Neglect

Neglect is a neurological attention disorder in which the affected person neglects one half of the room or one half of the body and / or object halves. It is an egocentric or allocentric disorder.

What is a neglect?

The patient only shaves or washes one half of the body. He does not react if he is spoken to by the injured party because he cannot hear or see anything.
© Reing - stock.adobe.com

A Neglect often occurs after hemorrhage of the arteria cerebri media (brain artery) and right-hemispheric cerebral infarction. This neurological disorder is due to a lesion in the parietal lobe of the cortex (cerebral cortex). Diagnosis is often difficult because the symptoms are varied. Neglect can affect all sensory modalities, although in most cases the patients are not aware of their deficits and classify their behavioral problems as normal. There is therefore no insight into the disease (anosognosia).

causes

A neglect occurs with damage to certain brain regions, the parietal lobe or the parietal lobe. This area of ​​the brain is responsible for controlling attention. Possible damage is brain tumors, strokes, cerebral haemorrhages, head trauma, meningitis, encephalitis, multiple sclerosis, muscle diseases as well as diseases of the peripheral nervous system and neurodegenerative diseases.

Most people with neglect syndrome have a right-sided stroke that damages the right hemisphere. You neglect the opposite, left half of your body or space. Left hemispheric cerebral infarction is less pronounced and less common.

Symptoms, ailments & signs

The patient only shaves or washes one half of the body. He does not react if he is spoken to by the injured party because he cannot hear or see anything. He bumps into or runs into obstacles that are on the neglected side. When eating, he only takes into account the food on one side of the plate, the other is ignored. If he is to draw a picture, only the parts of the perceived side are included. Those affected behave so strangely to outsiders because they often fail to notice their deficits.

For them, their behavior is normal, they lack insight into their illness and they react all the more violently when their social environment draws their attention to their abnormal behavior. You seem stubborn, defiant, ignorant, indifferent, unfriendly and stubborn. Clinical neuropsychology aims to reduce or eliminate these deficits with various therapeutic approaches. However, the prerequisite for a successful treatment is the patient's ability to understand. As long as this does not occur, the people affected are only very slightly motivated to undergo therapy and dealing with them remains difficult.

• The visual attention disorder occurs most frequently. Patients do not perceive objects, people and rooms on the neglected side or do so late. Your sense of direction is mostly concentrated on the non-neglected half.

• With the auditory neglect hearing is impaired and noises, conversations, music and speech are not or only partially perceived. If the persons concerned are addressed on the neglected side, they do not react or they react with a delay.

• With the personal neglect The patient fades out one half of the body and does not perceive incoming stimuli such as touch, pressure pain, injury pain or temperature stimuli. Alternatively, they assign these stimuli to the half of the body that has not been neglected.

• With the olfactory neglect smells are not perceived.

• Of the motor neglect leads to a reduced use of the extremities (hemiakinesis).

• Of the representational neglect leads to neglect of stimuli in visual perception. The patients perceive objects, rooms, people and obstacles only on the not neglected side and leave the affected side out of the picture description.

Diagnosis & course of disease

It is an acquired perception disorder as a result of a stroke or other forms of brain damage. The disruption process is basically reversed, as only the side opposite to the brain damage is neglected. If there is a right hemispheric brain disorder, stimuli from the left side of the room or body are not perceived and vice versa.

The terms hemineglect, half-sided attention disorder and half-sided neglect are also used. A Neclect can affect several sensory channels at the same time and cause visual, acoustic, sensory or motor disorders. With these complaints, only one side works while the other side is completely blanked out. Diagnosis is primarily based on behavioral abnormalities, imaging procedures, tissue removal and muscle biopsies.

Even simple tests quickly confirm the initial suspicion. The neurologists carry out search and cross-out tests, reading, writing and arithmetic tests as well as drawing exercises (visual exploration training) with the patients. In the therapy, everyday situations are trained taking the neglected side into account. With optokinetic simulation therapy, patients must follow symbols that move towards the neglected side.

Complications

A neglect is already a complication that often develops after a stroke. With existing neglect, however, further complications only arise from the typical behavior of those affected. Intensive therapy would be necessary to prevent this. The patient is not even aware of the disorder.

Therefore, he does not initially suffer from the direct effects of this condition and often does not allow therapy. Various complications can arise on this basis. Since the patient ignores all objects that are imaged due to the damaged hemisphere, it can lead to accidents and injuries when colliding with these objects.

Without nursing support, the person affected is often no longer able to feed themselves adequately or to carry out the simplest personal hygiene activities. In severe cases this can lead to malnutrition and social isolation with a tendency to neglect without help.

However, in about 65 percent of all cases, the neglect disappears within 15 months without any particular complications occurring despite the lack of therapy. In about 35 percent of those affected, however, clear symptoms remain, which are then only accessible to symptomatic therapy. However, the prerequisite for therapy is insight into the disease. A complete healing is then no longer possible.

When should you go to the doctor?

