Unilateral Spatial Neglect

Neglect has been defined as “the failure to report, respond, or orient to novel or meaningful stimuli presented to the side opposite a brain lesion, when this failure cannot be attributed to either sensory or motor defects.”1(p279) The purpose of this update is to provide a focused review of unilateral spatial neglect (USN). This update will describe the 3 major categories of USN, identify USN as an attentional deficit by describing a model for directed attention, and discuss the incidence and treatment of USN. An understanding of the different types of neglect and the emerging treatment ideas is important for physical therapists to provide optimal care for individuals with USN. This update will not address homonymous hemianopsia, hemihypesthesia, or hemiparesis that may occur after a stroke. Although these impairments frequently occur with USN, they are separate entities from USN.2 Researchers have subdivided USN into 3 major categories of attentional deficits: the memory and representational deficits, the action-intentional disorders (motor neglect), and inattention (sensory neglect).1,3 Neglect of representational space has been described by Bisiach and Luzzatti,4 who asked 2 patients with left unilateral neglect to describe, from memory, a square in Milan that contained a cathedral, shops, and palaces. The patients were oriented to their place in the square in relation to the cathedral. The patients described the right side of the square accurately, but they omitted descriptions of the left side. When the patients were “turned around” in their memory, they began to accurately describe what had previously been to their left while omitting what had previously been to their right. This study suggested that the memory of extrapersonal space is stored with a body-centered coordinate system. For these patients with right parietal lobe damage, the attentional deficits in mental representations reflected this body-centered frame of reference. More recently, Beschin et al5 described a patient who had had a cerebrovascular accident (CVA) of the right parietal lobe. This patient had a “pure” representational neglect. The patient showed no evidence of a visual perceptual neglect, but had great difficulty describing details of imagined representations from his long-term memory. The studies of representational space have demonstrated that neglect is not limited to motor and sensory deficits and that behavioral aspects of brain function can be involved.