Unilateral neglect : aspects of rehabilitation from an occupational therapy perspective

Sammanfattning: Unilateral neglect (UN) refers to an inability to orient the attention to stimuli in the contralesional hemispace. This may severely impair the performance of everyday tasks. UN is most common and severe after right brain damage. The general aim of this dissertation was to explore some aspects of importance for the rehabilitation of patients with UN and to develop and evaluate strategies for assessment and intervention. In study I, we developed a new type of neglect assessment, the Baking Tray Task (BTT), presented normative data and compared the BTT with standard neglect tests in a consecutive series of 52 brain-damaged patients. BTT seems to be a sensitive method for identifying extrapersonal neglect. The study also verified the importance of using several different types of tasks in the assessment of UN. Study II evaluated a training strategy based on the assumption that patients with persistent UN also have impaired sustained attention, which interferes with their ability to learn and to use strategies to compensate for their UN. In this experimental case study, all the eight patients improved in both sustained attention and UN. The aim of study III was to explore the motivation for training in four patients with UN. A qualitative approach was used. The findings suggest that motivation is a complex phenomenon, which is closely related to awareness of disabilities. In study IV, we examined if video feedback is a useful tool to give patients feedback on their neglect behaviour during task performance. Video technique allows the patients to see the left side of the task on the right side of the TV monitor. Video feedback seems to be a useful method for helping patients to become more aware of their disabilities related to UN. In study V, an attempt was made to train awareness of disabilities in everyday tasks. The assumption was that many patients with UN are unaware of their disabilities, which interferes with their engagement in learning compensatory strategies in everyday tasks. We found that training seems to improve not only awareness of disabilities, but also UN and ADL ability. In the phenomenological study VI, four patients with UN described how they experienced and discovered their disabilities and how they learned to handle them in everyday life. The study describes the features of a discovery process. Patients needed to experience their disabilities in the context of everyday life to become more aware of them and to learn how to use compensatory strategies.