Neglect after stroke: assess and understand.
How can we recognise neglect after stroke and understand its real-world impact before deciding how to intervene?
In this episode of the BTB Rehab Podcast, we discuss neglect after stroke as a heterogeneous clinical syndrome that may affect spatial attention, body representation and the orientation of action.
Neglect is not simply a matter of “not seeing one side”. It may interfere with self-care, mobility, navigation, safety and participation. We explore why clinical assessment should go beyond a single paper-and-pencil test and include observation of the person during meaningful everyday activities.
Rather than asking which technique is universally effective, we focus on a more clinically relevant question:
How can we identify the person’s neglect profile and link the intervention to the activity that is actually limited?
What you’ll learn
- What neglect after stroke means in clinical practice;
- Why neglect should not be reduced to a visual omission on a paper-based test;
- The difference between egocentric and allocentric neglect;
- What personal, peripersonal and extrapersonal neglect refer to;
- How neglect may affect body awareness, self-care, mobility and navigation;
- Why neglect can coexist with paresis, hemianopia, sensory impairment or lateropulsion;
- Why these conditions should be assessed separately;
- Why formal tests should be combined with functional observation;
- How the Catherine Bergego Scale and other observational measures may support assessment;
- How to define a measurable functional target;
- How visual exploration can be integrated into posture, mobility and task-specific rehabilitation;
- What the evidence suggests about prism adaptation and visuospatial training;
- What remains uncertain about mirror therapy, robotics, virtual reality and other approaches;
- Why improvement on a neglect test does not necessarily mean greater independence or safety;
- Why functional transfer should be assessed separately from change in impairment-level tests;
- How to explain uncertainty when discussing treatment options with the person and their family;
- Why clinical reasoning remains central to selecting and monitoring the most appropriate intervention.
A clinically useful approach combines:
- assessment of the neglect profile;
- observation during meaningful everyday activities;
- identification of a measurable functional target;
- an intervention linked to the activity that is limited;
- separate measurement of impairment and functional transfer;
- regular reassessment and adjustment.
Prism adaptation and visuospatial training may be considered within an individualised rehabilitation programme, particularly for peripersonal neglect, but the available certainty of evidence remains very low and recommendations are conditional.
The most defensible approach is not to apply one universal technique. It is to assess carefully, connect the intervention to the person’s functional goals and determine whether change is visible in self-care, safety, mobility and participation, not only on a paper-and-pencil test.
Assess the profile. Understand the activity. Measure what matters.
Apply this in your clinical practice
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