After a stroke, a person may sometimes behave as though one side of their surroundings does not exist. They may leave food untouched on one side of a plate, bump into objects, forget to dress one side of the body or fail to notice a person approaching from one direction.
This may look like forgetfulness or lack of attention, but it can be a neurological problem called post-stroke neglect or spatial neglect.
Post-stroke neglect can interfere with mobility, self-care, communication and safety. Recognising it early can help families and rehabilitation teams provide appropriate support.
What Is Post-Stroke Neglect?
Post-stroke neglect is a condition in which a person has difficulty noticing, responding to or orienting towards information on one side of their environment or body following a stroke.
It is not simply a problem with eyesight. A person can have adequate visual ability but still fail to respond to things on the affected side because the brain is not adequately directing attention towards that space.
Neglect most commonly occurs after strokes affecting the right side of the brain, which can result in difficulty attending to the left side. However, neglect can occur after other strokes as well.
The problem may involve the person’s body, nearby surroundings or wider space.
What Is Unilateral Neglect After Stroke?
Unilateral neglect after stroke refers to reduced awareness or attention towards one side.
For example, a person may:
- Eat food from only one side of the plate
- Leave one sleeve while dressing
- Fail to notice objects on one side
- Bump into furniture while walking
- Ignore a limb when performing daily activities
- Groom only one side of the face
- Read only part of a page
- Have difficulty finding objects positioned on the neglected side
The severity can vary considerably. Some people show neglect only during particular activities, while others have difficulty attending to one side across many situations.
Is Post-Stroke Neglect the Same as Visual Field Loss?
No. Although they can appear similar, spatial neglect after stroke and visual field loss are different problems.
With a visual field deficit, the person may be unable to see a particular area of their visual field because of damage to the visual pathways.
With neglect, the person may have the ability to see an object but fail to notice or respond to it because of impaired attention.
The two conditions can also occur together, which is why a proper neurological rehabilitation assessment is important.
Common Stroke Neglect Symptoms
The signs of neglect are not always obvious, particularly during the early stages of recovery.
Common stroke neglect symptoms may include:
1. Leaving food on one side of the plate
A person may eat everything they can see on one side while leaving food untouched on the other.
2. Dressing only one side
They may put a shirt or trouser leg on one side but fail to recognise that the other side still needs attention.
3. Bumping into objects
A person may repeatedly collide with doorframes, furniture or other obstacles positioned on the neglected side.
4. Missing objects
They may struggle to locate an item even when it is placed within their surroundings.
5. Grooming one side
They may brush hair, shave or wash only one side of their face or body.
6. Difficulty reading
Neglect can affect reading, with a person overlooking words or sections of text positioned on one side of a page.
7. Reduced awareness of a limb
Some people may pay little attention to an affected arm or leg during daily activities.
These symptoms can create significant safety concerns, particularly when the person is walking or transferring without assistance.
How Can Neglect Affect Everyday Activities?
Neglect can interfere with activities that appear simple.
A stroke survivor may have difficulty:
- Getting dressed
- Eating independently
- Walking safely
- Finding personal belongings
- Using the bathroom
- Grooming
- Moving from bed to chair
- Reading
- Navigating unfamiliar environments
For example, someone with left neglect may turn their wheelchair towards the right and fail to notice an obstacle on the left.
This can increase the risk of collisions and falls.
Neglect can also make rehabilitation more challenging because the person may not consistently notice or use the affected side during exercises and functional activities.
Treatment for Neglect After Stroke
There is no single treatment for neglect after stroke that is appropriate for everyone.
Management is usually incorporated into a broader stroke rehabilitation programme and depends on the person’s symptoms, abilities and goals.
Visual Scanning Training
The person may be taught to deliberately scan towards the neglected side.
For example, before walking through a doorway, they may practise turning their head and eyes towards both sides to identify potential obstacles.
Repetitive Functional Practice
Instead of practising attention only through isolated exercises, therapists may incorporate scanning into meaningful daily activities.
This could include:
- Searching for objects
- Reading
- Dressing
- Eating
- Grooming
- Walking
- Wheelchair mobility
Positioning and Environmental Strategies
The rehabilitation team may temporarily position important objects where the person can safely access them while simultaneously encouraging awareness of the neglected side.
The environment may also be organised to reduce avoidable hazards.
Multisensory Approaches
Depending on the individual’s assessment, therapists may use visual, tactile or auditory cues to encourage attention towards the affected side.
Safety Training
Because neglect can affect mobility and awareness of obstacles, safety education is an important part of rehabilitation.
Caregivers may also learn how to provide appropriate cues without doing every task for the person.
Can Post-Stroke Neglect Improve?
Recovery varies between individuals.
Some people experience substantial improvement as the brain recovers and they participate in rehabilitation. Others may continue to have difficulties for longer.
Progress should be monitored not only through formal assessments but also through practical activities.
For example, being able to notice an object on the neglected side during therapy is useful, but being able to safely navigate around that object at home is an even more meaningful functional outcome.
Stroke Rehabilitation at Antara
At Antara, stroke rehabilitation is planned around the individual’s neurological condition, functional limitations and recovery goals.
A multidisciplinary team can include doctors, physiotherapists, occupational therapists, speech therapists, nurses and trained care professionals. Depending on individual needs, rehabilitation may include mobility and gait training, balance exercises, functional task practice, speech and swallowing therapy, occupational therapy and support with activities of daily living.
For a person experiencing post-stroke neglect, rehabilitation can incorporate attention and awareness strategies into meaningful activities such as walking, transfers, dressing and other daily routines.
The focus is on helping the individual participate more safely and independently while caregivers learn how to support the rehabilitation process.
Conclusion
Post-stroke neglect can be easy to misunderstand. A stroke survivor who appears to ignore one side may not be doing so intentionally. Damage to brain networks involved in attention and awareness can make it difficult to notice or respond to part of the body or surrounding environment.
Recognising stroke neglect symptoms is important because the condition can affect mobility, self-care and safety. With appropriate assessment and rehabilitation for unilateral neglect, strategies such as visual scanning, functional practice, environmental modification and multidisciplinary therapy can be incorporated into the person’s recovery plan.
