Unilateral Neglect - Physiopedia

Unilateral neglect is an attention disorder that arises as a result of injury to the cerebral cortex. Unilateral neglect is also commonly known as ... Search Search Search Togglenavigation pPhysiopedia pPhysiopedia About News Contribute Courses Resources Contact Donate Login pPhysiopedia About News Contribute Courses Resources Shop Contact Donate p o + Contents Editors Categories Share Cite Contentsloading... Editorsloading... Categoriesloading... Whenreferingtoevidenceinacademicwriting,youshouldalwaystrytoreferencetheprimary(original)source.Thatisusuallythejournalarticlewheretheinformationwasfirststated.InmostcasesPhysiopediaarticlesareasecondarysourceandsoshouldnotbeusedasreferences.Physiopediaarticlesarebestusedtofindtheoriginalsourcesofinformation(seethereferenceslistatthebottomofthearticle).IfyoubelievethatthisPhysiopediaarticleistheprimarysourcefortheinformationyouarereferingto,youcanusethebuttonbelowtoaccessarelatedcitationstatement.Citearticle UnilateralNeglect Jumpto:navigation,search OriginalEditor-EmilyWood,KathyBueckert,AlexandraDansereau, CassandraSchillingaspartoftheQueen'sUniversityNeuromotorFunctionProject TopContributors-EmilyWood,CassandraSchilling,KathyBueckert,AlexandraDansereau,RedishaJakibanjar,KimJackson,WikiSysopandWoutVanHees Contents 1Definition 2Epidemiology 3Etiology/Pathology 4ClinicalPresentation 5Diagnosis 6Management/Interventions 6.1VisualExplorationTraining 6.2NeckMuscleVibration 6.3TranscranialMagneticStimulation 6.4OptokineticStimulation 6.5ColdWaterVestibularStimulation 6.6Galvanic-VestibularStimulation 6.7PrismAdaptation 6.8LimbActivationTraining 6.9MentalImageryTraining 6.10SustainedAttentionTraining 6.11EyePatching 6.12VirtualRealityTraining 6.13TrunkRotationTraining 6.14TranscutaneousElectricalNerveStimulation 6.15MirrorTherapy 6.16FeedbackTraining 7Prognosis 8References Definition[edit|editsource] Unilateralneglectisanattentiondisorderthatarisesasaresultofinjurytothecerebralcortex[1].Unilateralneglectisalsocommonlyknownascontralateralneglect,hemispatialneglect,visuospatialneglect,spatialneglect,orhemineglect [2][3]. Inunilateralneglect,patientsfailtoreport,respondororienttomeaningfulstimulipresentedontheaffectedside [2].Inmostcases,therightparietalcortexisinjuredandtheleftsideofthebodyand/orspaceis/areignored[4]. Unilateralneglectisaheterogeneouscondition;differentindividualsmaypresentwithdifferentsymptoms.Unilateralneglectmayinvolvevariousmodalities,includingvisual,auditory,somatosensoryorkinetic[4]. Unilateralneglectisgenerallyclassifiedinoneoftwoways:bythemodalitythatisaffectedorbythespacethatisaffected(i.e.personalorextrapersonalspace).Itisimportanttorememberthattheseclassificationsmayoverlapandintersect[3]. Epidemiology[edit|editsource] TheincidencerateforunilateralspatialneglectfollowingastrokeintheUnitedStatesisupwardsof80%inright-sidedstrokepatients[5].Right-sidedunilateralneglectresultingfromlefthemispheredamagewasfoundatleasttosomedegreein43.5%ofstrokepatients[6].One’slikelihoodofhavingunilateralneglectfollowingalefthemispherestrokeissubstantiallyincreasediftherewasdamagetotheposteriorassociationcortex[