Skip to main content
SpringerLink
Log in

Update on the Clinical Approach to Spatial Neglect

  • Behavior (H. Kirshner, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Spatial neglect is asymmetric orienting and action after a brain lesion, causing functional disability. It is common after a stroke; however, it is vastly underdocumented and undertreated. This article addresses the implementation gap in identifying and treating spatial neglect, to reduce disability and improve healthcare costs and burden.

Recent Findings

Professional organizations published recommendations to implement spatial neglect care. Physicians can lead an interdisciplinary team: functionally relevant spatial neglect assessment, evidence-based spatial retraining, and integrated spatial and vision interventions can optimize outcomes. Research also strongly suggests spatial neglect adversely affects motor systems. Spatial neglect therapy might thus “kick-start” rehabilitation and improve paralysis recovery.

Summary

Clinicians can implement new techniques to detect spatial neglect and lead interdisciplinary teams to promote better, integrated spatial neglect care. Future studies of brain imaging biomarkers to detect spatial neglect, and real-world applicability of prism adaptation treatment, are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Barrett AM, Burkholder S. Monocular patching in subjects with right-hemisphere stroke affects perceptual-attentional bias. J Rehabil Res Dev. 2006;43(3):337–45.

    Article  PubMed  Google Scholar 

  2. Husain M, Nachev P. Space and the parietal cortex. Trends Cogn Sci. 2007;11(1):30–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Heilman KM. Intentional neglect. Front Biosci. 2004;9:694–705.

    Article  PubMed  Google Scholar 

  4. Barrett AM, Muzaffar T. Spatial cognitive rehabilitation and motor recovery after stroke. Curr Opin Neurol. 2014;27(6):653–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Barrett AM. Perceptual-attentional “where” and motor-intentional “aiming” spatial bias. In: Chatterjee A, Coslett HB, editors. The roots of cognitive neuroscience: behavioral neurology and neuropsychology. New York: Oxford University Press; 2013.

    Google Scholar 

  6. Fortis P, Chen P, Goedert KM, Barrett AM. Effects of prism adaptation on motor-intentional spatial bias in neglect. Neuroreport. 2011;22(14):700–5.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Garbarini F, Piedimonte A, Dotta M, Pia L, Berti A. Dissociations and similarities in motor intention and motor awareness: the case of anosognosia for hemiplegia and motor neglect. J Neurol Neurosurg Psychiatry. 2013;84(4):416–9.

    Article  PubMed  Google Scholar 

  8. Loetscher T, Nicholls MER, Brodtmann A, Thomas NA, Brugger P. Disentangling input and output-related components of spatial neglect. Front Hum Neurosci. 2012;6.

  9. Smith GA, Heuer A. 6-OHDA toxin models of PD in the mouse. In: Lane EL, Dunnett SB, editors. Animal models of movement disorders: Vol 1. NY: Springer/Humana; 2012. p. 281–97.

    Google Scholar 

  10. Dunnett SB, Torres EM. Rotation in the 6-OHDA-lesioned rat. In: Lane E, , Dunnett, S.B., editor. Animal models of movement disorders: volume 1. Neuromethods: Springer Science and Business Media; 2011. p. 299–315.

    Google Scholar 

  11. Kwon SE, Heilman KM. Ipsilateral neglect in a patient following a unilateral frontal lesion. Neurology. 1991;41(12):2001–4.

    Article  CAS  PubMed  Google Scholar 

  12. Sharpe JA, Bondar RL, Fletcher WA. Contralateral gaze deviation after frontal lobe haemorrhage. J Neurol Neurosurg Psychiatry. 1985;48(1):86–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kim M, Na DL, Kim GM, Adair JC, Lee KH, Heilman KM. Ipsilesional neglect: behavioural and anatomical features. J Neurol Neurosurg Psychiatry. 1999;67(1):35–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Azouvi P, Olivier S, de Montety G, Samuel C, Louis-Dreyfus A, Tesio L. Behavioral assessment of unilateral neglect: study of the psychometric properties of the Catherine Bergego Scale. Arch Phys Med Rehabil. 2003;84(1):51–7.

