Cognitive rehabilitation for unilateral neglect: Review

Abstract

Unilateral spatial neglect, a striking difficulty in paying attention to one side of space, is a common consequence of cerebro-vascular disease. Although most patients appear to recover from this deficit relatively quickly, chronic forms of the disorder—usually resulting from right hemisphere damage and affecting left space—are associated with slowed motor recovery, poor response to rehabilitation, and difficulties in many everyday activities. This article reviews the theoretical underpinnings and efficacy of rehabilitation techniques including; behavioural training in leftward visual scanning, eye-patching, encouraging movement of the left limbs, and interventions designed to increase general alertness. Recent highly positive results from brief adaptation training with prism lenses are discussed. “Neglect” is a heterogeneous cluster of deficits that can arise following damage to a variety of brain structures. It is not yet clear whether one rehabilitation technique will be appropriate for all patients/manifestations of the disorder, or whether combining different interventions may produce additive benefits. There is growing evidence that chronic neglect is associated with—indeed possibly fostered by—limitations in a number of non-spatial attentional capacities. Whether reduction of the spatial bias is sufficient, in itself, to improve overall outcome for patients remains an open question.