Treating Neglect by Body Movements: A Case Report and Follow-Up Study (P3.043)

OBJECTIVE: To evaluate whether encouraging midline-body movements may increase spatial exploration in people with spatial neglect. BACKGROUND: Visual scanning has only shown mixed results in the rehabilitation of left spatial neglect, a disorder of spatially asymmetric attention and action, accompanied by functional disability. Adding body-centered instructions may improve spatial performance, but cuing right body movements could increase rightward bias. Here, we compared instructions using either midline or non-midline body parts, to enhance left-side spatial exploration in right-brain stroke survivors with spatial neglect. METHODS: A 68-year-old woman with spatial neglect (Behavioral Inattention Test score=28, Catherine Bergego Scale=24) after right basal ganglia infarct made errors identifying left-sided objects (pen, keys, phone). She was prompted using four instructions: “look to the left”, “point with your nose to the left”, “point with your [right] hand to the left”, and “stick out your tongue and point it to the left” (12 trials per instruction). RESULTS: Our patient named left-sided objects in 42% of trials looking left; 50% of trials moving the nose left, 0% of trials moving the hand left, and 100% of trials moving the tongue left. A chi-square test showed performance significantly improved when cuing with midline (nose, tongue), versus non-midline (looking, hand), body parts (X2=9.11, p=0.003). We then tested 10 more consecutive neglect patients using 15 trials per instruction, but only 4 made any errors naming the objects [48% of trials correct with looking, 38% with nose, 32% with hand, 42% with tongue]. DISCUSSION: Our initial neglect patient named left-sided objects better when cued to move midline structures to the left. If midline structures are represented more bilaterally in the brain, they may be less affected by body-centered “aiming” bias. Future research would examine whether cueing with the nose/tongue is selectively helpful for patients with more severe neglect or with “aiming” bias and limb akinesia. STUDY SUPPORTED BY: National Institutes of Health and Kessler Foundation. Disclosure: Dr. Chaudhari has nothing to disclose. Dr. Pigott has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Barrett has received personal compensation for activities with WebMD. Dr. Barrett has received research support from Kessler Foundation, National Institutes of Health, the Wallerstein Foundation for Geriatric Improvement, the Department of Education/NIDRR.