Visual neglect is most often the result of right-hemisphere brain damage, resulting in inattention to the left side. This condition is often called left visual neglect. The goal of therapy for both left and right neglect is to increase awareness of the affected side
This post offers tasks, strategies, and resources to treat visual neglect.
Treatments not covered include smooth pursuit eye-movement training, prism adaptation, eye-patching, mental imagery techniques, limb activation, and constraint-induced movement therapy. Refer to occupational therapy, physical therapy, or asha.org for more information on these treatments.
And for hundreds of evidence-based handouts, worksheets, and templates check out our bestselling Adult Speech Therapy Starter Pack!
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What is Visual Neglect?
Below is a simple definition of visual neglect for you to share with patients and their caregivers.
Visual neglect is a disorder that causes inattention to one side of the visual field (either the left or right side, although most commonly left). It’s caused by damage to the brain. Although the eyes can “see,” the brain fails to pay attention to that side. Therapy can help improve visual attention.-The Adult Speech Therapy Workbook
Teach the following visual neglect reading strategies to your patients:
FINGER SCANNING. Use your finger to scan the text as you read from left to right.
MENTAL IMAGERY. Visualize the space of your visual deficit (e.g. left space). Close your eyes, and think about what you should be seeing (Smania et al., 1997).
ANCHORS. Place a bright red piece of paper or draw a bold red line down the side of the paper (on the affected side). The color red has been shown to increase attention (Mehta & Zhu, 2009).
PAPER GUIDES. Use a brightly colored strip of paper or a blank piece of paper and place it directly underneath the line of text you’re reading to help you keep your place.
READ ALOUD. Reading aloud helps you notice if you accidentally skip words or a line of text. Your ears pick up when a sentence doesn’t make sense.
UNDERLINE OR HIGHLIGHT. If you are reading something you own (not a library book!), then underline what you’re reading with a pencil as you go along. You can also highlight the text as you read.
LARGER TEXT. It’s often easier to read larger text. Most library systems have a “Large Print” section and many popular magazines also have a larger text version. If you’re reading something on your phone, computer, or tablet, increase the text size in the settings.
TAKE IT SLOW. Pace yourself and remember to give your healing brain extra time to process information. Slow and steady wins this race.
ORGANIZED SCANNING. Use these tips to look for specific information while you’re reading (e.g. phone number on a credit card statement). They can also help you complete word search puzzles:
- Start at the top left corner of the page.
- Use your finger to scan left to right, looking for the first letter of the first word. For example, when looking for the telephone number on a credit card statement, search for the letter “T.”
- Once you get to the end of the sentence, go back to the left and scan the next sentence.
- Continue until you find the word; mark the word by highlighting or circling it.
- Move to the next word and repeat steps 1-5. If you have a hard time finding a word, move on to the next word, and come back to it later.
Prompt your patient:
“Use this technique when reading or when navigating in your environment, such as when you walk into a different room. Use your hand as a guide by sweeping your hand from left to right as you use this technique.”
- Start at the far left, turning your head all the way to the left.
- Slowly scan from left to right.
- Turn back to the left and scan from left to right again.
A short video summarizing the theory and evidence supporting the Lighthouse Technique.
Simple Visual Neglect Tasks
Start with these simpler visual neglect tasks to practice scanning strategies and to increase confidence.
CANCELLATION TASKS. Have your patient cross out specific items in a series of letters, numbers, or symbols.
Worksheets & tasks from The Adult Speech Therapy Starter Pack
Visual Attention Therapy App by Tactus Therapy (Image from the App Store)
CONNECT-THE-DOTS. Have your patient use organized scanning and “take it slow” during this task.
MAZES. Have your patient use finger scanning and “take it slow.”
WORD SEARCH PUZZLES. Have your patient use finger scanning, anchors,
and organized scanning to complete this task.
CARD GAMES. Have your patient use the lighthouse technique to play games such as Solitaire, Go Fish, or War.
“I SPY™” AND “WHERE’S WALDO®” BOOKS. Have your patient use organized scanning, “take it slow,” and the lighthouse technique.
Practical Visual Neglect Tasks
WRITING TASKS. Use the strategies during writing tasks.
Worksheets & tasks from The Adult Speech Therapy Starter Pack
READ MAPS. Find a map (such as a mall directory or hospital map) and have your patient locate different points using finger scanning. Have them trace the most direct route between two points. The patient can also draw a map of their current location (e.g., home, skilled nursing facility).
DESCRIBE VISUAL SCENES. Present photos and have your patient describe them in as much detail as possible.
READ WEEKLY ADS. Have your patient find certain items in the ad using “take it slow”, anchors, and/or finger scanning.
READ MAGAZINES AND BOOKS. Have your patient read aloud while using finger scanning, underlining, and/or organized scanning.
FILL OUT APPLICATIONS AND SURVEYS. Hospitals typically mail surveys after a visit. Have your patient use take it slow, anchors, finger scanning, underlining, and/or organized scanning to complete this task.
WALLS AND DOORWAYS. Place brightly colored tape (masking tape or painter’s tape) on the edges of doorways, walls, and tables.
COMPUTER. Stick bright post-it notes on the affected side of the computer screen.
REARRANGE FURNITURE. Reduce the risk of the patient running into objects or tripping. Create straight walking paths and as much open space as possible in rooms the patient spends time in. Remove unneeded furniture.
CLEAR CLUTTER. Declutter floors and tabletops. If an item hasn’t been used in the past year, get rid of it. Take away at least some knick-knacks that are at
eye-level or table-level—these tend to be especially distracting. Remove auditory distraction as well by limiting background noise.
ORGANIZE. Organize items by placing them in separate bins. Label the bins. Keep items in the same place so that they’re easier to find. For example, you may have separate bins for spices, beauty products, socks, first aid, etc.
USING THEIR AFFECTED SIDE. Encourage caregivers to sit on the affected side. Have objects of interest (window, television, etc.) on their affected side to encourage attention to that side.
USING THEIR “GOOD” SIDE. If the patient is fatigued or for matters of safety (e.g., medications, reviewing important documents, etc.), sit/place items on the patient’s unaffected side.
Don’t forget about Anosognosia
Visual neglect treatment is often complicated by patients’ reduced awareness of their deficit, also known as ‘anosognosia.’
Treat anosognosia using metacognition and other strategies to improve self-awareness. Read Professor Blake’s Medbridge post for anosognosia and visual neglect treatment strategies.
STEPS OF METACOGNITION
- Before the task, ask the patient to predict how they’ll do
- After the task, ask them to assess how they did
- Discuss how their assessment of their performance compares with how they actually did on the task