6]. Ameta-analysisfoundthatcontralateralunilateralneglectismorelikelyfollowingarighthemispheredeficitcomparedtoalefthemispheredeficit[7].Between12-100%ofrighthemispherestroke,patientshadunilateralneglectacross30studies,whereasbetween0-76%ofpatientswithlefthemispherestrokehadunilateralneglectacross17studies[7].Whencomparingtheeffectsofunilateralneglectbetweenrightandlefthemispheredamage,theyhavebeenfoundtohavesimilarlevelsofseverityinacutebraininjurypatients[8].Ageiscorrelatedwithincreasedriskforneglectfollowingstroke.AstudybyGottesmanetal.,[9] foundthat69.6%ofpeopleabove65yearsofagehadunilateralneglectfollowingstrokewhileonly49.4%ofpeoplebelowtheageof65hadneglect.One’schancesofhavingunilateralneglectincreasesby1.83%peradditional10yearsofageafter65[9].Therearenogenderdifferencesintheprevalenceorseverityofspatialneglectfollowingstroke[10]. Etiology/Pathology[edit|editsource] Unilateralneglectusuallyresultsfromdamagetotherightparietalarea,oftentheposteriorparietalcortex[1].Normally,neuronsintherightparietalcortexstronglyattendtoboththeleftandtherightsideofthespace,whileneuronsintheleftparietalcortexweaklyattendtotherightsideofthespaceonly[1].Therefore,inrightparietallesions,attentiontotherightsideofthespaceismaintainedbytheleftparietalcortex,butattentiontotheleftsideofthespaceceases.Inleftparietallesions,attentionistypicallymaintainedonbothsidesofthespacebytherightparietalcortex[1].However,lesionsindifferentcorticalandsubcorticalareasmayalsoleadtoneglectbycausingdysfunctioninbrainnetworks[2].Usually,unilateralneglectresultsfromstroke;however,itmayalsoresultfromtraumaticbraininjuriesorneoplasticdisease.Neglectismostlikelyincasesoflargerighthemispherestroke[4]. ClinicalPresentation[edit|editsource] Unilateralneglectisaheterogeneoussyndrome;theclinicalpresentationvarieslargelybetweenindividuals.Typically,thesyndromeoccursfollowingalesionoftherightparietalcortexofthebrain,andtheleftsideofthebodyorspaceisneglected.Right-sidedneglectmayalsooccur,butusuallytoamuchlesserextentthanleft-sidedneglect[3]. Inunilateralneglect,individualsbehaveasifthespaceoppositetothelesiondoesnotexistanymore[4].Individualsmayfailtoreport,respond,ororienttostimulipresentedonthecontralesionalside[4].Visual,somatosensory,kinesthetic,andauditorymodalitiesmaybedisregarded,despiteintactprimaryvisual/somatosensory/auditory/vestibularareas[4].Activeexplorationoftheenvironmentisalsobiasedtowardtheipsilesionalside[5]. Thedisordermayhaveadifferentdistributionindifferentindividuals:theneglectmaydifferentiallyaffectthepersonalspaceandtheextrapersonalspace[4].Inneglectofthepersonalspace,individualsfailtobeawareofonesideoftheirownbody[3].Theymayfailtodress,shave,orgroomtheaffectedside[4].Inseverecases,individualsmaydenyownershipofthelimbsontheaffectedside,aphenomenoncalledsomatoparaphrenia[6].Inneglectoftheextrapersonalspace,theindividualsfailtoacknowledgeandrespondtostimulilocatedintheirextrapersonalspace[4].Typicalbehaviorsincludeeatingfoodonlyononesideofaplateandbumpingintoobjectsontheaffectedsideastheynavigateinspace.Furthermore,individualsmayeitherignorevisualstimuliontheaffectedhemifield,ortheymayignoreone-halfofallobjects(object