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Understanding Left Neglect After Stroke & How to Treat It

plate half full of fruit on the right side to symbolize left neglect after stroke

Left neglect after stroke is a peculiar disorder that can lead to strange behavior.

For instance, patients with left neglect may only eat from the right side of their plates. Not because they aren’t hungry, but because they no longer have the spatial awareness on their left side to notice the remaining food.

To help you understand this condition, you’re about to learn the causes, symptoms, and treatment for left neglect after stroke. At the end, you’ll find some exercises to help boost awareness on the left side.

Causes of Left Neglect After Stroke

There are interesting nuances to the condition of left neglect after stroke. For instance, it’s widely accepted that left-side neglect is more common than right-side neglect; however, there are cases of right “inattention.”

To understand why left neglect occurs (and why it occurs more frequently than the right side), let’s look at the differences between the brain’s two hemispheres and the function of the parietal lobe.

First, we know that each hemisphere of the brain controls the opposite side of the body. Therefore, a stroke in the right hemisphere usually affects the left side of the body.

Furthermore, the parietal lobe plays a strong role in spatial awareness; and the right side of the parietal lobe plays an even bigger role in attentional processes. We rely on our right parietal lobe to help us notice the environment on the left side of our body.

Therefore, a right-side parietal lobe stroke is likely to result in left-side neglect.

This is one of many reasons why stroke patients are encouraged to ask their doctor or neurologist about the area of the brain affected by stroke. This information gives a big clue about what secondary effects may occur after a stroke.

Symptoms of Left Neglect After Stroke

The biggest symptom of left neglect after stroke is difficulty noticing things on the left side of the body and environment. Here are some examples of what left neglect after stroke may look like:

  • Bumping into objects on the left side of the body, and difficulty navigating the environment
  • Eating only the right side of the plate
  • Reading and writing only from the right side of the page
  • Putting a shirt only over your right arm
  • Ignoring caregivers unintentionally when approached on the left side, and often only turning head to the right

It’s important to know that left neglect is different from left visual field cuts. Left neglect is an attention issue while field cuts are a visual issue. Both conditions make it hard to notice things on the left side of the environment, though.

Therefore, it’s important to work with an occupational therapist or speech-language pathologist to accurately diagnose your condition.

drawing of a clock with the numbers filled in only on the right side

Image from Journal of Neurology

Your therapist may test for left neglect by asking you to fill in the numbers on an empty clock. A stroke patient with left neglect may only fill in the numbers on the right side like in the image above.

Treatment for Left Neglect

Now that you understand what causes left neglect after stroke, let’s discuss treatment.

It’s always best to begin treatment alongside a qualified therapist. They can help get you started on the right path and address any related complications that could make treatment more difficult (like left visual field cuts).

While seeking treatment with a therapist, it’s a good idea to pursue rehabilitation at home too. This helps keep the brain stimulated and recovery going.

Here are some evidence-based methods that therapists may suggest for treating left neglect after stroke:

  • Visual scanning training. The stroke patient is presented with various stimuli (like letters and symbols) and asked to point out specific ones, encouraging them to visually scan to the left. This retrains the brain to improve spatial awareness.
  • Prism adaptation. Prism glasses contain special lenses that pull items from the left into the central visual space. This helps stroke patients with left neglect notice more of their environment. It’s a compensation technique that should be paired with other restorative treatments like visual scanning training.
  • Limb activation. The left arm and leg are activated to stimulate the brain’s spatial and motor control centers. It should be combined with visual scanning training for best results.
  • Eye patching. The right eye (or the right fields of both eyes in some cases) can be patched to force more awareness of the left visual environment. This is a type of constraint-induced therapy, which can be difficult to practice without the help of a skilled therapist.
  • Sensory stimulation. Stimulating the left side with electrical stimulation may help improve left neglect, although more research is needed to prove the effectiveness.
  • Mental imagery. Visualizing yourself noticing both your left and right environment may help, although more research is needed. However, it’s a non-invasive treatment, so there’s no harm in giving it a shot. This may be difficult for severe cases of left neglect, because these people typically do not realize they have this problem without significant assistance from therapists and caregivers.
  • Trunk rotation. By simply turning your torso to left, you can help train your brain to notice your left side. However, remembering to turn your torso can be difficult.