    Article  PubMed  Google Scholar 

  15. Chen P, Chen CC, Hreha K, Goedert KM, Barrett AM. Kessler Foundation Neglect Assessment Process uniquely measures spatial neglect during activities of daily living. Arch Phys Med Rehabil. 2015;96(5):869–76.

    PubMed  Google Scholar 

  16. Chen P, Hreha K, Kong Y, Barrett AM. Impact of spatial neglect in stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility. Arch Phys Med Rehabil. 2015;96(8):1458–66.

    Article  PubMed  PubMed Central  Google Scholar 

  17. •• Chen P, Ward I, Khan U, Liu Y, Hreha K. Spatial neglect hinders success of inpatient rehabilitation in individuals with traumatic brain injury: a retrospective study. Neurorehabil Neural Repair. 2016;30(5):451–60. The syndrome of spatial neglect affects people with many kinds of right brain disorders, adversely affecting outcomes.

    Article  PubMed  Google Scholar 

  18. Gillen R, Tennen H, McKee T. Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke. Arch Phys Med Rehabil. 2005;86(4):763–7.

    Article  PubMed  Google Scholar 

  19. Jehkonen M, Laihosalo M, Kettunen JE. Impact of neglect on functional outcome after stroke: a review of methodological issues and recent research findings. Restor Neurol Neurosci. 2006;24(4–6):209–15.

    CAS  PubMed  Google Scholar 

  20. Alemdaroglu E, Ucan H, Topcuoglu AM, Sivas F. In-hospital predictors of falls in community-dwelling individuals after stroke in the first 6 months after a baseline evaluation: a prospective cohort study. Arch Phys Med Rehabil. 2012;93(12):2244–50.

    Article  PubMed  Google Scholar 

  21. Nijboer TC, Kollen BJ, Kwakkel G. The impact of recovery of visuo-spatial neglect on motor recovery of the upper paretic limb after stroke. PLoS One. 2014;9(6):e100584.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Bender MB. Disorders in perception: with particular reference to the phenomena of extinction and displacement. Aring CD, editor. Springfield, IL: Charles C. Thomas; 1952.

  23. Heilman KM, Watson RT, Valenstein E. Neglect and related disorders. In: Heilman KM, Valenstein E, editors. Clinical neuropsychology. 5th ed. New York: Oxford University; 2012. p. 296–348.

    Google Scholar 

  24. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70.

    Article  CAS  PubMed  Google Scholar 

  25. Woo D, Broderick JP, Kothari RU, Lu M, Brott T, Lyden PD, et al. Does the National Institutes of Health Stroke Scale favor left hemisphere strokes? NINDS t-PA Stroke Study Group. Stroke. 1999;30(11):2355–9.

    Article  CAS  PubMed  Google Scholar 

  26. Glymour MM, Berkman LF, Ertel KA, Fay ME, Glass TA, Furie KL. Lesion characteristics, NIH stroke scale, and functional recovery after stroke. Am J Phys Med Rehab. 2007;86(9):725–33.

    Article  Google Scholar 

  27. •• Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98–e169. This is a required reading for clinicians caring for stroke patients as they transition to the community, for appropriate assignment of evidence-based care.

    Article  PubMed  Google Scholar 

  28. Management of Stroke Rehabilitation Working Group. VA/DOD clinical practice guideline for the management of stroke rehabilitation. J Rehabil Res Dev. 2010;47(9):1–43.

    Google Scholar 

  29. National Institute for Health and Care Excellence. Stroke rehabilitation: long term rehabilitation after stroke. National Institute for Health and Care Excellence: clinical guidelines. London 2013.

