Patients with visual spatial neglect have a lot on their plates. On top of recovering from a stroke or other brain injury, they’re dealing with the realities of ignoring half of their visual field.
Thankfully, simple changes to their environment can help them be safer, happier, and more independent!
Many of these changes are quick, easy, yet powerful wins. In this article, you’ll learn visual neglect environmental modifications for:
- Lighting
- Visual contrast
- Organization
- Mealtime
- Cognition, and more!
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Why Modify The Environment?
Visual neglect is a failure to attend, orient, or respond to visual stimuli on the opposite side of a left or right hemisphere brain injury. It can’t be explained by sensory or vision deficits (Weightman et al., 2015).
Some people with visual neglect also ignore half of their body. This means that they’re more likely to ignore, run into things, and not feel things on that side of their body.
Common examples are neglecting to groom one side of their body and not protecting that side from bumps, burns, or other hazards.
Modifying the environment is an important way to improve safety, comfort, and independence.
Keep in mind that visual neglect is different from a visual field cut, which is also common after a stroke.
If you aren’t comfortable treating visual neglect, treatment isn’t working, or you suspect another vision disorder, like a visual field cut, don’t hesitate to refer out:
- To an OT who works with visual-perceptual disorders
- To an optometrist or ophthalmologist who works with neurological disorders
Lighting For Visual Spatial Neglect
Improve lighting to increase safety and comfort. Many people post-stroke also have vision loss and may need better lighting.
Here are ways to improve lighting:
- Turn on or add more lights (add lamps, replace dead lightbulbs)
- Avoid too-bright lights, especially if the patient has headaches, seizures, or light sensitivity
- Make sure dark areas of rooms and hallways are well-lit
- Provide natural light when possible
- Avoid flickering lights
- Avoid glare (cover shiny surfaces)
Visual Contrast For Visual Spatial Neglect
Use visual contrast to draw attention to the affected side. You can also use it to support overall vision, safety, and attention.
Ways to add visual contrast:
- Label items with large, bold font (black ink on white label)
- Use brightly colored paper on the side of neglect for tabletop tasks
- Post brightly colored signs that contrast with the wall
- Use high-contrast colors to highlight an obstacle (wheelchair handles, walker handles, stairs, railing)
- Use high-contrast colors to highlight other important items and safety hazards (bright-colored tape around a light switch, door handle, or burner)
- Use contrasting paint on an important door (bathroom door, exit)
Organizing For Visual Neglect
Organize the environment to make it easier for patients to find what they want—and harder to bump into the things they don’t.
Here are ways to organize the environment to support people with visual neglect:
- Keep hallways and walkways clear
- Remove clutter in a room, including extra furniture
- Clear off tables or desks when working on a tabletop
- Use bins to organize objects. Like daily household items in the bathroom, kitchen, office, etc.
- Use a filing system for important paperwork, like bills and medical documents.
- Label drawers, cupboards, and bins make it easier to find objects
- Use a filing system to organize books or files (A-Z, by subject)
- Hang clothing or use color coded or bins
- Keep items in the same place (keys, wallet, purse, phone)
Safety Modifications For Visual Neglect
Here are additional ways to make the environment safer for people with visual neglect:
- Secure electrical cords to the wall so they’re not underfoot
- Stick contrasting or brightly colored tape on the edges of stairs and other safety hazards (railings, burners)
- Stick bright tape on wheelchair brakes, walker
- Post signs to support safety (“Step”)
- Mark the edges of doorways with brightly colored tape
- Fix uneven thresholds or add bright tape to draw attention to it
- Wear non-skid slippers or shoes at home
- Remove rugs and runners or add non-stick backing
- Add nonskid bathmats to the shower or tub floor
- Keep sharp or dangerous objects in drawers/bins
- For higher-level patients, work on increasing safety on the affected side. Like turning off burners and managing sharp objects. Use cues to help them locate the object. Supervise and give assistance and cues as needed for safety.
- Use assistive devices, like a walker, as recommended by the doctor or physical therapist
Modifying Mealtimes for Visual Spatial Neglect
Patients with visual neglect may ignore food and drink on their affected side. Prioritize nutrition and hydration needs over their visual attention goals.
Here are ways to modify mealtimes when a patient has visual neglect:
- Rotate the plate or bowl so food is on the non-affected side
- Use high contrast colors (between food and plate, plate and table, placemat and plate)
- With severe neglect, feed/assist/cue the patient on their non-affected side to improve intake. Place food/utensils/drinks on the non-affected side.
- To challenge the patient, sit on their affected side and cue them to locate their food, utensils, etc., on their affected side.
- For higher-level patients, you can sit on their affected side and target eye contact with conversation.
- Stick brightly colored tape on the affected side of the table or tray to serve as an anchor line.
Cognitive Modifications for Visual Neglect
Here are ways to support cognition in patients with visual neglect:
- When reading, put a bright line down the left side page of books, newspapers, or magazines. This helps the patient practice reading from left to right.
- When reading, add tactile cues to help find the margin of the page on the neglected side. Examples are adding Velcro or sandpaper strips on the left margin.
- Use a number on each line when reading. Train the patient to follow each line with their finger to improve visual scanning.
- Keep the environment clutter-free to decrease distraction.
- Give extra time for thought processing and comprehension
- Give extra cues and assistance as needed to increase success
- Use errorless learning to improve progress and carryover
- Keep the environment quiet and calm
- Remove other distractions if possible
Noise Modifications for Visual Neglect
Here are ways to improve the auditory environment to help your patients pay attention to the task at hand.
- Close the window or door
- Turn off the TV or radio
- Ask others to leave the room if needed
- Close curtains to dampen sound
- Move to a space with better acoustics (carpets, curtains, quiet)
- Make sure that your patient’s hearing aids are in and working! This not only improves engagement but may also help prevent cognitive decline.
More Visual Neglect Resources
See what SLPs are saying about the Visual Neglect Pack!
I love this workbook. Despite having other materials that address visual inattention, I find myself reaching for this over and over. Very well done!
Kelly
Very useful, my clients enjoy the variety and improvements are observed.
Samantha
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References
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- Varindani Desai, R. (n.d.). Visual Scanning: A How-To Treatment Guide for Visual Attention. Tactus Therapy. Retrieved October, 2024, from https://tactustherapy.com/visual-scanning-treatment
- Weightman, M., Vining Radomski, M., Mashima, P., & Roth, C. (2015). Mild Traumatic Brain Injury Rehabilitation Toolkit. Borden Institute. https://medcoe.army.mil/borden-tb-tbi