The man whose brain ignores one half of his world - The ...

"Hemispatial neglect typically occurs after a stroke," says Dr Paresh Malhotra, senior lecturer in neurology at Imperial College London. Skiptomaincontent Skiptonavigation AdvertisementNewsOpinionSportCultureLifestyleShowMoreShowMoreNewsWorldnewsUKnewsCoronavirusClimatecrisisEnvironmentScienceGlobaldevelopmentFootballTechBusinessObituariesOpinionTheGuardianviewColumnistsCartoonsOpinionvideosLettersSportFootballCricketRugbyunionTennisCyclingF1GolfUSsportsCultureBooksMusicTV&radioArt&designFilmGamesClassicalStageLifestyleFashionFoodRecipesLove&sexHealth&fitnessHome&gardenWomenMenFamilyTravelMoneyMakeacontributionSubscribeSearchjobsHolidaysDigitalArchiveGuardianPuzzlesappGuardiancontentlicensingsiteTheGuardianappVideoPodcastsPicturesNewslettersToday'spaperInsidetheGuardianTheObserverGuardianWeeklyCrosswordsSearchjobsHolidaysDigitalArchiveGuardianPuzzlesappGuardiancontentlicensingsiteFashionFoodRecipesLove&sexHealth&fitnessHome&gardenWomenMenFamilyTravelMoneyNotes&TheoriesNeuroscienceThemanwhosebrainignoresonehalfofhisworldAstrokeleftAlanBurgesswithhemispatialneglect–aninabilitytopayattentiontosensorystimulionhisleftsideThomHoffmanFri23Nov201213.27GMT Patientsexplainthedisruptiontotheireverydaylivescausedbyhemispatialneglect,andDrPareshMalhotraofImperialCollegeLondondescribeshisresearchintothisbafflingsyndromeguardian.co.ukAlanBurgessdoesn'tneedarhymetorememberthe5thofNovember.He'llneverforgetthedayhehadhisstroke.Itlefthimwithasyndromeknownashemispatialneglectandastrangenewperspective.Iaskedhimhowheexplainsthistootherpeople."Isayit'stwodifferentworlds,"saysBurgess."Myoldworldfinishedon5November2007andthenewworldstartedthesameday."Hisstrokedamagedtheparietallobeontherightsideofhisbrain,thepartthatdealswiththehigherprocessingofattention.Thedamagecauseshimtoignorepeople,sounds,andobjectsonhisleft."Hemispatialneglecttypicallyoccursafterastroke,"saysDrPareshMalhotra,seniorlecturerinneurologyatImperialCollegeLondon."Itisnotblindnessinoneeye,andit'snotdamagetotheprimarysensorycortex,it'saprocessofignoring,forwantofabetterword,onesideofspace."Burgess,64,originallytrainedasatooldesigndraughtsmanand,beforehisstroke,hewasworkingasadriver.Hisvisualneglectmakesdrivingimpossible,andhewasforcedintoearlyretirement.Hehadneverpaintedbeforehisstroke,butitbecameanimportantoutletforhimafterwards.Lookathisartwork,though,anditisnotonlythevividcoloursthatgrabyourattention.Hehandsmeasketchofapigthathashalfitsheadmissing,andthenproducestworobinscopiedfromaChristmascard-therobinontherightisfullofrichdetail,buttheoneontheleftremainsunfinished."Visionismoststrikinglyaffectedbecausewearevisualcreatures,buthearing,touch,representationandsenseofselfarealsoaffected,"saysDrMalhotra.Peoplewithhemispatialneglectareoftenunawareoftheircondition.Friendsorrelativesmightsuggesttheylooktotheirneglectedsidebutthatinstructionmisunderstandstheproblemtheyhavewithnavigatingthespacearoundthem.Burgess,andpeoplelikehim,arenotawarethatsomethingismissing,sowhywouldtheyseekitout?Patientsmightbumpintothingsontheirneglectedside,shaveorapplymakeuponlyononesideoftheirface,orleavehalfofthefoodontheirplate.Alanoftenhastostopandthinktomakesenseoftheworldaroundhim.Walkingdownastreet,hehugstherightsideofthepavement,brushingupagainstwallsandhedges.Hewon'tnoticeanypotentialdangerscomingfromtheleft,sohecannotgooutonhisown."Ican'tdescribehowtheworldlookstoneglectpatients,"saysDrMalhotra."Partofthereasonit'ssodifficultisbecausewedon'treallyappreciatehowtheworldlookstoourselves.Wethinkit'sjustanicescreenandyoucanseeeverything,butthat'ssomethingthatyourbrainiscomputingandtellingyouyou'reseeing."Infactyou'reattendingtospecificthingsatspecifictimes.Youreyesaredartingallovertheplace,butyouhaveasensationofastaticworld."Afterhisstroke,BurgesswasassessedbyDrMalhotra,whotestedtheseverityofhisconditionbyaskinghimtomarkthecentreofa25cmlineonapieceofpaper.Duringhisfirstmeetings,Burgessmarkedapproximately2cmfromtherightedge-hesimplydidnotattendtotheleftsideoftheline.Nowadays,afterregularpractice,hismarkismoreaccurate,approximately10cmfromtheright."It'sinthemiddleofmyline,notthemiddleofyourline,"BurgesstoldDrMalhotraduringoneconsultation.DrMalhotrasaysthatpeoplewithvisualneglectdorealisesomethingiswrongwhenitispointedouttothemoverandoverandoveragain."SoinawayIthinkforthemit'sslightlyabstractthattheyknowthere'ssomeproblemonthelefthandside,andtheyusestrategiestotryandovercometheproblem,withoutreallybeingabletoappreciateitinitsfullness."Hismostrecentworkhaslookedathowpatientsmightreducethisbiastotheright.PreviousresearchsuggeststhatpeoplewithnormalvisionperformbetteratvisualattentiontaskswhentheyarerewardedforgoodperformanceandDrMalhotraandhisteamhavefoundthesamethinginneglectpatients.Intheexperiment,heaskedpatientstocircleimagesofcoinsandbuttonsonapieceofpapercoveredwithlotsofothersimilarsymbols.Ontheirfirstvisit,patientsperformedequallybadlywithcoinsorbuttons.Whentheyreturnedforasecondtest,theyweretoldtheywouldgetapoundforeachcointheycircled.Theirperformancesubsequentlyimprovedonthecoinstest,butnotonthebuttonstest–wheretheyweretoldtherewasnoreward–suggestingthatmotivationcouldbeusedintherehabilitationofstrokepatients. Burgessisgoingfromstrengthtostrengthinhisrehabilitation.AsIshookhishandtoleaveIremarkedonhismusculargrip.Thissomehowendedupwithourhavinganarmwrestle.Heis37yearsolderthanme,andyethewonhandsdown.TopicsNeuroscienceNotes&TheoriesHumanbiologyMedicalresearchHealthHealth&wellbeingblogpostsReusethiscontentcomments(…)CommentinghasbeendisabledatthistimebutyoucanstillsigninorcreateyourGuardianaccounttojointhediscussionwhenit'sbackcomments(…)CommentinghasbeendisabledatthistimebutyoucanstillsigninorcreateyourGuardianaccounttojointhediscussionwhenit'sbackFashionFoodRecipesLove&sexHealth&fitnessHome&gardenWomenMenFamilyTravelMoney