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    When Your Brain Forgets Half the World: Understanding Hemispatial Neglect

    by | May 24, 2025 | Balance, Speech and Language, Stroke | 0 comments

    male with hemispatial neglect, half of the image is dark and black, the other half of the image is bright

    When Your Brain Forgets Half the World

    A practical guide to hemispatial neglect after stroke

    Let’s talk about something that doesn’t get nearly enough attention—literally.

    It’s called hemispatial neglect.
    And if you’re dealing with it, you already know how frustrating, confusing, and isolating it can feel.

    One side of your world just… disappears.

    You’re not blind.
    You’re not “just not paying attention.”
    Your brain is actually ignoring everything on one side.
    For many, it’s the left side (due to a stroke on the right side of the brain).

    You might bump into doorways.
    Forget to eat food on the left half of the plate.
    Or only shave one side of your face.

    Here’s the thing:
    This isn’t laziness. And it’s not stubbornness.
    It’s what happens when your brain loses its internal map—and stops updating one side of space.

    But that map can be redrawn.
    You just have to give the brain the right kind of input.

    Let me show you how.

    First, what is neglect?

    It’s not a vision problem.

    It’s an attention problem.
    Specifically, the brain isn’t prioritizing or processing sensory information from one side.
    So that arm you’re “ignoring”?
    It’s not that you’re choosing to ignore it—
    It’s that your brain isn’t acknowledging it exists.

    So what can you do to help minimize the impact of hemispatial neglect on daily living? 

    Here’s the part that matters:

    General exercise isn’t enough to address the complexity of neglect.
    You have to get the brain’s attention first.

    You need to work the system that’s not working—
    not just hope it comes back online with repetition.

    Neglect responds best to targeted, brain-first strategies.
    And that means exercises need to be done with attention and intention.
    In other words—“3 sets of 10 reps” isn’t going to cut it.

    What follows is a breakdown of tools and techniques I’ve used over the years—
    some backed by research, some by experience (and usually both).

    You don’t need to do them all.
    But the ones you choose?
    You need to do them consistently.

    1. Visual Scanning Training

    This one’s foundational.

    You’re basically retraining the brain to look toward the side it’s forgotten.

    Start simple:

    • Line cancellation tasks

       

    • Crossing out letters or numbers across a full page
    • Reading sentences that start with a bold line on the left
    • Placing a red sticker on the far-left side of the tray or paper as a visual “anchor”

    Don’t rush it.
    It’s not about speed—it’s about intentional attention.

    The goal is to help the eyes start leading the brain back into neglected space.

    2. Limb Activation Therapy (LAT)

    Sometimes the brain doesn’t just forget about space—
    it forgets about the limb in that space.

    LAT is all about waking up that arm or leg through movement and repetition.

    A few ideas:

    • Have them reach with the neglected arm into the neglected field

       

    • Use both arms to pull a towel or stretch band
    • Raise and lower the affected shoulder while watching it move
    • Even just tapping or rubbing the arm to stimulate awareness can help

    This is often subtle—but powerful.
     It’s less about reps and more about reconnection.

    3. Mirror Therapy

    This one feels weird at first—but it works.

    You hide the affected limb behind a mirror and move the unaffected side while watching its reflection.

    To the brain, it looks like the neglected limb is moving—and that illusion can help rebuild the internal map.

    Start with:

    • Finger taps

       

    • Wrist extension
    • Reaching motions

    Just 10–15 minutes a day can make a difference if done with focus.

    4. Sensory Cueing & Stim

    Sometimes the best way to get the brain’s attention… is to wake it up with sensation.

    Options:

    • Gentle brushing on the neglected arm

       

    • Vibration (using a small handheld massager)
    • Cold (ice packs, chilled towels)
    • Even sound cues from the neglected side (calling their name from the left)

    This works best when paired with other tasks—like scanning or movement.

    It’s about layering input.
    Let the senses work together to restore awareness.

    5. Functional Tasks That Force Attention

    You can (and should) integrate this into daily life.

    Ideas:

    • Start all self-care tasks from the neglected side

       

    • Set up the eating tray so the fork or spoon is on the left
    • Have family and therapists sit or stand on the neglected side during conversation
    • Play games or puzzles that require leftward movement

    The more you make the left side necessary, the more your brain has to acknowledge it.

    6. Prism Adaptation Therapy

    Wearing prism glasses that shift the visual field, encouraging patients to adjust their movements and attention toward the neglected side.Wikipedia

    Prism adaptation has been shown to improve neglect symptoms in patients with unilateral spatial neglect after stroke

    Final Thought

    Neglect can be one of the most misunderstood challenges after stroke.

    It’s not obvious.
    It’s not physical.
    And it doesn’t always improve without specific intervention.

    But with consistent, focused work—
    the brain can come back to that side.

     

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