Patients with cognitive impairment have unilateral neglect. What should their family members pay attention to?

Author: Liu Chunyan, deputy chief physician of Aviation General Hospital

Reviewer: Xing Yan, Chief Physician of Aviation General Hospital

Unilateral neglect is a common problem in patients with cognitive impairment. Do you know about unilateral neglect?

①The specific concept of unilateral neglect:

Unilateral neglect is a lesion that occurs in one cerebral hemisphere, especially the right hemisphere, which leads to a state of blindness to the body or space on the opposite side of the damaged cerebral hemisphere. It is different from visual field loss.

For example, if you stand on my left side, I will have unilateral neglect, and I will not see you. When you talk to me, I will still look somewhere else and not look at you at all.

When unilateral neglect is more serious, we can easily find it. However, when some patients have right brain damage and their limbs are fine, it is often ignored and not discovered. And when we do some paper-and-pencil tests, we may not find it, but in some more advanced activities, the danger is reflected.

One is driving. When he is not driving, he will feel that the things beside him are lagging behind, and that one side is invisible and ignored. When driving, if you ignore the road conditions on one side, it will be very dangerous.

Another is the door frame. When going out, the patient can see the door frame on the right but not the left, so he will walk to the left because he wants to avoid hitting the right side. As a result, he hits the left door frame and may hit his head or one side of the body. This is quite common in clinical practice.

Figure 1 Original copyright image, no permission to reprint

Another thing is when crossing the road, one has to look left and right, this way and that way. At this time, if he doesn't look to the left and there is a car coming, it can be very dangerous.

For example, going up and down stairs is also very dangerous if there is no handrail on the left.

②The impact of unilateral neglect on patients’ daily life:

The clinical incidence of unilateral neglect is very high and will also affect the patient's daily life.

For example, a patient with severe unilateral neglect can only see one side when reading a newspaper, so he certainly cannot understand it, so he will have problems with reading.

Another thing is that he is also in a state of blindness to space, and he also shows some special characteristics towards his body. For example, when men shave, they often only shave one side and not the other.

When we put on clothes, if it is a pullover, we usually tidy it up after putting it on. But patients with left-sided neglect will not tidy up the clothes on the left side.

When the condition is more serious, the patient will not be able to recognize the left side of his body. If you ask him what this leg is, he will say he doesn’t know and it’s not his.

Figure 2 Original copyright image, no permission to reprint

So if the family of a patient with brain damage feels that the patient is not paying enough attention to the left side or the right side, I would suggest that he go to the hospital for a check-up to see if he has a problem of unilateral neglect.

③ Patients with cognitive impairment have unilateral neglect, and family members should pay attention to the following:

First, when eating, he usually leaves some food on one side, for example, only the left side is left and the right side is eaten up. You would think he is full, but in fact he is blind to it. If he eats with a bowl, it may not be so obvious, but when he eats with a plate, it will be very obvious. So at this time, we will make a very bright stimulus on the side of the plate or on this side of the table to let the patient know and constantly remind him that there is food on the other side. In fact, this is also a kind of training in life.

Second, when walking, the patient's view of the world actually changes. When he looks at people, he may think that his body is not straight, so his trunk and body will be crooked. At this time, you need to straighten his trunk. When walking, make a clear mark on the ground, such as a red or blue line with a very bright color, to remind him to walk in the middle and not to lean to one side.

Third, when reading, you can put a ruler on the side as a reminder. This is a stimulus and a reminder. The color should be bright. In addition, when doing reading training for him, according to the patient's condition, you can mark each paragraph with numbers, 1, 2, 3, 4, 5, 6. Let the patient point with his finger. After reading the first line, he must find 2 and then 3. Of course, there are many other reminders in the middle. According to the patient's condition, these reminders can be slowly removed one by one. It is important to carry out training step by step.

Another thing is that stroke patients often have some limb hemiplegia, such as left hemiplegia. During rehabilitation training, they usually need to complete the task of moving objects from the left side to the right side. During this process, the patient's eyes should follow the movements of his hands.

For example, if we want to take something, because of hemiplegia, he often holds the object with both hands. If we want to take something here, should we take it here or there? We need to design it during treatment. The principle is to proceed step by step, starting from the midline and then gradually moving to the normal distance. This position must be mastered.

Of course, it should be emphasized that in addition to this, there are many professional training methods for unilateral neglect, and all of them need to be carried out under the guidance of a doctor.