Navigating Life with Hemi Spatial Neglect

Introduction

How Life Would Be Affected by the Sudden Development of Hemi spatial Neglect

Introduction

My sudden development of hemi spatial neglect three months ago significantly impacted on my life. I suffered from a stroke that subsequently left me with hemi spatial neglect. According to doctor’s reports, the stroke damaged my parietal lobe, the part of the brain that is responsible for higher processing of attention. Whereas stroke is the second leading cause of death globally, the key cause of long-lived disability, as well as loss of healthy and productive life years (Skolarus and Burke, 2015), it also results in nearly 30% of stroke patients experiencing hemi spatial neglect (Bartolomeo, 2014). After this, I had problems identifying people and was accused of ignoring people, sounds and objects to my left. My neglect made me incapable of driving myself around, something I had greatly enjoyed. While in the past I had never even once tried out painting, this soon went on to become my most important outlet. It is worth noting that throughout this entire period, it really never occurred to me that there was something wrong with me, or rather I never noticed that something was amiss. From time to time, I would bump into things on my neglected side, and I was incapable of noticing potential dangers coming from my left side, and as a result of this my family and friends, prohibited me from ever going out by myself. I was assessed by a doctor who tested the severity of my condition and who went on to put me on a rehabilitation program. I have to admit that over time, my condition has been improving, albeit slowly and I am presently at least capable of walking myself around, and doing things on my own. This essay will explore a hypothetical situation of how life would be affected if someone suddenly developed hemi spatial neglect.

Effect of Hemi spatial Neglect on Life

Developing hemi spatial neglect, especially to a severe degree in the near-time, would not only adversely affect an individual’s functional competence, but also significantly decrease their chances of effectively reintegrating into the society and family life (Di Monaco et al., 2014; Oh-Park et al., 2014). One of the main reasons for this is that unilateral neglect has the potential of bearing dramatic consequences even though it is frequently unappreciated. Its effects on functional ability as measured by the Barthel ADL index are increasingly negative, as compared to sex, age, power, side of stroke, balance, cognition, proprioception, and premorbid ADL status (Halligan and Robertson, 2018). According to Gammeri et al. (2020), the presence of the neglect during the first days of one suffering from a stroke, is usually a strong indicator of poor functional recovery after one year, as compared to several other variables, and these include, age, hemianopsia, hemiparesis, visual memory, vasoconstriction ability, and verbal memory. Most probably, vision is one of the reasons why patients who have suffered hemisphere damage have a higher likelihood of fall in comparison to those with brain damage on the left side. The rehabilitation of patients who suffer from neglect requires more time and their daily progress is lower as compared to patients whose functional status is similar (Klinke et al., 2018). In addition, patients with neglect have a lower likelihood to live independently as compared to patients who suffer from right hemiparesis and severe aphasia.

Neglect also affects an individual’s life by resulting in lateral spatial bias. The neglect is characterised by an individual’s inability to process and perceive stimuli on their side of the body that is neglected. Hemi spatial neglect would also impact on how individuals process attention. This would be due to the damage of the parietal lobe on the right (ipsilesional) side of their brain, which is concerned with the processing of attention (Ronchi et al., 2014). The impact of this damage is that it would result in them demonstrating significant lateral spatial prejudice away from the left (contralesional) and toward the ipsilesional side. As a result, they would experience varying extents of suppressed awareness, whereby they ignore sounds, people, touch and objects on their left (Corbetta and Shulmann, 2011). Evidence points to such distortion being greater on the left relative to the ipsilesional side (Nijboer et al., 2013). Therefore, patients suffering from neglect are incapable of adequately constructing adequate perceptual representations of patterns in the left part of their world and there is the possibility that they would misinterpret these representations. This lateral spatial bias toward the right would manifest as the tendency of patients turning their heads and gazing to their right, and failing to notice stimuli (sound, people, touch, object or people) from their left. Additionally, they would be predisposed to the consumption of food on the right side of the plate only and the tendency to veer rightward, whether while walking or moving in a wheelchair (Robertson and Halligan, 1999). According to Danckert and Ferber (2006), even in instances where these people manage to cross the centreline and identify objects to their left, they may not be able to remember what they just observed or explored. The lateral spatial bias could also result in them demonstrating an exaggerated gradient attention/attraction to the right side. As a result, according to Bartolomeo (2014) and Van der Stoep (2013), they might be predisposed to focus more on the object to their furthest right even within their right side of space.

