Neglect is a neurological attention disorder in which the affected person neglects one part of the room or one part of the body and/or parts of an object. It is an egocentric or allocentric disorder.
What is a neglect?
Neglect often occurs after bleeding from the middle cerebral artery (cerebral artery) and right-hemispheric cerebral infarction. This neurological disorder is due to a lesion in the parietal lobe of the cortex (brain cortex). The diagnosis is often difficult because the symptoms are varied. Neglect can affect all sensory modalities, although in most cases patients are unaware of their deficits and classify their behavioral problems as normal. As a result, there is no insight into the disease (anosognosia). See phonejust for Childish Fat Foot Meaning.
A neglect occurs with damage to certain brain regions, the parietal lobe or the parietal lobe. This area of the brain is responsible for controlling attention. Possible damage is brain tumors, stroke, cerebral hemorrhage, craniocerebral trauma, meningitis, encephalitis, multiple sclerosis, muscle diseases as well as diseases of the peripheral nervous system and neurodegenerative diseases.
Most patients with neglect syndrome have a right-sided stroke with damage to the right hemisphere of the brain. They neglect the opposite, left half of the body or space. The left-hemispheric cerebral infarction is less severe and occurs less frequently.
Symptoms, Ailments & Signs
The patient shaves or washes only one side of the body. He doesn’t react when spoken to from the injured side because he doesn’t hear or see anything. He bumps or runs into obstacles that are on the neglected side. When eating, he only considers the food on one side of the plate, ignoring the other. If he is supposed to draw a picture, only the parts of the perceived side are included. Those affected behave so strangely for outsiders because they often do not notice their deficits.
Their behavior is normal for them, they lack the ability to understand their illness and they react all the more violently when their social environment draws their attention to their behavioral problems. They come across as unapologetic, defiant, ignorant, indifferent, unfriendly, and stubborn. Clinical neuropsychology aims to reduce or eliminate these deficits with various therapeutic approaches. However, the prerequisite for a successful treatment is the ability of the patient to understand. As long as this does not occur, the people affected are only slightly motivated to undergo therapy and dealing with them remains difficult.
- The visual attention disorder is the most common. The patients do not perceive objects, people and premises on the neglected side or perceive them with a delay. Your sense of direction is mostly focused on the non-neglected half.
- With auditory neglect, the ability to hear is impaired and noises, conversations, music and speech are not perceived or only to a limited extent. If the persons concerned are addressed on the neglected side, they do not react or react with a delay.
- With personal neglect, patients hide one half of the body and do not perceive incoming stimuli such as touch, pressure pain, pain from injury or temperature stimuli. Alternatively, they assign these stimuli to the half of the body that is not neglected.
- With olfactory neglect, odors are not perceived.
- Motor neglect leads to reduced use of the extremities (hemiakinesis).
- Representational neglect entails a neglect of stimuli in visual perception. The patients perceive objects, rooms, people and obstacles only on the side that is not neglected and leave out the affected side in the description of the picture.
Diagnosis & course of disease
It is an acquired perception disorder as a result of a stroke or other forms of brain damage. The disruption process is fundamentally reversed, since only the side opposite to the brain damage is neglected. If there is a right hemispheric brain disorder, stimuli from the left side of the room or body are not perceived and vice versa.
The terms hemineglect, unilateral attention deficit disorder, and unilateral neglect are also used. A neclect can affect multiple sensory channels simultaneously and cause visual, auditory, sensory, or motor disturbances. With these ailments, only one side will function while the other side is completely spent. Diagnosis is primarily based on behavioral abnormalities, imaging techniques, tissue removal and muscle biopsies.
Even simple tests quickly confirm the initial suspicion. The neurologists perform search and strikethrough tests, reading, writing and arithmetic tests as well as drawing exercises (visual exploration training) with the patients. In therapy, everyday situations are trained, taking into account the neglected side. With optokinetic simulation therapy, patients must follow symbols that move toward the neglected side.
A neglect is already a complication that often develops after a stroke. In the case of existing neglect, however, further complications only arise from the typical behavior of those affected. Intensive therapy would be necessary to prevent this. The patient himself is not even aware of the disorder.
Therefore, at first he does not suffer from the direct effects of this condition and often does not allow therapy. On this basis, various complications can arise. Because the patient ignores any objects that are imaged due to the damaged cerebral hemisphere, collisions with these objects can cause accidents and injuries, among other things.
Without nursing support, the affected person is often no longer able to feed themselves adequately or to carry out the simplest personal hygiene activities. In severe cases, without help, this can lead to malnutrition and social isolation with a tendency to neglect.
However, in about 65 percent of all cases, the neglect disappears within 15 months without any particular complications occurring despite the lack of therapy. In about 35 percent of those affected, however, clear symptoms remain, which are then only accessible to symptomatic therapy. However, a prerequisite for therapy is insight into the disease. However, complete healing is then no longer possible.
When should you go to the doctor?
