One-side Neglect: Improving Awareness to Speed Recovery
by Jan Davis, Occupational Therapist and President, International Clinical Educators, Port Townsend, Wash.
Published in Stroke Connection Magazine March/April 2003
Have you seen your stroke survivor leave food on half of their plate? Forget to put their recovering arm into a shirt sleeve? Bump into the door jam with the left side of their wheelchair? Not turn their head in your direction when you speak? If you have noticed any of these things, you've very likely witnessed one-side neglect. (see Possible Causes of One-Side Neglect)
One-side neglect can be very frustrating and is often misunderstood. Neglect is more than not being able to use the recovering side. Think of it as a lack of awareness of that side. This common effect of stroke can reduce the possibility of independent living and increase potential of painful injury. However, there are several things that you can do to help a person improve awareness of their recovering side.
Whatever the reason for someone's lack of awareness of one side, everyone (including family members, caregivers, nurses or visiting friends and relatives) can be helpful. Everything you do and how you do it helps improve awareness of the neglected side. Take every opportunity, large or small, to help them "tune in" to that side.
At home or at the hospital, have a comfortable chair next to the bed on the neglected side. This encourages them to look in your direction as you talk to them. Hold that hand, touch their arm, make contact with them, helping them become more aware of that side. If they have difficulty turning their head in your direction, gently place your hand on their chin and slowly help them turn their head toward you, far enough for their eyes to meet yours. Initially you may need to do this several times a day, until they can do this on their own.
Place the Nightstand on Their Neglected Side
Placing the phone, TV remote control, glass of water or other necessities on the neglected side encourages them to look and reach for objects on that side. When I was first instructed to do this as a new therapist 25 years ago, I though it was mean and unnecessary. But I have seen significant improvement and am convinced that it can be one of the most helpful things you can do. One exception: Make sure the control for calling the nurse in on the strong side, where they can find it quickly.
As your stroke survivor improves, you may notice that they are still unaware of objects on one side. Don't scold or say things that may increase their frustration or embarrassment. If they haven't seen the fork to their left, saying things such as "What did you forget?" or "Look to your left" aren't very helpful. Instead, gently remind them by saying "here is your fork."
The most helpful thing you can do is take their hand in yours and guide it to the fork. There is an interesting phenomenon that occurs when you take someone's hand - their head automatically turns in that direction and their eyes follow. By first telling them "let's get your fork" and then taking their hand in yours to "search" for the fork, you have now combined the sense of hearing with the sense of touch. The improvement in awareness can be dramatic and many stroke survivors begin to try to move and "use" the hand as you guide it. I encourage holding a washcloth, squeezing the toothpaste tube and brushing hair, among other examples.
These strategies help you encourage awareness immediately following a stroke. That can significantly improve the stroke survivor's overall recovery and potential for independent living. Every day provides limitless opportunities that are simple and easy to do at home or in the hospital. Helping them incrementally overcome weak-side neglect is one way family members and caregivers can make a big difference in a stroke survivor's life.
In some cases, the stroke injures the optic nerve, which sends information for the eyes to the brain. This is called a "visual field deficit" or "hemianopsia," and it means that the person only sees out of a part of each eye, instead of the whole eye. This is different from blurred vision and cannot be corrected by glasses. If you want to understand how this might feel, take a pair of glasses and mask half of each lens with tape. Now look at the world around you. When part of our visual field is blocked, we are less aware of that side.
Many people experience some numbness or loss of feeling in the face, arm or leg. It may be temporary, or it may be more severe. I have known of people who awaken during the night, frightened that some stranger is lying in bed next to them, not knowing that it is their own arm that they are seeing but unable to feel. When we experience numbness of any kind, we are less likely to be aware of, or use, that side.
It is not uncommon for a stroke affecting the left side of the body to impair judgment and contribute to poor safety awareness. Often described as perceptual problems, the inability to take in information and make sense of the surrounding world is extremely complex. Occupational therapists and speech pathologists provide specific therapy to help with perceptual problems.