Neglect After Stroke: Ignoring One Side
Spatial neglect (unilateral inattention) means the patient fails to notice or respond to things on one side, usually the left, even though vision may be intact. It occurs in a significant proportion of stroke patients, especially after right-hemisphere stroke [2], and reflects damage to attention networks in the brain [3].
Signs
- Eating food only from one side of the plate
- Bumping into objects on one side, ignoring people standing there
- Shaving or dressing only one side of the body
- Reading only one half of a page
- Not recognising the weak arm or leg as one’s own
Further reading: the guide “Stroke” and the articles Stroke Rehabilitation: Ischaemic and Haemorrhagic Stroke and Depression and Psychological Problems After Stroke.
Why does it matter?
Neglect increases the risk of falls and injury, and it slows functional recovery because the patient may be unaware of the problem.
Rehabilitation
Several approaches are used, including visual scanning training, prism adaptation, limb activation, and stimulation techniques, although the evidence for long-term benefit is still limited [1, 4]. Family members can help by approaching from the neglected side over time and placing important items within the patient’s attention, as advised by the therapy team.
The typical course
Neglect (also called unilateral spatial neglect) is most common after right-hemisphere stroke and usually affects attention to the left side. It is often most pronounced in the first days and weeks and frequently improves over the following months. In some people, milder neglect persists and becomes evident only in demanding situations, such as busy streets or reading long texts. Because the person is often unaware of the problem (reduced insight), family observations are very valuable.
How neglect is assessed
The team uses simple paper-and-pencil tests, such as crossing out lines or symbols on a page, bisecting a line or copying a drawing, together with observation in daily activities like eating, dressing and moving in a wheelchair. The PM&R physician distinguishes neglect from visual field loss (hemianopia) and from other attention or memory problems, as the treatment differs. An eye examination may be advised.
Treatment options in general terms
- Visual scanning training: learning to search systematically towards the neglected side
- Prism adaptation (training with special glasses that shift the visual field) in selected patients
- Limb activation: encouraging movement of the affected arm on the neglected side
- Mirror therapy, sensory stimulation and virtual-reality-based tasks
- Strategies in daily life, such as anchors (a coloured line at the edge of a page or plate)
- Brain stimulation is being researched and may be considered in selected cases as an add-on
Safety at home and what families can do
- Place a coloured strip or marker on the neglected side of the plate, book or table
- Gradually encourage turning towards the neglected side, as advised by the team
- Supervise walking, wheelchair use and kitchen tasks, as bumping into objects and falls are common
- Check that the affected arm is not trapped or injured
- Do not leave the person alone near roads or stairs until the team confirms it is safe
When to see your physical medicine and rehabilitation specialist
After acute hospital care, the rehabilitation process is best led and advised by a physician specialised in physical medicine and rehabilitation (PM&R, also called physiatry). At home, too, it is worth consulting a PM&R specialist, who examines the patient, sets goals and guides therapy and supportive treatments together with the physiotherapist and the wider team. Ask for a review if:
- function is getting worse instead of better, or progress has stalled for several weeks
- new pain, stiffness, swelling or falls appear
- mood, sleep, swallowing or bladder control change
- you are wondering whether a robotic or other advanced therapy might be suitable
Whether robotic or other advanced therapies are suitable is decided by a PM&R specialist focused on neurorehabilitation. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, consult a PM&R specialist near you.
Call emergency services immediately for sudden new weakness, facial drooping, difficulty speaking, a severe headache or loss of consciousness: these can be signs of a new stroke.
Frequently asked questions
Is neglect the same as blindness on one side? No. It is an attention problem, although it may coexist with visual field loss.
Does neglect improve? It often improves in the first months, but some patients have lasting problems. See Left or right-sided stroke.
Can a person with neglect drive? Neglect is a serious safety concern for driving. Driving should not be resumed until fitness is assessed individually and local regulations are followed.
Why does the person deny the problem? Reduced awareness of the deficit (anosognosia) is part of neglect in many cases. Gentle, repeated feedback and practical strategies work better than arguing.
Assessment and contact
You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.
Sources
- Longley V, et al. Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury. Cochrane Database Syst Rev. 2021. PMID: 34196963
- Esposito E, et al. Prevalence of spatial neglect post-stroke: A systematic review. Ann Phys Rehabil Med. 2021. PMID: 33246185
- Corbetta M, et al. Spatial neglect and attention networks. Annu Rev Neurosci. 2011. PMID: 21692662
- Li J, et al. Effects of Prism Adaptation for Unilateral Spatial Neglect After Stroke: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil. 2021. PMID: 32969965