Post-Stroke Spatial Neglect: Assessment, Safety and Rehabilitation

Clinical framework

Unilateral spatial neglect is reduced attention or response to one side of space, often after right-hemisphere stroke with left-sided neglect. It can affect dressing, eating, transfers and walking, and may fluctuate with fatigue or distraction. It is not simply weakness or a primary sensory loss.

Assessment and differential diagnosis

• Review onset, stroke history, vision, cognition, communication, sensation and medication effects. Observe everyday tasks as well as structured cancellation, line-bisection or other validated screens.
• Consider coexisting homonymous field loss, ocular-motor impairment, delirium, aphasia, sensory loss and generalized inattention; neglect and field loss can coexist.
• New focal neurological signs, reduced consciousness, sudden severe headache or abrupt decline require urgent medical escalation.

Safety and intervention

• Document which space and tasks are affected, cueing required, collisions and supervision needs. Coordinate a consistent plan with the multidisciplinary team and carers.
• Use repeated meaningful tasks: visual search, reaching, grooming, meal tasks and mobility with graded cues toward the affected side. Reduce distractions initially, then build environmental complexity.
• Intervention evidence varies; choose strategies from assessment and local stroke guidance rather than promising one technique will resolve neglect.

Dose and reassessment

There is no single universal dose. Use repeated, tolerable task practice distributed around fatigue. Track omissions, accuracy, cueing, collisions and a functional measure such as the Catherine Bergego Scale where available. Better tabletop scores alone do not prove safe community mobility.

Clinical summary

• Do not equate neglect with hemianopia.
• Pair screening with real-world observation and safety planning.
• Reassess function as task complexity increases.