-centeredneglect),regardlessofthelocationoftheobjects[3].Individualswithneglectalsomayshifttheirgazetowardtheipsilesionalsidewhenatrest[5].Theymayalsoshifttheirposturetowardtheipsilesionalside[4]. Neglectmayalsoaffectinternalmapsofspatialrepresentations[3].Representationalneglectmaybeanterogradeorretrograde.Inanterograderepresentationalneglect,individualsperceivestimuliinthecontralesionalhemispacebutareunabletorecallthem.Oneexampleisthefailuretorecallauditoryinformationpresentedontheaffectedsideafterdistraction[3].Inretrograderepresentationalneglect,individualsareunabletorecallthecontralesionalhalfofapreviouslyknownscene.However,theyareabletorecallthosedetailswhenimaginingthemselvesfacingtheoppositedirection[3]. Inmotor,orintentionalunilateralneglect,theinitiationofmotorbehaviormaybeaffected[1][3].Inmotorneglect,theindividualmaybeawareofthestimuli,butfailtomovethecontralesionalsideofthebodytorespondtothemdespitenormalstrength[3].Inaddition,patientsmaynotrealizethattheyaremissinghalfofthespace,asymptomcalledanosognosia[7].  [11]. Diagnosis[edit|editsource] Unilateralneglectcanoftenbeseeninapatient’sbehaviourevenbeforeaconclusivediagnosis,astherewillfrequentlybeadistinctlackofawarenessdisplayedbythepatienttowardstheiraffectedside.Theymayexhibitbehaviourssuchasonlyshavinghalfoftheirface,onlyeatinghalfofthefoodontheirplate,repeatedlywalkingintowalls,etc.Thesebehavioursshouldbethecuethatinitiatesanassessmentforunilateralneglect.However,itispossiblethatthesesymptomscouldbeattributedtootherdeficitsfollowingastrokeanditisimportanttoruleoutpossibledifferentialdiagnoses,suchasvestibularimpairment,extinction,hemiplegia,hemianopsia,orsomatoparaphrenia.Itisimportanttorememberthatinacaseofunilateralneglecttheseorotherdeficitsmayalsobepresentandthattestingforneglectshouldbedoneinsuchawaythattheseotherdeficitsdonotgiveafalsepositiveornegative. Tothisend,thereareseveralteststhatspecificallyevaluatespatialorvisualpresentationsofunilateralneglect.Traditionalassessmentofneglectusesapencilandpapermodeltodeterminethepatient’sawarenessandprocessingabilityinaclose-upspace.Examplesofthetraditionaltestsinclude,butarenotlimitedto,thelinebisection,thesinglelettercancellation,andthebehaviourinattentiontests. [12] Morerecentlytherehasbeenashifttowardsmorefunctionalassessment,allowingtheevaluatortodeterminewhichtasksofdailylivingthepatientmaystrugglewith.Examplesofthesetestsincludehavingthepatientnavigateanobstaclecourseortrytowalkastraightline.OneofthemostcommonpencilandpapertestsistheLineBisectionTest.Inthistestpatientsdrawalinetoindicatewheretheyperceivemidlinetobeonahorizontalline [3][9].OneofthemostcommonfunctionaltestsistheCatherineBergegoScale(CBS).This10itemchecklistisusedmostlyinthecaseofpatientswhohaveveryfewadditionalfunctionallimitationsandassessesfunctionalactivitiessuchasgroomingandeatingaswellasattentionalandmotorskillsnecessarytodailytasks[3].Thereareseveralotherteststhatcanbeusedtoassessanddiagnoseunilateralneglect;thesetestsaredesignedtocoverthewidespectrumofpresentationsandspatialdifferencesthatmayoccurwithunilateralneglect[3]. Management/Interventions[edit|editsource] Therearetwotypesofrehabilitationinterventionsusedtoimproveneglect. Thefirstoneaimsatimprovingthepatient’sattentiontotheneglectedspace;thesecondoneaimsataddressingtheproprioceptiveandkinestheticdeficits[10]. Theseinterventionsmayincludethefollowingmethods:visualscanning/explorationtraining,neckmusclevibration,transcranialmagneticstimulation(TMS),optokineticstimulation(OKS),coldwater(caloric)vestibularstimulation(CVS),galvanic-vestibularstimulation(GVS),prismadaptation,limbactivationtraining,mentalimagerytraining,sustainedattentiontraining,eyepatching,virtualrealitytraining,trunkrotationtraining,transcutaneouselectricalnervestimulation(TENS),mirrortherapy,andfeedbacktraining. Traditionally,treatmentoftenalsoincludesadaptingtheenvironmentsothatstimuliareconstantlypresentedontheneglectedsidealthoughtheredoesnotseemtobealotofscientificevidencetosupportthis[1] Physiotherapytypicallyinvolvestreatingthemotorandsensorydeficitscausedbythestroke,butinstrokepatientswithneglect,itisimportanttoensurethattheattentionaldeficitsareaddressedaswell[1]. VisualExplorationTraining[edit|editsource] Visualexplorationtrainingcanbeconductedbytrainingbothsmoothpursuitandsaccadiceyemovements.[2] Patientsperformedsmoothpursuiteyemovementsbyfollowingslowpencilmovementsperformedbyatherapist.Saccadiceyemovementtrainingcanbeachievedbyusingacomputerprogram.IntheprogramusedbySchindleretal.,patientshadtoidentifywhetherthesquarethatappearedontheirscreenwasredorgreenasonetaskandreadthewordthatappearedontheirscreenasasecondtask[2].Apotentialbenefitfromthistypeoftreatmentistheacquisitionofcompensatorystrategies[2]. NeckMuscleVibration[edit|editsource] Neckmusclevibrationhasaproprioceptiveeffectwherebyitcreatestheillusionthatthesemusclesarebeinglengthened(i.e.theneckisturningtooneside)[3]. Vibrationofcontralesionalposteriorneckmuscleswhencombinedwithvisualexplorationtrainingresultsinlastingimprovementinneglectsymptomsspecificallywhenmeasuredbyvisualstraightahead,cancellation,tactileexploration,andtextreadingandalsoreducesdifficultiesthatapatientmayhavewithactivitiesofdailyliving(ADL’s)[2]. TranscranialMagneticStimulation[edit|editsource] TMSisanoninvasivemethodofstimulatingthenervecellsinthebrainwiththeuseofshortmagneticpulses.RepetitiveTMScanbeusedtocreatesignificant,long-lastingdecreasesinunilateralneglect[4]. OptokineticStimulation[edit|editsource] OKSusesmovementonalargevisualdisplaytochangeapatient’sperceptionofwheretheirbodyisinspacewiththeassumptionthattheywilltrytoreorientthemselvesbasedonthisvisualinformation. AsystematicreviewbyKerkhoff&SchenkshowedthatthereisalotofevidencetosupportthatOKSisaneffectivetreatmentforneglect[3]. OKStreatmentcombinedwithvisualscanningtrainingleadstosignificantimprovementsonneglecttestslastinglessthanaweekandsignificantimprovementsonreadingandwritingtaskslastingmorethanaweek[5]. ColdWaterVestibularStimulation[edit|editsource] CVSstimulatesthehorizontalearcanalofthevestibularsystemusingcoldwaterforthecontralesionalearorwarmwaterfortheipsilesionalear,therebyinducingnystagmus.MultimodalpositiveeffectscanbeseenwithCVSincludingimprovedvisualscanning,improvedsubjectivestraightahead,andreducedsomatosensoryneglect. However,theeffectsofCVSareshort-term(sometimeslimitedto10-15minutes),andrepetitiveCVSisnotthoughttoproducelong-termeffectsduetotheadaptationofthevestibularsystem[3]. Galvanic-VestibularStimulation[edit|editsource] GVSistheelectricalstimulationofthevestibularsystemachievedbyplacingelectrodesonapatient’smastoidprocesses.SimilartoCVS,GVSappearstohaveapositive,yetshort-termeffect.Moreresearchisneededtodetermineifrepetitivestimulationwouldhavealong-termeffect[3]. PrismAdaptation[edit|editsource] Thistreatmentrequirespatientstowearright-shiftwedgeprismglasses/goggles.Withtheuseofsuccessiveperceptualmotorpointingtasks,adaptationtotheprismswilloccur[6].Thisadaptationresultsinashiftofapatient’sperceivedstraightaheadtowardsthecontralesionalside,therebycorrectingtheipsilesionalshiftexhibitedbyneglectpatients. [13] Theevidencesuggeststhatasinglesessionwillnotresultinlastingbenefits,butmultiplesessions(i.e.>10)couldleadtolonger-lastingbenefits(i.e.5weeks).However,thebenefitsofprismadaptationtreatmentarenotgreaterthanotherformsofneglecttreatment,neitheristheprocesslesstimeconsuming[3]. LimbActivationTraining[edit|editsource] Limbactivationtraininginvolvesgettingthepatienttoperformactivelimbmovementsonthecontralesionalsideofthebodyinanattempttobringmoreattentiontothatsideofthebody.Thishasbeenshowntosignificantlyreducevisualneglect[6]. MentalImageryTraining[edit|editsource] Visualandmotorimageryexercisescanbeusedinindividualswithneglecttoimprovecontralesionalspaceexplorationaswellasarmsensationandcopying/drawingperformanceonneglecttests[6][7]. Thiscanbeachievedbyhavingpatientsmentallypracticepositionsandmovementsofthecontralesionalupperlimb[7]. SustainedAttentionTraining[edit|editsource] Sustainedattentiontrainingincreasesapatient’sarousalthroughthepresenceofexternalalertingstimuliproducedbythetherapistandresultsinsignificantimprovementsincancellationtests[6]. EyePatching[edit|editsource] Aneyepatchoverthepatient’sipsilesionaleyecanimprovesymptomsofvisuospatialneglect[6]. VirtualRealityTraining[edit|editsource] Virtualrealitytrainingcanbeperformedthroughtheuseofavarietyofdifferentprogramsandhasbeenshowntobemoreeffectivethanconventionaltreatmentforimprovingunilateralspatialneglect[8]. TrunkRotationTraining[edit|editsource] Trunkrotationtrainingleadstoimprovedvisualexplorationonthecontralesionalsideandimprovedcancellationandlinebisectiontests[6]. SchindlerandKerkhoffachievedthistrainingbyhavingapatientsitinachairandorientingthemwiththeirheadandtrunkfixatedstraightforward,headortrunkfixated20degreestotheleft,andheadortrunkfixated20degreestotheright.Theresultswerethatanorientationoftheheadortrunk20degreestothelefthadasignificanteffect[9]. TranscutaneousElectricalNerveStimulation[edit|editsource] Transcutaneouselectricalstimulationoftheposterioraspectofthesternocleidomastoidmusclecanbeusedtoimproveposturalcontrolinpatientswithneglect. Pérennouetal.settheirTENSparameterstoafrequencyof100Hzandapulsewidthof200usandnoticedasignificantlylargerdecreaseinposturalinstabilityinstrokepatientswithneglectcomparedtostrokepatientswithoutneglect[10]. TENStreatmentcombinedwithvisualscanningtrainingleadstosignificantimprovementsonneglecttestslastinglessthanaweekandsignificantimprovementsonreadingandwritingtaskslastingmorethanaweek[5]. MirrorTherapy[edit|editsource] Mirrortherapycanbecarriedout,aswasdonebyThiemeetal.byhavingthepatientplacebothoftheirarmsonatablewithamirrorplacedbetweentheirarms[1].Theyarethenrequiredtolookinthemirrorwhilemovingbotharms.Thereflectingsideofthemirrorfacesthenon-affectedarm.Mirrortherapyhasbeenshowntohaveasignificanteffectonspatialneglect[1]. FeedbackTraining[edit|editsource] Feedbacktrainingcanbeachievedthroughverbal,video,andvisualfeedback. Simplypointingoutapatient’sneglectbehaviour(verbalfeedback)orshowingthemavideooftheirperformancecanleadtoanincreaseinself-awarenessandadecreaseinneglectsymptoms[6]. Significantimprovementsinneglectsymptomswerealsoseeninastudythatusedrodliftingasaformofvisuomotorfeedback.Theinterventionsimplyconsistedofhavingpatientsliftandbalancerodswithacentralgrip;therodprovidesimmediatefeedbackastowhetherornottheirgripisactuallycentral[2]. Prognosis[edit|editsource] Thereismuchevidencetosupportthatitis“unilateralneglectratherthanoverallstrokeseverity,thatpredictspooroutcomeinrighthemispherestroke”[3]. Patientswithunilateralspatialneglecthavepoorerrehabilitationoutcomescomparedtosimilarlymatchedstrokevictimswithoutunilateralspatialneglect. Unilateralspatialneglectiscorrelatedwithanincreasedlengthofstayinaninpatientrehabilitationfacility,aswellasaslowerprogression[4]. Patientswithunilateralspatialneglectspendanaverageofelevendayslongerinaninpatientrehabilitationfacilityandhavelessfunctionalimprovementperdaycomparedtostrokevictimsofsimilarfunctionaladmissionstatuswhoarenotsufferingfromunilateralneglect[5]. Recoveryfromvisualneglectismostrapidoverthefirst10dayspost-strokeandplateausatthethreemonthsmark[6].Themajorityofpatientswillhaveminimaltonosignsofunilateralvisualneglectatthreemonthspost-stroke[6]. Thechancesofafullrecoveryarehigherinthosewhosufferedalefthemispherestrokecomparedtothosewhosufferedarighthemispherestroke[6]. Unilateralneglectnegativelyaffectsdisabilityone-yearpost-stroke;thishasbeenfoundtobetrueregardlessofaperson’spre-strokecognitivelevels[7]. AstudybyAppelrosetal.,[7] hasshownneglecttobeavalidpredictorofdependency,butnotanindependentpredictorofdeathone-yearpost-stroke. Researchhasfoundthathavingneglectadverselyaffectsaperson’slong-termprognosisintheareasoffunctionaloutcome,rehabilitationoutcome,lengthofhospitalstayaswellasone’sdischargetohome[7].Unilateralneglectiscorrelatedwithanincreasedneedforshelteredlivingandhomeassistance[7]. Comparedtostrokepatientswithoutunilateralneglect,thosewithunilateralneglecthadlowerperformanceonmeasuresofbothsensory-motorandcognitiveimpairmentaswellasdisabilityinactivitiesofdailylivingandinstrumentalactivitiesofdailyliving[8].Thiswasfoundtobetruefollowingdischargefromtherehabilitationhospital,andatfourmonthsandone-yearpost-stroke[8]. References[edit|editsource] ↑1.01.11.21.31.41.51.61.71.8HillisAE.Neurobiologyofunilateralspatialneglect.Theneuroscientist.2006Apr;12(2):153-63.fckLRDOI:10.1177/1073858405284257(LevelofEvidence5) ↑2.02.12.22.32.42.52.62.7MenonA,Korner-BitenskyN.Evaluatingunilateralspatialneglectpoststroke:Workingyourwaythroughthemazeofassessmentchoices.Topicsinstrokerehabilitation.2004Jul1;11(3):41-66.DOI:http://dx.doi.org/10.1310/KQWL-3HQL-4KNM-5F4U(LevelofEvidence1A) ↑3.003.013.023.033.043.053.063.073.083.093.103.113.123.133.143.153.163.173.18PlummerP,MorrisME,DunaiJ.Assessmentofunilateralneglect.