  30. •• Intercollegiate Stroke Working Party. National Clinical Guidelines for Stroke. London: Royal College of Physicians; 2016. These British guidelines complement the 2016 AHA/ASA publication, with staffing recommendations in stroke care (e.g., for clinical neuropsychology) and information on specific rehabilitation interventions.

  31. Azouvi P The ecological assessment of unilateral neglect. Ann Phys Rehabil Med 2016.

  32. Chen P, Hreha K, Fortis P, Goedert KM, Barrett AM. Functional assessment of spatial neglect: a review of the Catherine Bergego Scale and an introduction of the Kessler Foundation Neglect Assessment Process. Top Stroke Rehabil. 2012;19(5):423–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Barrett AM, Diaz-Segarra N, Patel K, Gillen R, Kaplan EL, Masmela JR, Gonzalez-Snyder C, for the Practice-RRuN network,. A care pathway for post-stroke spatial neglect: initial analysis of a practice-based rehabilitation research network (abstract). Neurology. 2019.

  34. •• Pitteri M, Chen P, Passarini L, Albanese S, Meneghello F, Barrett AM. Conventional and functional assessment of spatial neglect: clinical practice suggestions. Neuropsychology. 2018. Clinicians need to use functional performance—not just paper-and-pencil testing—to reliably identify spatial neglect.

  35. Goedert KM, Chen P, Botticello A, Masmela JR, Adler U, Barrett AM. Psychometric evaluation of neglect assessment reveals motor-exploratory predictor of functional disability in acute-stage spatial neglect. Arch Phys Med Rehabil. 2012;93(1):137–42.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wilson B, Cockburn J, Halligan P. Behavioural Inattention Test. Titchfield: Thames Valley Test Company; 1987.

    Google Scholar 

  37. Halligan PW, Cockburn J, Wilson BA. The behavioural assessment of visual neglect. Neuropsychol Rehabil 1991;1(1):5–32.

    Article  Google Scholar 

  38. Edwards DF, Hahn MG, Baum CM, Perlmutter MS, Sheedy C, Dromerick AW. Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. Neurorehabil Neural Repair. 2006;20(1):42–8.

    Article  PubMed  Google Scholar 

  39. Chen P, McKenna C, Kutlik AM, Frisina PG. Interdisciplinary communication in inpatient rehabilitation facility: evidence of under-documentation of spatial neglect after stroke. Disabil Rehabil. 2013;35(12):1033–8.

    Article  PubMed  Google Scholar 

  40. Fink JN. Underdiagnosis of right-brain stroke. Lancet. 2005;366(9483):349–51.

    Article  PubMed  Google Scholar 

  41. Chen P, Pitteri M, Gillen G, Ayyala H Ask the experts how to treat individuals with spatial neglect: a survey study. Disabil Rehabil 2017:1–15.

  42. Barrett AM, Goedert KM, Basso JC. Prism adaptation for spatial neglect after stroke: translational practice gaps. Nat Rev Neurol. 2012;8(10):567–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Luaute J, Halligan P, Rode G, Jacquin-Courtois S, Boisson D. Prism adaptation first among equals in alleviating left neglect: a review. Restor Neurol Neurosci. 2006;24(4–6):409–18.

    PubMed  Google Scholar 

  44. Goedert KM, Chen P, Boston RC, Foundas AL, Barrett AM. Presence of motor-intentional aiming deficit predicts functional improvement of spatial neglect with prism adaptation. Neurorehabil Neural Repair. 2014;28(5):483–92.

    Article  PubMed  Google Scholar 

  45. •• Goedert KM, Chen P, Foundas AL, Barrett AM. Frontal lesions predict response to prism adaptation treatment in spatial neglect: a randomised controlled study. Neuropsychol Rehabil. 2018:1–22. Prism adaptation treatment can improve spatial neglect, especially after a frontal stroke.

  46. Turton AJ, O’Leary K, Gabb J, Woodward R, Gilchrist ID. A single blinded randomised controlled pilot trial of prism adaptation for improving self-care in stroke patients with neglect. Neuropsychol Rehabil. 2010;20(2):180–96.

