Reintegrating space and object representations in patients with hemispatial neglect: two case studies.

Abstract

This article examines the effectiveness of differentiated rehabilitation programmes for patients with two distinct types of hemispatial neglect: body-centred and object-focused. We hypothesized that patients with body-centred neglect would respond to motor-control programmes designed for patients with limb apraxia, while those with object-focused neglect would require visually oriented therapy. The article describes the rehabilitation of two patients treated by the authors 6-9 months after right-hemisphere infarct. Both showed significant left-sided hemispatial neglect: body-centred in one case (patient BC), object-focused in the other (patient OF). A modified AB-BA experimental design was used, where A represents visual training, and B is spatio-motor training. For patient BC, the sequence was A-B; for patient OF, B-A. Neglect was measured using standard tests for neglect and the analysis of drawings made during therapy by both patients. As hypothesized, patient BC showed no progress after conclusion of programme A, while after programme B she showed virtually no lingering neglect. In the case of patient OF, the results were exactly reversed. Body-centred neglect is essentially a defect in space formation, while object-focused neglect is a disorder of object formation. The patients described here both benefited from neuropsychological therapy for neglect, but not from the same programme.