What is visual neglect after a stroke?

What is spatial neglect?

Spatial neglect, sometimes called unilateral neglect or hemi-inattention, happens when the brain fails to direct attention to one side. It is most common after strokes affecting the right side of the brain, so the left side is ignored. The eyes may be working normally, but information from that side does not reach awareness.

Neglect can affect the space around the person, the space within reach, or their own body. Some people ignore sounds or touch from one side as well as what they see.

How does neglect show in daily life?

Typical signs include eating only the food on one side of the plate, shaving or applying make-up to one side of the face, dressing only one arm, reading only the right side of a page, missing people standing on the left, bumping into doorframes or furniture, and wheelchair users colliding with objects on one side.

Many people are not aware that they have neglect, a problem called anosognosia. This lack of awareness makes it harder for them to use strategies and increases safety risks.

How is neglect different from loss of vision?

A stroke can also cause hemianopia, loss of vision in one half of the visual field in both eyes. People with hemianopia usually know that they cannot see on one side and learn to turn their head to compensate. In neglect, the problem is attention, so the person does not realise anything is missing and does not compensate spontaneously.

Both conditions can occur together. Assessment by the rehabilitation team, often including simple paper tests such as crossing out targets on a page and observation during daily tasks, helps distinguish them.

Why does neglect matter for recovery?

Neglect is associated with more falls, longer hospital stays and greater difficulty with independence in daily activities. It affects walking, wheelchair use, dressing, eating, reading and safety at home. It can also make physical rehabilitation harder, as people may not attend to the weaker side of their body.

Stroke guidelines recommend that people are assessed for neglect and that their rehabilitation and discharge plans take it into account 3.

What treatments are used?

Visual scanning training teaches people to systematically look towards the neglected side, often using anchors such as a brightly coloured strip at the edge of a page. Evidence reviews of cognitive rehabilitation support visual scanning training for neglect after right-hemisphere stroke as a practice standard 2.

Other approaches include prism adaptation, where special glasses shift the visual field and the brain adjusts, limb activation, where the person moves the arm on the neglected side, mirror therapy and video feedback. A Cochrane review found that none of these approaches has yet been proven to improve independence in daily activities in high-quality trials, although some improve performance on neglect tests 1. Treatment is therefore chosen individually and its effect monitored.

How can families and carers help?

Early on, placing important items such as the call bell, drink and phone on the side the person attends to helps safety. As rehabilitation progresses, therapists may encourage gradually approaching from and placing items on the neglected side to promote attention, with reminders to look.

Verbal cues such as 'look to the left' or tapping the neglected side can help. Keeping the environment tidy, removing obstacles, supervising in the kitchen and bathroom and checking that meals are finished reduce risks.

Does neglect get better?

Many people improve over the first weeks and months after a stroke, and neglect often becomes milder. In some people it persists and affects independence long-term. Continued strategies and adaptations make daily life safer and easier.

People with neglect usually should not drive, because they may miss hazards on one side. Driving decisions follow medical assessment and national licensing rules.

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