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Spatial Neglect is Debilitating, Treatable

Spatial Neglect is Debilitating, Treatable

Weakness and paralysis after stroke are well recognized, but some stroke survivors have complications that are much less apparent. Hidden disabilities are common after stroke: They are relatively easy to detect but are often overlooked. These hidden disabilities can prolong recovery and increase the risk of injury and other complications.

Spatial Neglect is Common

Spatial neglect is a hidden disability that affects vision and movement responses. It can occur following a cerebral infarction -- a disturbance in the blood vessels supplying blood to the brain — or a hemorrhage. The person with spatial neglect has a hard time recognizing objects and events in a three-dimensional space on the side opposite the brain injury. Unaware of the problem, the person might ignore objects in this space or perceive them as displaced to the right or left. If not recognized and treated, spatial neglect increases the risk of:

  • Auto accidents.
  • Falls.
  • Cooking-related injuries and accidents.
  • Poor personal hygiene.

Anna Barrett, M.D., director of the Stroke Rehabilitation Research Laboratory at Kessler Foundation Research Center, conducts research on spatial neglect. She explains that lack of awareness is common in patients with hidden disabilities.

"The symptoms of spatial neglect are often subtle problems with functional vision," Barrett said. Functional vision stems from the brain, not the eye, which is why the person can usually still recognize objects, colors and people.

Even people with mild strokes can have hidden disabilities that are highly disabling. This might cause the person to avoid social situations or have a hard time driving or communicating. These disabilities might not be obvious to others, but the obstacles they present are very real and their impact on quality of life can be devastating.

Raising awareness among clinicians is a large part of Barrett's plan. "Quite simply, when you look for hidden disabilities, you find them," she says. Most clinicians, she feels, could look more consistently and carefully.

Signs of Hidden Disabilities

  • Consistent asymmetry in dressing or grooming, such as eyeglasses only hooked over one ear, shaving one side of the face.
  • Imbalance in posture and positioning, such as head turned to one side, usually the right, one leg dangling out of the bed.
  • Veering toward one side while walking or using a wheelchair.
  • Collisions with objects on the left side.

Finding the Right Treatment

While treatments are available, it is not always clear which therapy is works best for a given patient. More research is needed to develop effective rehabilitation strategies. The studies being conducted in Barrett's lab are helping address key questions such as:

  • Which patients are likely to recover from spatial neglect?
  • Which will need treatment?
  • What types of treatment will be most beneficial?

Kessler Foundation Research Center is looking at optical prism therapy, an innovative treatment for spatial neglect. Researchers are also exploring the effects of medications. The goal of the Stroke Research Lab is to explore ways to help stroke survivors achieve optimal recovery through effective rehabilitation for both physical and hidden disabilities.

Find out more about research conducted at Kessler Foundation.

By: Carolann Murphey, P.A., Kessler Foundation
By: Anna Barrett, M.D., Director of the Stroke Rehabilitation Research Laboratory at Kessler Foundation Research Center; Associate Professor of Physical Medicine, Rehabilitation, Neurology/Neurosciences, University of Medicine and Dentistry, New Jersey Medical School

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"Even people with mild strokes can have hidden disabilities that are highly disabling. This might cause the person to avoid social situations or have a hard time driving or communicating."

Quick Facts

Spatial neglect is:

  • A common, disabling complication of stroke that is under-diagnosed.
  • Likely to affect one of two people who have had a stroke of the right cortical hemisphere causing left-sided weakness.
  • An obstacle to independent function that increases the risk for other complications, such as injury, and is associated with longer hospital stays.

In fact:

  • People with spatial neglect are often unaware that they have the problem.
  • Symptoms of spatial neglect can be falsely attributed to lack of motivation, depression, personality change or intellectual impairment.
  • Kessler Foundation Research Center estimates that more than $200 million is spent annually for in-hospital care of spatial neglect in the United States.
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