Brain Dysfunction: Left Syndrome Hemineglect

Suppose one morning mom wakes up and noises indicate that she is primping herself in the bathroom. The blow-dryer flips on and off, her lipstick opens and closes, and scurrying through the make-up bag indicates that once again mom can not find her waterproof mascara. When she exits the bathroom and sits down to a plate of warm breakfast in front of her, horror is the only reaction. Mom’s hair is only brushed and styled on the right side—the left is still mangled and dripping wet from her shower. Mom has also only applied blush, lipstick, mascara, and eye shadow to right side of her face as well. Upon closer inspection she has also finished her breakfast and the left side is untouched. Mom gets up to leave the table not noticing a single difference between today and any other day. A short jaunt to the doctor, and a few psychological tests later, it is revealed that grandma has not gone crazy but is suffering from Hemineglect (Blakeslee & Ramachandran, 1998).

What is Left Hemineglect Syndrome?

In order to understand this condition, let’s break down the word. “Left” refers to the fact that this ailment directly affects the right hemisphere of the brain because the right brain controls the left area of the body. Hemineglect refers to “half” being neglected which is literally what happens. An entire half of the body (the left half) is neglected and neglect is, according to Meyers and Bierig, “…the inability of a patient to report or respond to a stimulus presented contralateral to the damaged hemisphere.”

However, Hemineglect presents itself in different intensities. “Left Hemineglect syndrome can range in severity from a simple rightward attentional bias to an inability to recognize one’s extremities are actually a part of one’s own body” (Bierig & Meyers, 2000).

What causes Hemineglect?

Hemineglect occurs when there is damage to the right hemisphere of the brain, often times following a stroke. The right hemisphere is now known to be central in (1) emotional behavior, (2) paralinguistic tasks, (3) facial recognition and most importantly (4) spatial attention (Bierig & Myers, 1998). Spatial attention with hemineglect patients is geared toward making all the attention focus in on the right of the visual field making it as if the left side is gone.

Signs of Hemineglect

There are a few exercises that will reveal the presence of hemineglect. One exercise is drawing. In pictures copied by a patient with hemineglect, there will be a tendency for leaving the left side of the drawing to be absent as seen in the figure to the right. The picture to the left is the original. The picture to the right is the drawing a patient with hemineglect created based off the original. As one will notice, the original clock includes all 12 numbers spaced equally around the circle whereas the patient’s drawing only includes numbers 1-7 and a good majority on the patient’s clock left side is blank. In regard to the houses, it is almost identical to the clocks; the right side of the drawing is packed with a mirror image of the original but the left side is again absent (Blakeslee & Ramachandran, 1998).

Elderly stroke Patients: Evaluation of a test battery for Hemineglect

This study was put together to (1) “measure performance of healthy elderly subjects on a better of validated tests for hemineglect in order to establish appropriate cut-off score” and (2) “to assess performance of a large sample of elderly stroke patients in a rehabilitation unit, using the same battery” (Bailey, et al., 2000).

The sample size had suffered from a stroke with in the past twelve months. There were 23 men and 23 women. 10 of those patients had brain damage to the right side, and 34 patients had left-sided damage, and 2 had bilateral damage. Within the control study there was another 43 non-brain damaged subjects willing to participate. Each subject was given the battery of tests which took twenty minutes per person. There were seven tests total. The tests consisted of star cancellation, line bisection, copy-a-daisy, the baking tray task, draw-a-clock, exploratory motor task, and personal neglect (Bailey, et al., 2000).

In the star cancellation, the subject was given a pen in which he/she was to cancel out as many stars as they could. There were “52 large stars on a page, 10 short words and 13 letters, randomly positioned with 56 small stars interspersed. The subjects were instructed to cross out…all the small starts” (Bailey, et al., 2000).

Next, the subjects were given 24 lines to bisect. The idea of this test was to see how close the subjects could get to the middle of the line.

Then, the subjects were instructed to copy-a-daisy. This was a task where they had to copy an image of a flower.