Hemi spatial neglect would not just affect one’s present sensation, but also their recall perceptions and memory. Whereas hemi spatial neglect would most strikingly affect a patient’s vision, it would also impact on their hearing, representation, touch and self-perception. Often times, individuals with hemi spatial neglect are not aware of their condition (Bosma et al., 2020)- as a result, even when someone asks them to look to their neglected side, they might not be able to execute this instruction or suggestion due to the problem with navigating the spaces around them. This is because of their lack of awareness that something is missing, so it becomes impossible for them to seek it out (Ten Brink et al., 2018). As a result, when asked to recall the memory of a particular object and subsequently draw it, they might just draw half of the object. For example, in those scenarios that an individual with neglect is required to draw a clock, their drawings end up only showing the numbers 12 to 6, while the other half is either blank or distorted to some extent. There is also the possibility of neglect patients ignoring their body’s contralesional side by, for instance, leaving half of the food on the plate, applying make up to and shaving only the side that is not neglected. From time to time, neglect patients end up colliding with objects and structures including door frames on the neglected side (Corbetta, 2014). As Kesayan, Gasoyan and Heilman (2018) posit, it is however, not clear whether this happens as a result of perceptive memorial deficit, or whether the brain plainly ignores the information within its memory, despite being whole, just as aspects of physical objects in the patient’s surroundings get ignored.

Developing hemi spatial neglect could also result in the possibility of neglect presenting in a delusional manner, which is characterised by patients denying ownership of limbs or whole sides of the body. Because the delusion comes about by itself, without being accompanied by any other delusions, it is commonly referred to as monothematic delusion (Gurin and Blum, 2017). For instance, the monothematic delusion may result in individuals denying their contralesional extremities or to allege that they can walk on their own while, in fact, they are paralyzed (Pugnaghi et al., 2012). And given that neglect is different from mental disorders or intellectual disabilities, and they would express themselves smoothly and confidently (Danckert, 2014), this exhibition of delusional properties as a result of neglect could cause the people they interact with to regard them as peculiar.

An interaction of the spatial with the nonspatial neglect components would give rise to an intricate situation that impact a patient’s life in various ways (van Kessel et al., 2010). Nonspatial components of neglect signify overall attentional deficits that individuals with neglect encounter while trying to disengage from stimuli or objects on their right once they capture their attention, selective attention shortcomings, and maintaining their attention while performing tasks (Sing-Curry and Husain, 2010; van Kessel et al., 2010). These neglect difficulties are often exacerbated by hemianopia, left-sided paralysis, among other concomitant stroke symptoms. These concomitant symptoms of stroke might also aggravate the comorbidity disorders, including somatoparaphrenia and anosognosia, which arise from an individual’s neglect. Suffering from neglect could cause one to experience anosognosia, which results in everyday life concerns since it could cause them to completely deny their disabilities or even overrate their abilities, thereby posing a risk to their life (Vossel et al., 2012). According to Chen and Toglia (2019), given that neglect patients might not be aware of their condition, anosognia might cause them to, for example, try to ambulate by themselves since, according to them, nothing is wrong, and in some instances deny their contralesional extremities and not move despite having no basic motor disadvantages. On the other hand, somatoparaphrenia which, although is less common, occurs alongside anosognosia, could result in neglect patients’ failure to identify the contralesional extremities they exhibit as their own (Gandola et al., 2012; Invernizi et al., 2013). As a result, during a neurological examination, for example, if one is shown their left hand, they might insist that it is the examiners. This would be due to extinction, which according to de Haan, Karnath and Driver (2012), accompanies neglect and results in the inability to identify left stimuli when stimuli is simultaneously applied to the right side. de Haan, Karnath and Driver (2012) and Vossel et al. (2011) assert that this combination results in the monopolization of a neglect patient’s attention to their ipsilesional side in situations where there exist multiple distractions.

Conclusion

Neglect gives rise to a multitude of conflicting perceptions and difficulties that result in neglect patients encountering challenges that reduce the overall quality of their lives. It is therefore important for neglect patients’ caregivers and healthcare professionals to demonstrate an awareness and understanding of these challenges. Additionally, they should seek their alleviation as well as provide them with facilitation methods that enhance their opportunities to communicate and express themselves. This way, neglect patients will be able to improve their lives.

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