The Lighthouse Strategy for Visual Neglect

Visual neglect is a disabling condition where a patient no longer pays attention to one side (left or right) of their visual field.

Thankfully, research shows that visuomotor “imagery training” can help (Smania et al., 1997; Cicerone et al. 2022).

In this post, you’ll learn how to do a well-known imagery training strategy: The Lighthouse Strategy.

What Causes Neglect & How To Treat It

Neglect occurs in at least 50% of people with right hemisphere brain damage after a stroke (Chen & Hreha, 2015). It can also be caused by traumatic brain injury, anoxic brain injury, brain tumor, or brain surgery. 

With this disorder, the patient doesn’t pay attention to visual information on the opposite side of the brain injury. And while it can happen in the left or right visual field, left neglect is more common.

Although many patients spontaneously recover from visual neglect, it can negatively impact daily safety, independence, quality of life, and even overall recovery (Moore et al., 2021).

One of the best-regarded treatments for visual inattention is visual imagery training. The Lighthouse Strategy is an evidence-based way to use it your patients.

For visual neglect worksheets and handouts, see the Visual Neglect Pack.

What Is The Lighthouse Strategy?

The Lighthouse Strategy (LHS) was created by rehabilitation psychologist Janet Niemeier. It uses visual visual imagery to help patients with visual neglect pay attention to their affected side. 

Patients learn to scan a target space by turning their heads from side to side, imagining that their eyes are the lights of a lighthouse.

Research shows that visual imagery is a quick and effective way to improve visual inattention after a brain injury (Niemeier, 1998).

Specific to stroke, patients who used the visual image of a “lighthouse” during functional tasks performed better on a visual cancellation test.

How To Do The Lighthouse Strategy (LHS)

Here’s how to teach the Lighthouse Strategy to your patients:

1. Lighthouse Image. Place an image of a lighthouse on a table in front of your patient.
2. Introduce The Lighthouse Strategy. Ask your patient to imagine that they’re a lighthouse. Their eyes and head are the light that scans the entire horizon, all the way to the left and all the way to the right, to guide ships to safety. You can go further with the analogy by discussing what would happen to ships if a lighthouse skipped one side of the horizon. 
3. Practice The Lighthouse Strategy. If your patient has left neglect, teach them to start at the far left, turning their head all the way to the left. Ask them to slowly scan the room from left to right. If it helps, have them use their outstretched hand as an anchor to find the far left. Turn back to the left and scan from left to right again. 
4. Simple Tabletop Practice. Place several objects on the table, on both the left and right sides. One-by-one, name objects for your patient to find. Cue as needed to use the LHS.
5. Simple Environmental Scanning Practice. Review the Lighthouse Strategy again. Have your patient locate objects in the environment on their left and right sides. Cue to use the LHS as needed.
6. Multi-Step Tabletop Practice. Once your patient can successfully use the LHS to scan the tabletop and the environment, add on multi-step tabletop tasks. This may be visual neglect worksheets, reading, tabletop grooming, computer work, etc. Cue to use the LHS as needed.
7. Navigation Tasks. When ready, move on to navigation tasks like cooking and other ADLs, following a map, navigating the environment, etc. 

Lighthouse Strategy Video by Peggy Blake

Watch Dr. Peggy Blake discuss The Lighthouse Technique and the evidence behind it.

More Visual Neglect Resources

References

• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Chen, P. & Hreha, K. (2015). Kessler Foundation Neglect Assessment Process: KF-NAP™ 2015 Manual. Kessler Foundation. https://kesslerfoundation.org/sites/default/files/files/KF-NAP_2015_Manual.pdf
• Cicerone, K. D., Dams-O’Connor, K., Eberle, R., Fraas, M., Ganci, K., Langenbahn, D., Shapiro-Rosenbaum, A., Tate, R. L., Trexler, L. E., & American Congress Of Rehabilitation Medicine. (2022). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition: Translating evidence-based recommendations into practice.
• Moore, M. J., Vancleef, K., Riddoch, M. J., Gillebert, C. R., & Demeyere, N. (2021). Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke. Neurorehabilitation and Neural Repair, 35(9), 823-835. https://doi.org/10.1177/15459683211032977
• Niemeier, J. P., Cifu, D. X., & Kishore, R. (2001). The lighthouse strategy: Improving the functional status of patients with unilateral neglect after stroke and brain injury using a visual imagery intervention. Topics in stroke rehabilitation, 8(2), 10–18. https://doi.org/10.1310/7UKK-HJ0F-GDWF-HHM8
• Niemeier J. P. (1998). The Lighthouse Strategy: use of a visual imagery technique to treat visual inattention in stroke patients. Brain injury, 12(5), 399–406. https://doi.org/10.1080/026990598122511
• Smania N, Bazoli F, Pivia D, Guidetti G. Visuomotor imagery and rehabilitation of neglect. Arch Phys Med Rehabil. 1997;78(4):430–436.