Of all the treatments for left neglect listed above, visual scanning training is the most effective – and has the most research behind it.

Up next, you’ll find some visual scanning exercises that you can do at home to improve left neglect after stroke.

Exercises for Left Neglect

You will see the best results from rehabilitation exercises if you practice them with consistency. The brain needs regular stimulation in order to activate neuroplasticity and rebuild skills.

Here are some left neglect exercises that can help retrain the brain to become aware of your left side:

  • Look both ways. Before you start any activity, make a habit of looking both ways. By turning your head to the left and right, you help train the brain to notice more space.
  • Letter hunting. Print out a word search and hunt for specific letters. The goal is to train your brain to notice letters on the right and left side. If this is too difficult, ask a caregiver to mark each letter with a highlighter and then tell you how many there are. Then, you can keep looking until you know you’ve found them all.
  • Anchoring techniques. Use a highlighter to draw a bright line down the left side of a book, and then practice moving your eyes all the way to the left until you find the highlighter mark. This can ensure that you are seeing/reading from the left-most point to the right. This is a popular occupational therapy treatment activity for left neglect. It helps to ask a caregiver to draw the line and sit with you to ensure you’re reading the whole line.
  • iSpy. Go on a walk with a caregiver and play a game of iSpy. Ask your caregiver to specifically find things on your left side. Your job is to find the object and point to it! If it’s too cold or rainy out, try doing this indoors.
  • Mazes. Print out some mazes and try your best to complete them. Turn your head to the left when you get stuck to notice more paths.
  • Mix up your routine. Ask a caregiver to strategically place things on your left side throughout your daily routine. For example, have them place your clothes on the left side of the dresser, or place your silverware on the left side of the plate. If this is too frustrating in the beginning, start with small tasks that you don’t mind taking longer, like placing your toothbrush on the left side of the sink.

You can get creative with your left neglect exercises, especially if you’re currently working with an occupational therapist. Ask your OT to send you home with some exercises to try, and get your family involved.

Success Story: How Jerry Is Improving Left Neglect After Stroke

Visual scanning is a popular exercise for left neglect after stroke.

At Flint Rehab, we recently heard from a stroke survivor named Jerry who is improving left neglect through visual scanning – unintentionally!

It happened because visual scanning is required to use our music-based hand therapy device called MusicGlove.

user demonstrating how to use MusicGlove hand therapy in sync with the music

As notes scroll down the screen, the user must make a therapeutic hand movement in sync with the music. Because this requires visual scanning of the screen, it helped Jerry improve his left neglect.

Here’s what Jerry’s wife, Monica, recently said about the progress:

“My husband’s stroke was 2.5 years ago. He has come a long way with FitMi and MusicGlove! His fine motor skills have improved tremendously!

The program has 3 balls coming down 3 paths. Jerry has left neglect but this program has even helped this deficit because he has to look left to see the leftmost ball and path. So glad I found Flint Rehab!”

Monica’s MusicGlove review 3/23/21

While MusicGlove is designed to improve hand function, it’s great to see that it’s helping with left neglect, too!

Overcoming Left Neglect After Stroke

Visual scanning training is the most effective treatment available for left neglect, and the good news is that you can do it from the comfort of home.

If you find it too difficult, then work with your occupational therapist or speech-language pathologist to get started. It’s important to keep your medical team involved because left neglect can be mistaken for other conditions like left visual field cuts.

We hope this article provided the insight you need to overcome left neglect after stroke.

Featured image: ©iStock.com/Ayman-Alakhras

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Get Inspired with This Stroke Survivor Story

5 stars

Mom gets better every day!

When my 84-year-old Mom had a stoke on May 2, the right side of her body was rendered useless. In the past six months, she has been blessed with a supportive medical team, therapy team, and family team that has worked together to gain remarkable results.

While she still struggles with her right side, she can walk (with assistance) and is beginning to get her right arm and hand more functional. We invested in the FitMi + MusicGlove + Tablet bundle for her at the beginning of August.

She lights up when we bring it out and enjoys using it for about 20 to 30 minutes at a time. While she still doesn’t have enough strength to perform some of the exercises, she rocks the ones she can do!

Thanks for creating such powerful tools to help those of us caring for stroke patients. What you do really matters!

David M. Holt’s review of FitMi home therapy, 11/09/2020

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