Hemispatial Neglect: When half the world goes unnoticed

Hemispatial Neglect, also called unilateral neglect or spatial neglect, is a brain condition where a person ignores one side of their surroundings. This often happens after a stroke or brain injury, usually affecting the right side of the brain and causing the person not to notice things on their left side. To understand this condition, we need to look at its causes and symptoms, how it is diagnosed and treated, and how it affects the lives of those with it.

What is Hemispatial Neglect?

Hemispatial neglect, also called unilateral neglect or spatial neglect, is a brain condition where a person ignores one side of their surroundings, usually the left side after a stroke or brain injury to the right side of the brain. For example, someone with this condition might only eat food from the right side of their plate, only dress the right side of their body, or bump into things on their left side because they don’t see or notice them. This condition can make everyday tasks difficult and requires special attention and therapy to help the person improve.

Causes

Hemispatial neglect happens when there’s damage to the brain, usually the right side, which helps us pay attention to our surroundings. The main causes are:

1. Stroke: This is the most common cause. When a stroke affects the right side of the brain, it can make it hard for a person to notice things on their left side.
2. Head Injury: A severe hit to the head can injure parts of the brain that help us be aware of both sides of our environment.
3. Brain Tumors: Tumors on the right side of the brain can press on areas that control spatial awareness, causing neglect.
4. Surgery: Sometimes, brain surgery, especially on the right side, can lead to neglect if complications arise.
5. Infections or Inflammation: Infections like encephalitis that affect the brain can also damage the areas involved in attention and awareness, leading to neglect.

Types of Hemispatial Neglect

In the case of hemispatial neglect, the condition can be broken down into different types:

1. Perceptual Neglect: This means patients don’t notice things on one side of their environment. For example, they might not see objects or people on their left side.
2. Motor Neglect: Here, patients have trouble using a limb on the neglected side, even though it works fine. For instance, they might forget to use their left arm to pick up things.
3. Representational Neglect: This is when patients ignore or forget about the left side in their mind’s picture of things. They might only remember or think about the right side of an object or scene.

Symptoms

Hemispatial neglect shows up in several ways, all involving a lack of awareness of one side of space, usually the left side. Here are the common signs:

1. Ignoring Things on One Side: The person might not see objects or people on their left side. For example, they might only eat food from the right side of their plate or draw only the right side of a picture.
2. Not Hearing Sounds on One Side: They may not notice sounds coming from their left side. If someone speaks to them from that side, they might not respond.
3. Not Feeling Touch on One Side: They might not feel when someone touches them on their left side or if they bump into something on that side.
4. Not Using a Limb: Even if their left arm or leg works fine, they might not use it much. For example, they might only use their right hand to pick things up.
5. Ignoring One Side of Their Body: They might only take care of one side of their body, like shaving or putting makeup on only one-half of their face.
6. Missing Things When Both Sides are Stimulated: If something happens on both sides at once, like being touched on both arms, they might only notice it on the right side.

How to Diagnose

Diagnosing hemispatial neglect involves a few simple tests and observations to see how a person interacts with their surroundings. Here are the common ways to diagnose it:

1. Watching Behavior: Doctors watch how the person behaves in daily activities, like eating or getting dressed, to see if they ignore one side.
2. Line Test: The person is asked to mark the middle of a straight line on a piece of paper. If they have neglect, they often mark it off-center, closer to the side they notice.
3. Finding Items Test: The person is given a paper with many shapes or letters and asked to find all of a specific kind. Those with neglect usually miss the ones on the neglected side.
4. Drawing Test: The person is asked to draw a simple object, like a clock or a house, or copy a picture. If they have neglect, they might leave out details on the left side.
5. Reading and Writing Tests: These tests show if the person skips words or letters on one side of the page.
6. Daily Task Test: The person does everyday tasks like dialing a phone number or reading a map to see if they ignore one side.
7. Asking Questions: The doctor asks the person or their family about any difficulties they have in daily life to get more information.

Related Article: Episodic Buffer: Where your experiences come together

Treatment

Treating hemispatial neglect involves different ways to help the person become more aware of their neglected side and improve their abilities. Here’s how they do it:

1. Practice Looking: They practice turning their head or eyes towards the neglected side to pay more attention to it.
2. Special Glasses: Wearing glasses with prisms helps them see more on the neglected side, helping them adjust their perception of space.
3. Feeling More: Gentle touches or vibrations on the neglected side help them notice it more.
4. Brain Exercises: Doing activities that challenge their attention and awareness of the neglected side, like sorting things or following instructions.
5. Changing the Environment: Moving important things, like a phone or clock, to the neglected side helps draw their attention to it.
6. Using a Mirror: They might use a mirror to make it seem like their neglected side is normal, which can encourage them to use it more.
7. Therapy: Working with a therapist to practice everyday activities, focusing on using both sides equally.
8. Using Tools: Visual cues or reminders can help them remember to pay attention to their neglected side.
9. Family Help: Teaching family members how to support and assist them in daily tasks can make a big difference.
10. Medicine: Sometimes, medications that help with attention might be used, but they’re not specifically for treating neglect.

Hemispatial neglect is a tricky condition caused by brain injury, often from a stroke. It really messes with how people see and understand space, which can make life tough. Catching it early and giving lots of therapy is super important to help folks get better. Luckily, scientists are learning more about how it works and finding better ways to treat it, so there’s hope for folks dealing with this challenge.