What is unilateral spatial neglect?
Unilateral spatial neglect is a condition that can occur after a stroke in which a person has difficulty noticing or paying attention to one side of their body or environment. It is primarily a problem of attention and awareness rather than vision itself. The eyes and visual system may be functioning normally, but the brain does not properly process or respond to information coming from the affected side.
Why does it happen?
A stroke can damage areas of the brain responsible for attention and spatial awareness. It is more common with right-sided brain strokes. This often leads to left-sided neglect.
Because of this:
- The brain may ignore information from one side
- The person is often not aware they are missing it
Neglect vs. Inattention
These terms are often used together, but there is a difference:
- Hemi-neglect (more severe): The person may completely ignore one side of their body or environment and may behave as if that side does not exist or is not present.
- Hemi-inattention (milder): The person is still able to notice the affected side but may require frequent reminders or cues to consistently attend to it and use it during activities.
What does it look like?
You may notice:
- Eating only one side of the plate
- Dressing only one side of the body
- Not using or noticing one arm
- Not turning when spoken to on one side
- Bumping into objects or doorways
This can increase fall risk and injury
How can you help?
Approach from the affected side
- Stand or sit on the side they ignore
- Encourage them to turn their head and eyes toward you
Set up the environment
- Place important items on the affected side: Food, drinks, phone, remote
- Keep emergency items (like call buttons) on the strong side
Use touch and movement
- Instead of just saying: “Look to your left”, Try: “Let’s find your fork” (while guiding their hand)
- Touch helps trigger the brain to turn the head and eyes
Practice visual scanning
- Therapists may teach strategies like the “lighthouse strategy”: Turn the head slowly side to side, like a lighthouse scanning the horizon
- This helps systematically check the affected side
Include the affected side in daily tasks
- Help them use both hands
- Encourage looking toward the affected side during activities including eating, dressing, grooming
Unilateral spatial neglect is a brain-based condition, not related to laziness or lack of effort. Individuals are often unaware of the deficit, which can make it difficult to recognize and manage. Recovery may take longer than other stroke effects because the brain must relearn attention and awareness of the affected side, not just movement. However, improvement is possible with consistent practice, repetition, and rehabilitation. Support from family, friends, and the therapy team through reminders and cueing is an important part of recovery.