Unilateral Spatial Neglect
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Unilateral spatial neglect (USN) is one of the disabling features of a stroke, and is defined as a failure to attend to the side opposite a brain lesion. Clinically, the presence of severe USN is apparent when a patient often collides into his/her surroundings, ignores food on one side of the plate, and attends to only one side of his/her body. Many terms are used interchangeably in the literature to describe USN, such as unilateral neglect, hemi-inattention, visual neglect and hemi spatial neglect. It is estimated that as many as 30% of patients experience USN following a stroke.
A client with USN is unable to attend to either one side of his/her body (personal neglect), the space within reaching distance (near extrapersonal neglect), the space beyond reaching distance (far extrapersonal neglect), or to a combination of these three spaces in the environment. USN continues to be commonly associated with a right stroke, but evidence from the literature suggests that all patients with stroke might benefit from USN screening.
The presence of USN has been strongly associated with an increased risk for injury and with poor functional outcomes. The effects of USN extend beyond the basic skills for self-care (bathing, dressing, walking, etc.) to instrumental activities of daily living (IADL) that are crucial for successful reintegration into community life.
Typically, right hemisphere patients with left neglect omit elements to their left when copying simple objects (A), drawing a clock face (B), and cancelling targets among distractors (C). They also tend to err to the right when asked to bisect a horizontal line (D). When asked to name objects in their surroundings, they will tend to name only those on the right. Crosses in (E) mark the locations of reported objects with respect to the patient.
Parton, A et al. J Neurol Neurosurg Psychiatry 2004;75:13-21 reproduced with permission from the BMJ Publishing Group
Authors*: Anita Menon, MSc; Anita Petzold, BSc OT; Nicol Korner-Bitensky, PhD OT.