of stroke patients experience speech problems after a stroke. Many of these individuals begin to recover within a few months, with significant progress typically observed within three to six months.

In another study, 62% of subjects had speech challenges after suffering from a stroke. By six months post-stroke, 74% were able to completely recover their communication abilities.

However, the figures above provide a general timeline for post-stroke speech and language recovery. Stroke speech recovery time is highly individualized and can vary depending on several factors. These can include the following:

Severity of the Stroke: More severe strokes often lead to extensive brain damage, resulting in longer and more challenging recovery periods for speech.
Location of the Brain Injury: The brain’s specific regions control different speech and language functions; damage to these areas directly impacts recovery complexity and duration.
Age and Overall Health of the Patient: Generally, younger patients with better overall health before the stroke tend to experience faster and more complete recoveries.
Pre-existing Conditions and Comorbidities: Conditions such as diabetes or hypertension can slow down recovery by complicating the overall health scenario and rehabilitation process.
Individual Variability and Resilience: Personal resilience, the support system’s strength, and the individual’s motivation significantly influence the pace and success of speech recovery efforts.

The first three months after a stroke is a crucial period for recovery, as a majority of stroke patients see the most significant improvement during this period. However, it’s also important to note that, although at a slower pace, recovery can continue well past the 6-month mark with continued therapy and practice.

This underpins the importance of early intervention and ongoing rehabilitation efforts, including speech therapy, to maximize each patient’s recovery potential.

What Does the Stroke Speech & Language Recovery Process Look Like?

The journey to regain speech and language after a stroke is multifaceted and varies significantly from one individual to another. Understanding the structured phases of recovery can provide insight into what patients and their families can expect during this challenging time.

Here’s a closer examination of each phase in the stroke speech recovery process.

Initial Assessment and Diagnosis

Before recovery can begin, a thorough evaluation is conducted by a team of healthcare professionals led by an SLP. This assessment aims to identify the type and severity of the speech and language disorder, be it aphasia, dysarthria, or AOS. The evaluation may include cognitive-linguistic assessments, comprehension tests, speech production analysis, and functional communication measures.

Based on this assessment, a personalized therapy plan is crafted to address the patient’s specific needs.

Acute Phase

The acute phase typically occurs within the first days to weeks following a stroke. During this period, medical stabilization is the primary focus, with healthcare teams working to manage the immediate effects of the stroke.

Speech therapy may begin with simple exercises or assessments to gauge the patient’s abilities. However, intensive therapy usually does not start until the patient is medically stable. During the acute phase, the goal is to support overall recovery and prevent complications immediately after the stroke.

Subacute Phase

The subacute phase generally spans from two weeks to three months post-stroke and is characterized by more intensive speech therapy interventions. As the patient’s medical condition stabilizes, the focus shifts to active rehabilitation. Therapy during this phase is tailored to the individual’s specific speech and language deficits and may include:

Exercises to improve articulation, fluency, and voice control for those with dysarthria.
Language therapy to enhance understanding, speaking, reading, and writing skills in patients with aphasia.
Motor speech exercises and strategies to improve speech planning and production in apraxia of speech.

The subacute phase is crucial for taking advantage of the brain’s natural recovery processes and neuroplasticity, where the brain begins reorganizing and adapting to the loss of function.

Chronic Phase

The chronic phase of recovery extends from several months to years after the stroke. It focuses on long-term rehabilitation and adjustment to any residual speech deficits. During this time, patients may continue to see gradual improvements in their speech and language abilities, although the rate of recovery may slow. Therapy in the chronic phase often includes:

Advanced communication strategies to cope with ongoing challenges in daily life.
Maintenance exercises to preserve and enhance speech gains achieved in earlier phases.
Supportive technologies and aids, such as communication devices, to assist in effective communication.
Community reintegration activities to help patients return to as normal a life as possible, engaging in social, vocational, or recreational activities.

What Is the Role of Neuroplasticity in Speech & Language Recovery?

Neuroplasticity refers to the brain’s fundamental property to change and adapt its responses to new experiences, learning, and environmental changes. This adaptive capacity enables the brain to reorganize itself by forming new neural connections.

When the brain, or a part of the brain, is damaged after a stroke, neuroplasticity is what allows the other parts of the brain to take over the functions of the damaged area. Through targeted rehabilitation and therapy, such as speech therapy for stroke survivors, patients can retrain other brain areas to perform the lost functions and facilitate recovery.

Enhancing Stroke Speech & Language Recovery Time

Adopting a comprehensive approach involving several key strategies is vital to enhance the stroke speech and language recovery time. This multifaceted approach can maximize the chances of regaining speech and communication abilities.

This comprehensive approach must incorporate the following strategies:

Early intervention to leverage the brain’s highest potential for neuroplasticity in the initial period following a stroke, significantly improving the chances for recovery.
Alternative communication strategies, such as gestures, writing, and visual aids, to help maintain communication during the recovery process.
Adopting technology, including speech-generating devices and software applications designed for speech rehabilitation, for personalized exercises and continuous practice, which is vital for progress.
Providing continuous support from psychologists, support groups, and therapy to help manage feelings of frustration, depression, and anxiety, fostering a positive mindset essential for rehabilitation.
A healthy diet and lifestyle to supply essential nutrients that support brain function, along with regular physical activity, adequate sleep, and management of medical conditions.

Begin Your Post-Stroke Recovery Journey With Moody Neurorehabilitation

Moody Neurorehabilitation understands the complexities and challenges that come with post-stroke rehabilitation. We are dedicated to supporting patients and their families through this critical time with specialized care and personalized treatment plans.

Since our inception in 1982, Moody Neurorehabilitation has been a leader in brain injury rehabilitation. Our approach centers on providing comprehensive care tailored to each patient’s needs and goals. We believe in treating the whole person, not just the symptoms, to improve overall quality of life.

We invite you to start your recovery journey with us. Contact Moody Neurorehabilitation today to schedule a consultation with our experts. Let us help you navigate the path to recovery with care, compassion, and expertise.