Behavioral problems or an appearance that is socially perceived as above the norm should be discussed with a doctor. If the person concerned has a special attitude towards his own body, he usually needs help and support. Attention disorder, body schema disorder, and obsessive-compulsive behavior should be discussed with a doctor.

Since neglect sufferers lack insight into the disease, it is very unlikely that there is a need for a doctor to clarify the symptoms. Often there is therefore no visit to the doctor for their own reasons. Therefore, close relatives, confidants and friends are subject to an increased duty of care. If they notice irregularities, they should gain the trust of the person concerned and discuss how to proceed with a doctor. In order that you do not fail with your project, sufficient information about the clinical picture is necessary beforehand. A visit to a doctor is advisable for comprehensive information.

If the person concerned washes or pays attention to one half of the body noticeably more than the other, this is a sign of a discrepancy. If the people present register peculiarities of a shift in perception in different situations in everyday life, a conversation with the person concerned should be sought. Failure to detect smells, sounds or stimuli is cause for concern.

Therapy & Treatment

Relatives can take a few steps to make their everyday lives easier. Glasses, cups and plates are placed on the table at a slight angle to the neglected side. All activities are brought to the person concerned via the restricted side in order to train awareness of this side. The bed is set up so that the patient lies with the healthy side facing the wall. A conscious and patient approach is essential, as the ability to pay attention and concentrate is limited.

Everyday situations, conversations and visits are exhausting. Repeated breaks are therefore indicated. Excessive criticism and impatience are counterproductive and reinforce the blocking attitude. A small device the size of a cigarette packet acts as a signal transmitter. A signal sounds at regular intervals and the person concerned must switch off the device with the neglected side.

A vibrator can stimulate the muscles and increase sensitivity. Various exercises train eye and head movements. Informational stimuli facilitate perception, for example colored markings on objects, light signals or acoustic stimuli. If there is insight into the disease, the person affected can motivate himself through the self-function technique to consciously perceive his neglected side.

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Outlook & forecast

If a stroke is the cause of neglect, patients must seek emergency medical assistance immediately. If the neglect occurs alone, those affected often have no awareness of the disease without treatment. This is shown by the fact that patients do not perceive or disregard the side of the environment and the body opposite the brain lesion.

The prognosis deteriorates because the following senses remain impaired: visual, auditory, tactile and olfactory. The result is a reduced attention to the stimuli of the outside world. Social participation is made more difficult because interlocutors are not looked at properly or not even sought out. Due to the reduced perception of motor skills, movements of the extremities take place less, which leads to a reduction in muscles and general skills. Patients have difficulty reading, grooming themselves, eating and exercising - all areas of everyday life that represent a massive cut in their independence.

The prospect of improvement increases with neuropsychological therapy, as it helps to develop awareness of the disease. Even with treatment, the prospect remains that patients will continue to need help in their everyday lives. This applies above all to the topic of mobility and requires increased attention from the environment.

prevention

There is no prevention in the clinical sense, since strokes, cerebral hemorrhages, brain tumors and other neurological disorders occur unexpectedly and can affect everyone regardless of age and living conditions. Only a healthy lifestyle can prevent this.

Aftercare

A neglect usually goes away on its own within a few months without treatment. Follow-up examinations are therefore not absolutely necessary. In many cases they are still advisable, as the healing can be supported by various medical measures. It is advisable to visit a neurologist or at least your family doctor regularly.

This is especially necessary if the neglect was triggered by a stroke. In addition, there are a variety of optional follow-up measures that can accelerate healing. Vibration therapy for the neck muscles, optokinetic stimulation or visual exploration training are often used for neglect.

In addition, the effects of neglect can be improved by wearing so-called prism glasses. However, the specific therapeutic measures for aftercare depend on the type and severity of the disease. There are also a number of measures that those affected can integrate into their everyday lives.

For example, it is advisable to consciously include the neglected side in activities such as eating, drinking, combing and getting dressed. In addition, head and eye movements can be specifically trained. In addition, people with a neglect need to be particularly careful in traffic for a few months. First of all, you should refrain from driving. You should also be careful as a pedestrian. Ideally, patients should be accompanied by relatives.

You can do that yourself

In order to gradually reduce the neglect, it is important to become more aware of the neglected half of the body or side of the room. If possible, it helps to position the bed so that the affected side is facing the room. As a result, more stimuli come from the neglected side. Since the neglect is naturally not noticed by the patient himself, he must always be made aware of it by his environment. Over time he learns that he has to look for objects and sources of noise on both sides. If one side of the body is not or insufficiently perceived, it can help to pay specific attention to this side. Here, the affected arm and leg are firmly creamed or massaged towards the heart with a massage brush.

The neglected side should be integrated into everyday activities as often as possible so that it is registered in the brain as an associated area of ​​the body. When eating, both hands should always be on the table, even if only the healthy hand is doing something. The affected person should hold his impaired arm against the body even with the healthy one.This actively protects him from being trapped or twisted when he is being transferred or lying down.