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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 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.
[Related: Why Brain Injury Education Is Important]
Here are a few signs that rehabilitation professionals commonly see when diagnosing cases of left neglect or hemispatial neglect:
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]
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]
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.
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.
[Related: Different Parts, Different Speeds]
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.
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.
[Related: What Is the Goal of Rehabilitation?]
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.
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.
[Related: Visual Scanning Skills With I Spy]
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.
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.
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!
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Moody Neurorehabilitation Institute (Moody Neuro) provides personalized care to treat the unique challenges of brain injury with the singular purpose of achieving the best possible outcome for patients and their families.