Tuesday, October 29, 2013

Tasks Ideas for Visual attention, Left Neglect/Inattention

Portions of Janelle Barrett's student project continued...

Visual Inattention or Visual Neglect are such a bizarre phenomenon.  I remember when I was a beginner clinician and saw my first patient with left neglect.  It was hard to wrap my head around the fact that it's not a VISUAL problem.  The patient absolutely could not see things on the left, only because they were "not looking."  Totally blew my mind as I watched the patient struggle to find my eyes, bang into the wall on the left, and eat only the food on the right side of his plate.  The patient was just as baffled as I was (I mean, I had learned about this in school, but seeing it in real life was so wacky!)  Of course, left neglect is most common, but despite those non-believers, I HAVE seen true right-sided inattention or neglect as well!

People seem to make relatively quick progress in this area if they work really hard on it.

There has been some argument about whether or not the word "neglect" is truly correct, versus inattention, etc.  Call it what you want- but how do you attack it.  Here are some ideas from a few SLPs and SLP students.  The high- and low-level are all mixed together.  What about your ideas?  Leave me a comment!

Image courtesy of: cognitiveneuro.wordpress.com

  • Of course I always sit to the patient's neglected side, and try to ask them to look at me all throughout the session.  
    • I also ask staff and family to always sit to the neglected side
    • I have their TV put on the left, or shift the bed around if needed so that they are looking to the left
    • A couple of my patients have loved looking out their window or out into the hallway, so I have had the bed switched around so those things are on the left. 
    • I will literally hold the patient's head to the left in severe cases (where they cannot sustain a left sided turn of the head and they instantly "sprinkler" back to the right or non-nelgected side).
  • I put all therapy tasks on the neglected side (if the patient can do it)
  • Cancellation and cross out tasks 
    • For really severe cases this can be as simple as having two pictures on a page and having the patient find the one on the left
    • Letter cancellation tasks (large or small print, full or part-page)
    • Symbol cancellation can be even tougher.
      • I think it's important to make sure the patient goes line by line, left to right. No jumping around.  That will not help them with reading in the future.
  • Reading tasks
    • Newspapers, magazine articles, large print if needed
    • Can use colored line on side of neglect or inattention if needed
    • Can use colored index card to follow lines of writing
    • I usually have them follow along with their finger
    • Can also number the lines if needed 
    • My co-worker has patient follow along as she reads
  • Writing tasks
  • Keyboarding/typing tasks
  • Web navigation
    • Google searches
    • Email
    • Reading and typing
  • Apps: 
    • Dr. Ben
    • Doodle Pro
    • Little Things
    • Reading and typing tasks on iPad
  • Games: 
    • Memory or concentration 
  • Cooking tasks: keep necessary items on side of neglect
  • Visual search tasks 
    • Find all the similar symbols
    • Where's Waldo
    • I Spy 
    • Fruit Ninja
      • "Oops, you missed that bomb. It must have been on the left side!"
  • Going for a walk or an outing 
    • I'll have them look for things on the neglected side
      • Post-its or pictures on the wall
      • Hidden clues 
      • Ask about details in the pictures on the wall, etc.
    • Sometimes we place obstacles on the neglected side
  • Having the patient read and follow a map
  • We have really liked some of the tasks and worksheets in the book Focus on Function (among many other great cog books) and have used everything from check writing, to maps, to filling out forms, to reading a TV guide from this book.  
  • Hide things in the drawers of the room (on the left side of the drawer (e.g., Where's your chap-stick?).
  • Some of the Lumosity games are great (we have a staff log-in we can all use which has worked well.
  • Tic-tac-toe
  • Mazes
  • There is a task we like that is hard to describe- it has a poem at the top, and then the poem below with many similar and extraneous words throughout.  We have the patient circle the correct words as they read along.  In the end you have the poem in order once again.
  • Kitchen tasks 
    • Have the patient find the ingredients or utensils they will need
    • Have them search for safety problems (my OT co-worker sets up an awesome room full of hazards, including cords ready to trip someone, running water, a burner left on, a knife placed precariously, etc.) 
 Happy Left-Scanning!



  1. Thanks for all the great ideas! I've used many of these before with success. There's even a program called "Look to the Left" which can be helpful. However, now I have a patient that has only a split second attention and no use of either arm. Trying to get the pt to look at my eyes and/or a picture to identify or describe it is almost impossible. I feel like I'm a broken record. Any other ideas?

  2. Oh yes I have that Look to the Left book somewhere-- never use it! I think the OTs here use it a lot more. I should check it out again.
    As for your pt with severe L neglect, I think it's ok to be a broken record, and be on their case about it constantly. Sometimes I physically pull their head to the left and hold it in place. Left neglect seems to me to be the areas that improves faster than any other cog skill when worked on aggressively so hopefully they will soon be able to maintain midline and L side gaze for at least a few seconds