Behavioral problems or an appearance that is socially perceived as abnormal should be discussed with a doctor. If the affected person has a special attitude towards their own body, they usually need help and support. Attention disorders, body schema disorders and compulsive behaviors should be discussed with a doctor.
Since the person concerned lacks insight into the illness in the case of neglect, it is very unlikely that there is a need for a medical clarification of the symptoms. Therefore, they often do not visit the doctor of their own accord. Therefore, close relatives, confidants and friends have an increased duty of care. If you notice any irregularities, you should win the trust of the person concerned and discuss further action with a doctor. So that you do not fail with your project, sufficient information about the clinical picture is necessary beforehand. For a comprehensive explanation, a doctor’s visit is advisable.
If the person affected noticeably washes or pays attention to one side of the body more than the other, this is a sign of a discrepancy. If the persons present notice particularities of a shift in perception in various situations in everyday life, a conversation with the person concerned should be sought. If smells, sounds or stimuli are not perceived, there is cause for concern.
Treatment & Therapy
Relatives can take a number of measures to make everyday life easier for them. Glasses, cups and plates are placed on the table at a slight angle to the neglected side. All activities are brought to the person concerned via the restricted page in order to train awareness of this page. The bed is set up so that the patient lies with the healthy side against the wall. Conscious and patient handling is essential, as the ability to pay attention and concentrate is limited.
Everyday situations, conversations and visits are exhausting. Therefore, repeated breaks are indicated. Excessive criticism and impatience are counterproductive and reinforce the blocking attitude. A small device the size of a pack of cigarettes serves as a signal generator. A signal sounds at regular intervals and the person concerned must switch off the device with the neglected side.
A vibrator can stimulate muscles and increase sensitivity. Various exercises train eye and head movements. Cues facilitate perception, for example colored markings on objects, light signals or acoustic stimuli. If the ability to understand the disease is available, the person affected can use the self-function technique to consciously perceive their neglected side.
Outlook & Forecast
If a stroke is the cause of a neglect, patients must go to the emergency doctor immediately. If the neglect occurs alone, those affected often have no awareness of the disease without treatment. This is reflected in patients not being aware of or disregarding the side of the environment and body opposite the brain lesion.
The prognosis worsens because the following senses remain impaired: visual, auditory, tactile, and olfactory. The result is reduced attention to the stimuli of the outside world. Social participation is made more difficult because the person you are talking to is not looked at properly or not even sought out. Due to the reduced perception of motor skills, movements of the extremities take place less, which results in a reduction in muscles and general skills. Patients have difficulties with reading, personal hygiene, nutrition and exercising – all areas of everyday life that mean a massive cut in independence.
Neuropsychological therapy increases the prospect of improvements, as it helps to develop awareness of the disease. Even with treatment, the prospect remains that patients will continue to need help in their everyday lives. This primarily affects the issue of mobility and requires increased attention from the environment.
Prevention in the clinical sense does not exist, as strokes, cerebral hemorrhages, brain tumors and other neurological disorders can occur unexpectedly and affect anyone, regardless of age and circumstances. Only a healthy lifestyle can prevent it.
As a rule, a neglect disappears on its own within a few months without treatment. Follow-up examinations are therefore not absolutely necessary. In many cases, however, they are advisable because healing can be supported by various medical measures. It is advisable to see a neurologist or at least your family doctor on a regular basis.
This is particularly necessary if the neglect was triggered by a stroke. In addition, there are a variety of optional aftercare measures that can speed up healing. Vibration therapy of the neck muscles, optokinetic stimulation or visual exploration training are often used for neglect.
In addition, the effects of neglect can be improved by wearing so-called prism glasses. However, the specific therapeutic measures for follow-up care depend on the type and severity of the disease. There are also a number of measures that those affected can integrate into their everyday lives.
For example, it is advisable to consciously include the neglected side in activities such as eating, drinking, combing your hair and getting dressed. In addition, head and eye movements can be specifically trained. In addition, people with a traffic neglect need to be extra careful for a few months. First of all, you should avoid driving. Pedestrians should also be careful. Ideally, patients should be accompanied by relatives.
You can do that yourself
In order to reduce the neglect step by step, it is important to become more aware of the neglected half of the body or side of the room. If possible, it helps to position the bed so that the affected side faces the room. As a result, more stimuli come from the neglected side. Since the neglect is naturally not noticed by the patient himself, he must be made aware of it again and again by those around him. Over time, he learns that he has to look for objects and sources of noise on both sides. If one side of the body is not perceived, or only insufficiently, it can help to give this side specific attention. Here, the affected arm and leg are creamed firmly, or massaged towards the heart with a massage brush.
The unnoticed side should be involved in everyday activities as often as possible so that it is registered again in the brain as a part of the body. When eating, both hands should always be on the table, even if only the healthy hand is doing something. The affected person should hold his or her affected arm with the healthy one on the body. This actively protects him from being trapped or twisted when he is transferred or laid down.