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Left Neglect After Stroke: Symptoms, Treatment, and Exercises

right half of plate eaten due to left neglect after stroke

Left neglect may cause stroke patients to leave the left side of their plates uneaten. It’s not that they aren’t hungry, but they no longer have the spatial awareness on their left side to notice the remaining food. And left neglect is not limited to mealtime, either.

A stroke patient with left neglect may not notice people that talk to them on their left side, or they may only brush the right side of their hair. Anything on their left side may be unintentionally ignored.

To help with 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 for left neglect that you can practice at home.

Let’s get started.

Cause of Left Neglect After Stroke

Left neglect is a spatial awareness problem that often occurs after a parietal lobe stroke. Left side neglect is more common than right side neglect, but why?

First, we know that each hemisphere of the brain controls the opposite side of the body – for most functions. However, the parietal lobe, which governs spatial awareness, is different.

A popular theory suggests that the right parietal lobe attends to both sides of the environment, while the left parietal lobe only attends to the right side. Therefore, when a stroke occurs in the right parietal lobe, it may lead to left neglect.

Diagnosis becomes more complex in left-handed (left-side dominant) patients because, in these unique individuals, the roles of the parietal lobes are switched. This means that the right parietal lobe only attends to the left side, while the left parietal lobe attends to both sides.

As you can see, understanding the side effects of stroke can be complex because every stroke is different and every brain is different. Talk to your neurologist to get a better understanding of your unique stroke side effects.

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
  • Eating only the right side of the plate
  • Reading and writing only from the right side of the page
  • Putting a button-up shirt only over your right arm

It’s important to know that left neglect is different from left 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 of speech-language pathologist to accurately diagnose your condition.

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 this:

drawing of clock only filled in on right side from left neglect after stroke

Image from Journal of Neurology

Treatment for Left Neglect

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

The following methods can be used to treat left neglect after stroke, with the most effective, evidence-based treatments listed first:

  • Visual scanning training. The stroke patient is presented with various stimuli (like letters and symbols) and asked to point out specific ones. 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 left eye can be patched to force awareness of the right side. 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.
  • 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.
  • Transcranial magnetic stimulation. This involves placing powerful magnets over the skull to stimulate the brain. More research is needed to prove whether or not magnetic brain stimulation can help left neglect after stroke.

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

The following left neglect exercises can help train 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.
  • Reading from the left. Use a highlighter to draw a bright line down the left side of a book, and then practice reading from left to 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.

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 yourself at home.

If you find it too difficult, then work with your occupational therapist of 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 cuts, so be careful.

Featured image: ©iStock.com/Ayman-Alakhras

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