Next, the baking tray was a whiteboard that was about the size of a real baking tray where the subject had to, as symmetrically as they could, place fake buns across the white board. After, they were asked to draw a clock. In order to standardized this, a point scale was instituted ranging from 4 -1.

Then, the exploratory motor task was a blind-folded task. The subjects had a certain number of objects put on a board. They were not instructed as to how many objects there actually were. Once they believed they were done, they had to say “finished.”

And finally, the “subjects were presented with 3 objects, on at a time: (1) comb; (2) razor (for men), powder compact (for women); (3) spectacles.” Subjects were asked to show the instructors how each item was used. Scoring was on a scale from 0-3.

The results revealed that, “hemineglect is not a single entity and requires a range of tests to be used to maximize the possibility of identifying neglect disorder and to distinguish the selective impairments” (Bailey et al., 2000). This battery of tests paved the way for more precise treatment options and a better understanding of hemineglect and what exactly it affects (Bailey et al., 2000).

Treatment: Optokinetic Stimulation

A study was put together to show the potential of Optokinetic Stimulation (OKS). Ten participants with left-sided chronic neglect were given a batter of tests. The neglect screening broke the ten participants into two groups of five each. The first group of five was to receive the OKS. The other group of five was used as a control group to compare the success of the treatment (Keller & Kerkhoff, 2006).

The participants were put through a series of tests which included cancellation tests, reading tests, and line bisection. During the cancellation test, participants were instructed to use a pen to cancel out numbers “1” and “9” from a total of 200 numbers ranging from 0-9. Then, the reading test was screening for neglect dyslexia. The patients were asked to read 55 words. The text was located in the center of a monitor at a distance of 0.4 m. The test giver was looking for words that were left out and if the patient substituted all or part of certain words. And finally, the last task was line bisection where they were instructed to put a mark where they thought the line’s middle is located (Keller & Kerkhoff, 2006).

Next, OKS was administered to the first group of five participants. Thirty to seventy dots appeared on a 17” screen. The dots kept moving slowly more and more to the left. No movement of their head was allowed. Speed of the dots was constantly varied depending on the attention span of the patients. The participants completed the OKS exercise four times each session with ten minute breaks (Keller & Kerkhoff, 2006).

Then, the second group of five, which was the control group, was given the same OKS treatment only the dots that were on the screen remained still instead of moving to the left. They were also given this exercise four times a session with ten minute breaks (Keller & Kerkhoff, 2006).

According to Keller and Kerkhoff, OKS directs “attention towards neglected regions of space. This improved attention allocation lead to subsequent improvements in all visual neglect tasks requiring systematic leftward exploration, as in cancellation, reading, size comparisons or line bisection” With the limited amount of resources available to treat

Treatment: Virtual Reality (VR)

Developed by the Kaiser Rehabilitation Center, a Virtual Reality system assesses the severity of Left Hemineglect Syndrome and offers possible treatment with their new technology design. The Virtual Reality uses a tracking and cueing program which gauges the individual’s responses within the VR environment. The new Virtual Reality innovation offers “accurate and consistent assessment, therapy, and outcome measurements.” The Virtual Reality simulation is made up of a three room home and a backyard. Kaiser’s Virtual Reality Tracking and Cueing Program (VRTC) “measures (1) maximum angle of head rotation to the left and to the right; (2) the time to maximal angle in each direction (3) in the case of a patient who ignores the left hemifield, the number of cues the patient requires to turn to the left” (Bierig & Meyers, 2000). Beirig and Meyers states that “Because this technology is computer-based, the interactions can be accurately qualified (Bierig & Meyers, 2000).

While many neglect patients can not recover enough to fully continue an independent lifestyle nor go back to their previous vocation (Keller & Kerkhoff, 2006), The Kaiser Rehabilitation Center offers promising treatment for Left Hemineglect Syndrome patients. It offers “the ability to immerse the patient in a carefully planned and controlled environment, the ability to quantify responses in a bias-free manner, the ability to track and measure head movement and the opportunity to use the cueing capabilities of the VRTC program as a therapeutic adjunct” (Beirig & Meyers, 2000).