Neglect and Inattention

Unilateral neglect signs

ignores one side (usually left after right hemisphere stroke), eats from half the plate, shaves half the face, bumps objects on one side, reads half a line, and often lacks awareness.

unilateral neglect ot role

screen and evaluate (line bisection, cancellation tasks, BIT, Catherine Bergego Scale), assess function and safety, educate the team and caregivers, and set up the environment.

unilateral neglect best intervention

combine top-down (scanning training, verbal cues, awareness training) and bottom-up (anchoring, bright cues, limb activation, placing items on the neglected side) approaches, and fade cues as the client improves.

Personal neglect signs

ignores one side of the body (does not dress, wash, or groom it).

OT intervention for personal neglect

self-grooming with a mirror and verbal cues, tactile cues to the affected side, and a structured routine that includes the neglected side.

Anosognosia (lack of awareness) signs

denies or minimizes deficits, says “I’m fine.”

Anosognosia (lack of awareness) intervention

OT role: use performance-based assessment instead of relying on self-report, and compare client rating vs. therapist rating (Catherine Bergego Scale).

Best intervention: awareness training with video feedback, graded feedback during tasks, errorless approach to reduce frustration, caregiver education, and supervision for safety.

Anchoring

Place a bright, vertical, or tactile marker on the neglected side of a page or workspace so the client has a visual landmark to scan to. Used for reading, writing, and tabletop tasks.

Environmental adaptation for neglect

Place important items on the neglected side to draw attention (if safe), approach the client from the neglected side during therapy, declutter, and use cues and labels. For severe neglect, ensure safety first (protect the neglected limb and supervise).

Neglect: safety priorities

Protect the neglected limb during transfers and positioning, supervise mobility, clear paths, and educate on stove, driving, and hazard awareness.

Neglect and driving

OT role: recommend no driving until evaluated and refer to a driver rehabilitation specialist

Cueing hierarchy for neglect

Start with verbal cues (“look to your left”), add visual or tactile cues if needed, and fade cues as the client improves.