    Article  PubMed  Google Scholar 

  47. Jung JH, Peli E. Impact of high power and angle of incidence on prism corrections for visual field loss. Opt Eng. 2014;53(6):061707.

    Article  Google Scholar 

  48. Yang NY, Zhou D, Chung RC, Li-Tsang CW, Fong KN. Rehabilitation interventions for unilateral neglect after stroke: a systematic review from 1997 through 2012. Front Hum Neurosci. 2013;7:187.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. •• Champod AS, Frank RC, Taylor K, Eskes GA. The effects of prism adaptation on daily life activities in patients with visuospatial neglect: a systematic review. Neuropsychological Rehabilitation. 2016:1-24. Spatial neglect rehabilitation reduces functional disability and improves daily life. We need to use it.

  50. Bowen A, Hazelton C, Pollock A, Lincoln NB. Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database Syst Rev. 2013:7, CD003586.

  51. de Haan GA, Melis-Dankers BJ, Brouwer WH, Tucha O, Heutink J. The effects of compensatory scanning training on mobility in patients with homonymous visual field defects: a randomized controlled trial. PLoS One. 2015;10(8):e0134459.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. Bahnemann M, Hamel J, De Beukelaer S, Ohl S, Kehrer S, Audebert H, et al. Compensatory eye and head movements of patients with homonymous hemianopia in the naturalistic setting of a driving simulation. J Neurol. 2015;262(2):316–25.

    Article  PubMed  Google Scholar 

  53. Behrmann M, Watt S, Black SE, Barton JJ. Impaired visual search in patients with unilateral neglect: an oculographic analysis. Neuropsychologia. 1997;35(11):1445–58.

    Article  CAS  PubMed  Google Scholar 

  54. Houston KE, Woods RL, Goldstein RB, Peli E, Luo G, Bowers AR. Asymmetry in the collision judgments of people with homonymous field defects and left hemispatial neglect. Invest Ophthalmol Vis Sci. 2015;56(6):4135–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Kerkhoff G. Spatial hemineglect in humans. Prog Neurobiol. 2001;63(1):1–27.

    Article  CAS  PubMed  Google Scholar 

  56. Bowers AR, Keeney K, Peli E. Randomized crossover clinical trial of real and sham peripheral prism glasses for hemianopia. JAMA Ophthalmology. 2014;132(2):214–22.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Peli E. Field expansion for homonymous hemianopia by optically induced peripheral exotropia. Optom Vis Sci. 2000;77(9):453–64.

    Article  CAS  PubMed  Google Scholar 

  58. •• Houston KE, Bowers AR, Peli E, Woods RL. Peripheral prisms improve obstacle detection during simulated walking for patients with left hemispatial neglect and hemianopia. Optom Vis Sci. 2018;95(9):795–804. Optometric low vision care and assistive devices may improve spatial neglect.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Rowe F, UK VISg. The profile of strabismus in stroke survivors. Eye (Lond). 2010;24(4):682–5.

    Article  Google Scholar 

  60. Rowe F, UK VISg. Prevalence of ocular motor cranial nerve palsy and associations following stroke. Eye (Lond). 2011;25(7):881–7.

    Article  Google Scholar 

  61. Houston KE, Keilty M. Initial response to prism treatment in an inpatient rehabilitation hospital setting: preliminary results (abstract). Arch Phys Med Rehabil. 2015;96(10):e73.

    Article  Google Scholar 

  62. Chang MY, Velez FG, Demer JL, Isenberg SJ, Coleman AL, Pineles SL. Quality of life in adults with strabismus. Am J Ophthalmol. 2015;159(3):539–44 e2.