(Update).PhysicalTherapy.2003,August;83(8):732-740.DOI:https://doi.org/10.1093/ptj/83.8.732(LevelofEvidence1A) ↑4.004.014.024.034.044.054.064.074.084.094.104.11YangNYH,ZhouD,ChungRCK,Li-TsangCWP,FongKNK.RehabilitationInterventionsforUnilateralNeglectafterStroke:ASystematicReviewfrom1997through2012.FrontiersinHumanNeuroscience.2013May10;7:1–11.DOI:10.3389/fnhum.2013.00187(LevelofEvidence1A) ↑5.05.15.25.35.45.5BarrettA,JohnS,HoffmannM,Galvez-JimenezN,JacobsD,TalaveraF.SpatialNeglect:Overview,Etiology,MechanismsandMorbiditiesinSpatialNeglect[Internet].Overview,Etiology,MechanismsandMorbiditiesin.2017[cited2017May7].Availablefrom:http://emedicine.medscape.com/article/1136474-overview?pa=NK01EYVNCkZ80xTbSjIJtAhKz7Dnjtwp3tB6H9gcQnK9f9OGGITaJaB6%2Bp9gHoAVaVJN%2F1bSjMcE71A%2Fk94li8Edx1ifJJK66DE1LVUlRZo%3D#a4 (LevelofEvidence5) ↑6.006.016.026.036.046.056.066.076.086.096.106.116.12BeisJ-M,KellerC,MorinN,BartolomeoP,BernatiT,ChokronS,etal.Rightspatialneglectafterlefthemispherestroke:Qualitativeandquantitativestudy.Neurology.2004Aug;63(9):1600–5.DOI:10.1212/01.wnl.0000142967.60579.32(LevelofEvidence2B) ↑7.07.17.27.37.47.57.67.77.8BowenA,MckennaK,TallisRC.ReasonsforVariabilityintheReportedRateofOccurrenceofUnilateralSpatialNeglectAfterStroke.Stroke.1999Jan;30(6):1196–202.DOI:10.1161/01.str.30.6.1196(LevelofEvidence3A) ↑8.08.18.28.3SuchanJ,RordenC,KarnathH-O.Neglectseverityafterleftandrightbraindamage.Neuropsychologia.2012;50(6):1136–41.DOI:10.1016/j.neuropsychologia.2011.12.018(LevelofEvidence2B) ↑9.09.19.29.3GottesmanRF,KleinmanJT,DavisC,Heidler-GaryJ,NewhartM,KannanV,HillisAE.Unilateralneglectismoresevereandcommoninolderpatientswithrighthemisphericstroke.Neurology.2008Oct28;71(18):1439-44.DOI:10.1212/01.wnl.0000327888.48230.d2(LevelofEvidence2B) ↑10.010.110.2KleinmanJT,GottesmanRF,DavisC,NewhartM,Heidler-GaryJ,HillisAE.Genderdifferencesinunilateralspatialneglectwithin24hoursofischemicstroke.Brainandcognition.2008Oct31;68(1):49-52.DOI:10.1016/j.bandc.2008.02.122(LevelofEvidence2B) ↑StrokeFoundation.“HemispatialNegelectSyndrome”.YouTube.March19,2013.Accessed2017May8.Availablefrom:https://www.youtube.com/watch?v=d4FhZs-m7hA. ↑EinsteinHealth,VirtualRealityTestforHemispatialNeglectPatientsavailablefrom:https://www.youtube.com/watch?v=1-P5TdH4DVQ ↑kesslerfoundationprismadaptationtreatmentdemonstration.availablefromhttps://youtu.be/DvlCWTXh12E Retrievedfrom"https://www.physio-pedia.com/index.php?title=Unilateral_Neglect&oldid=246014" Categories:Queen'sUniversityNeuromotorFunctionProjectNeurologyNeurological-ConditionsStrokeStroke-ConditionsHeadHead-ConditionsConditions GetTopTipsTuesdayandTheLatestPhysiopediaupdates EmailAddress IgivemyconsenttoPhysiopediatobeintouchwithmeviaemailusingtheinformationIhaveprovidedinthisformforthepurposeofnews,updatesandmarketing. 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