Neglect and Constructions

Neglect and Constructions

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Hemineglect is an abnormality in attention to one side of the universe that is not due to a primary sensory or motor disturbance. In sensory neglect, patients ignore visual, somatosensory, or auditory stimuli on the affected side, despite intact primary sensation (see Neuroanatomy Through Clinical Cases 3e, Chapter 19). This can often be demonstrated by testing for extinction on double simultaneous stimulation. Thus, patients may detect a stimulus when the affected side is tested alone, but when stimuli are presented simultaneously on both sides, only the stimulus on the unaffected side may be detected. In motor neglect, normal strength may be present; however, the patient often does not move the affected limb unless attention is strongly directed toward it. Sensory and motor neglect are usually tested as part of the visual, auditory, somatosensory, and motor exams (which are described in Neuroanatomy Through Clinical Cases 3e, Chapter 3). During the reading and writing portions of the language exam, patients may be noted to neglect one side of the page.

Patients with suspected neglect should be asked, "Is anything wrong with you right now?" because patients with anosognosia may be strikingly unaware of severe deficits on the affected side of their body. For example, some patients with acute stroke who are completely paralyzed on the left side believe there is nothing wrong and may even be perplexed about why they are in the hospital. Some patients do not even comprehend that affected limbs belong to them. In addition, certain drawing tasks, such as asking the patient to bisect a line or draw a clock face, can demonstrate neglect. Construction tasks that involve drawing complex figures or manipulating blocks or other objects in space may be abnormal as a result of neglect or other visuospatial impairments. However, constructional abilities can also be abnormal because of other cognitive difficulties, such as impaired sequencing (see the next page, Sequencing Tasks and Frontal Release Signs) or apraxia.

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