    Article  PubMed  Google Scholar 

  63. Pineles SL, Repka MX, Yu F, Lum F, Coleman AL. Risk of musculoskeletal injuries, fractures, and falls in medicare beneficiaries with disorders of binocular vision. JAMA Ophthalmol. 2015;133(1):60–5.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Barrett AM. Rose-colored answers: neuropsychological deficits and patient-reported outcomes after stroke. Behav Neurol. 2010;22(1–2):17–23.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Barrett AM, Crucian GP, Beversdorf DQ, Heilman KM. Monocular patching may worsen sensory-attentional neglect: a case report. Arch Phys Med Rehabil. 2001;82(4):516–8.

    Article  CAS  PubMed  Google Scholar 

  66. Chen P, Erdahl L, Barrett AM. Monocular patching may induce ipsilateral “where” spatial bias. Neuropsychologia. 2009;47(3):711–6.

    Article  PubMed  Google Scholar 

  67. •• Houston KE, Barrett AM. Patching for diplopia contraindicated in patients with brain injury? Optom Vis Sci. 2017;94(1):120–4. Monocular patching may worsen, or even induce, spatial neglect.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Flanders M, Sarkis N. Fresnel membrane prisms: clinical experience. Can J Ophthalmol. 1999;34(6):335–40.

  69. Saevarsson S, Eger S, Gutierrez-Herrera M. Neglected premotor neglect. Front Hum Neurosci. 2014;8:778.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Chen P, Goedert KM, Shah P, Foundas AL, Barrett AM. Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment. Brain Imaging Behav 2014;8(3):346–58.

    Article  Google Scholar 

  71. Ungerstedt U. Striatal dopamine release after amphetamine or nerve degeneration revealed by rotational behaviour. Acta Physiol Scand Suppl. 1971;367:49–68.

    Article  CAS  PubMed  Google Scholar 

  72. Riestra AR, Barrett AM. Rehabilitation of spatial neglect. Handb Clin Neurol. 2013;110:347–55.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Shinsha N, Ishigami S. Rehabilitation approach to patients with unilateral spatial neglect. Top Stroke Rehabil. 1999;6(1):1–14.

    Article  PubMed  Google Scholar 

  74. Biswal B, Yetkin FZ, Haughton VM, Hyde JS. Functional connectivity in the motor cortex of resting human brain using echo-planar MRI. Magn Reson Med. 1995;34(4):537–41.

    Article  CAS  PubMed  Google Scholar 

  75. Baldassarre A, Ramsey L, Hacker CL, Callejas A, Astafiev SV, Metcalf NV, et al. Large-scale changes in network interactions as a physiological signature of spatial neglect. Brain. 2014;137(Pt 12):3267–83.

    Article  PubMed  PubMed Central  Google Scholar 

  76. •• Ramsey LE, Siegel JS, Baldassarre A, Metcalf NV, Zinn K, Shulman GL, et al. Normalization of network connectivity in hemispatial neglect recovery. Ann Neurol. 2016;80(1):127–41. Interaction of the coordinated brain activity that defines functional systems may be a key biomarker of disability.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Barrett AM, Boukrina O, Saleh S. Ventral attention and motor network connectivity is relevant to functional impairment in spatial neglect after right brain stroke. Brain Cogn. 2019;129:16–24.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Stroke Rehabilitation Research, Kessler Foundation, East Hanover, NJ, USA

    A. M. Barrett

  2. Harvard Medical School, Department of Ophthalmology, Spaulding Rehabilitation Hospital, Boston, MA, USA

    K. E. Houston

Authors
  1. A. M. Barrett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. E. Houston
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. M. Barrett.

Ethics declarations

Conflict of Interest

A.M. Barrett is an employee of the Kessler Foundation and also reports grants from Dart Neuroscience LLC, grants from National Institutes of Health, others from eMedicine/WebMD, grants from Bright Cloud International Corp., outside the submitted work. Kevin Houston declares no potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Behavior

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barrett, A.M., Houston, K.E. Update on the Clinical Approach to Spatial Neglect. Curr Neurol Neurosci Rep 19, 25 (2019). https://doi.org/10.1007/s11910-019-0940-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-019-0940-0

Keywords

Search

Navigation