Left Neglect vs. Field Cut

It is possible for multiple distinct symptoms of an acquired brain injury to present in remarkably similar fashions.  For instance, a brain-injured survivor’s failure to take medication could be due to a memory deficit leading that survivor to simply forget his or her medication or it could be due to an attention deficit leading the survivor to be too distracted to take the medication in question.  In each case the medication was missed, but for acutely separate reasons.  A similar issue comes to light in observation of post-injury visual deficits.  Did a survivor fail to notice information to his or her left due to left neglect or due to a field cut?

Let’s start off with outlining precisely what a field cut is, as it is the simpler of the two to understand.  Under the effects of a field cut, the survivor has actually permanently lost the ability to perceive a portion of the field of vision.  That area of the field formerly available has now been “cut” away.  Due to his or her injury, the survivor is now in effect partially blind.  In medical terms, this loss of vision is often called “hemianopsia.”  So a survivor contending with a field cut has had actual visual loss  in his or her left visual field and thereby misses seeing information on his or her left side.

Left neglect is an attention issue which often manifests in the visual attention domain.  It is associated with an injury to the right side of the brain.  With left neglect, the brain fails to pay attention to information to the left side of the survivor.  If you ask a survivor with left neglect to turn his or her head all the way to the right, he or she will generally turn until the chin reaches the right shoulder.  However if you ask the same survivor to turn to the left, he or she may only bring the chin half-way to the the left shoulder despite fully understanding the request and giving a best effort to fulfill it.  It is almost as if the survivor’s brain is saying, “the left side of the world does not exist.”  The survivor’s eyesight can be perfectly intact, yet his or her brain is ignoring information generated from the left side.  This ignoring is not voluntary; as far as the survivor is consciously aware, he or she did look all the way to the left even though an outside observer can clearly see that the survivor did not make it all the way over.  Again, though it appears functionally as if the survivor has lost vision, the underlying issue is one of attention.

In the case of a field cut, most survivors do reasonably well after becoming sufficiently aware of their field cuts.  They will after enough practice naturally turn and make that extra effort to look for the information in their blind spots.  For a survivor with left neglect, improvement requires not just awareness but also daily repetition of scanning exercises and consistent use of visual aids.  As example, a survivor with left neglect may practice scanning techniques by slowly looking for information on a piece of paper being sure to start all the way on the left of that page before scanning across.  It can also be helpful to put a brightly colored highlighter mark on the paper to identify the far left of the page.  Sadly, in some cases a survivor will suffer from both left neglect and a field cut.  This combination can of course make successful functioning especially difficult, but with appropriate dedication and determined effort most any such goal gains entrance into the realm of the attainable.

I hope this clarifies the differences between left neglect and a field cut.  Please leave me a comment below with any questions, thoughts or ideas!

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: tlcrehab.org

Advertisements

21 responses to “Left Neglect vs. Field Cut

  1. Hannah Crockett-Naini

    Hi, I was just wondering what would happen if therapist told patients that they had left neglect? Wouldn’t they then understand that they always have to look to the left? Hence no need for therapy?!
    Or why can’t they understand that they have left neglect?

    • Excellent question! The therapists and staff tell the patients that they have left neglect multiple times per day, as left neglect causes problems throughout the day for the patients such as bumping into door frames while trying to exit a room. And, after some time the patients can generally state that they have left neglect. However, intellectual understanding is not enough for effective management of this problem.
      Essentially, the brain is saying “you have already looked all the way to the left and seen everything”. The patient must constantly over-rule this new “natural” tendency, which is particularly difficult to do when actually engaging in a task. For instance, a patient with left neglect in a wheelchair must remind themselves every step that he or she must look farther to the left than his or her brain is indicating it is necessary to do while at the same time that he or she is generally trying to operate the wheelchair safely. To be able to do this “online” correction during a task takes tremendous practice and repetition. This must be drilled so that the extra scanning (and consequently, over-ruling what their brain says is necessary) becomes a new habit.
      Hope this helps! Let me know if you have further questions!

  2. Hannah Crockett-Naini

    Thank you!!! That makes a lot more sense. One last question 🙂
    How would you answer:
    How does left neglect presents itself? As in what symptoms lead you to believe to think that it is a visual deficit?

    • Another great question! Ultimately, left neglect is an attention issue which mostly commonly manifests in the visual attention domain and is not a true visual deficits. Some of the more common presentations are:
      1. The patient only eats food on the right side of the plate because he/she does not notice the left side of the plate.
      2. Bumping against objects with the left side of the body or wheelchair. Typically, patients who are just beginning to understand their left neglect and have not become proficient in scanning techniques will have bruises on the left arm.
      3. Not facing people on their left, even when talking with them.
      4. Missing shaving a piece of the left side of the face.
      5. Missing the words on the left side of the page.
      6. Unable to find rooms located on the left side of a hallway.
      7. Usually, patients with left neglect will start all activities on the right side and not make it to the left. So, a patient may play Connect 4 and always place their chips on the right side of the game.

      Hope this help!

  3. Hannah Crockett-Naini

    That has helped me so much. Thank you!
    I am currently writing my year 11 high school research project in Australia and am extremely interested in this topic. Would you be able to recommend any other resources that may be beneficial in answering a question at this level. My question is “Is the cognitive condition of left neglect or inattention a result of visual deficits?”
    The answers you have given me were great and I would love to reference this valuable information. How could I best do this?
    Much appreciated,

    Hannah Crockett-Naini
    Year 11 Student
    Australia

  4. Hannah Crockett-Naini

    Wow these links are great 🙂
    Thank you very much.

    Hannah Crockett-Naini

  5. Hannah Crockett-Naini

    Hi Jason, just one quick question…

    Is the posterior parietal cortex the part of the brain which is damaged in left neglect patients? I have read a couple articles which say that “it remains unclear” so I am a bit confused.

    Hannah Crockett-Naini

    • The Posterior Parietal Cortex often is tied to left neglect but it is not the only brain location that can be involved. How much specific information on neuroanatomy do you need on this?

  6. Hannah Crockett-Naini

    Okay, that makes more sense.
    I only need a little bit as I will only be required to write one paragraph on this. Would you recommend any sources which are easy to understand without having a neurological background?
    Thank you very much for your help! I really appreciate it.

  7. Hannah Crockett-Naini

    I have just finished my draft of my final essay.. Would you mind having a read and giving some feedback?

  8. Hannah Crockett-Naini

    I have sent it through! Thank you so much 🙂

  9. Hannah Crockett-Naini

    Have you received my email? If not I will try sending it through again.

  10. Hannah Crockett-Naini

    Of course! Thank you very much.

  11. Reblogged this on bria varner and commented:
    They specialize in brain injury rehab. The comments on the original post have some great question and answer on the topic as well, so check those out too!

  12. Pingback: Signs of Left Neglect | The Transitional Learning Center's Blog

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s