Monthly Archives: July 2017

Signs of Left Neglect

Left neglect is one of the more curious symptoms of brain injury.  Briefly, left neglect is an attention deficit in which a patient’s brain essentially tells that patient to ignore the left side of his or her world.  For that individual, it is almost as if the left side of the world does not exist.  It is most commonly observed when a patient ignores items in the left visual field (even when visual acuity is perfect) but can also involve hearing and sensation on the left side.  Left neglect is due to an injury to the right side of the brain.  Different techniques (such as practicing scanning skills) are used to help manage left neglect.  For more general information on left neglect, please see these previous posts on the topic:

What is Left Neglect? https://tlcrehab.wordpress.com/2015/01/08/what-is-left-neglect/

Left Neglect vs. Field Cut https://tlcrehab.wordpress.com/2015/06/25/left-neglect-vs-field-cut/

What I would like to do with this post is to give a few signs that rehabilitation professionals commonly observe when diagnosing cases of left neglect.  Below is a list of these common indicators of left neglect.

1. The patient only eats food on the right side of plates and does not notice food on the left side.  Often the patient will complain that he or she is not being fed enough because the patient believes that he or she is only being offered half-sized portions (since food to the left is necessarily ignored).

2. The patient bumps against objects with the left side of the body or wheelchair.  For instance, the patient may catch the left side of a door frame as he or she attempts to enter or exit a room.  Typically, patients who are just beginning to understand their left neglect and have yet to become proficient in scanning techniques will have bruising visible along the left arm or leg.  Staff often have to monitor patients in wheelchairs who have left neglect to ensure that the patients’ left arms do not fall down and get caught in the wheels of their wheelchairs.

3. The patient does not face people to his or her left, even when talking with these people.  Many times the patient may begin a conversation face to face, but slowly during that conversation his or her gaze can be observed to drift to the right.

4. The patient only shaves the right side of the face, only washes the right side of the face or only puts make-up on the right side of the face.

5. The patient misses words on the left side of the page.  This can cause a patient to complain that the reading material he or she is given does not make sense because the patient does not realize that he or she is only reading words on the right side of the page.

6. The patient is unable to find rooms located on the left side of a hallway.  Sometimes a patient will claim that a room has “moved” or “disappeared” since the patient cannot find the room in question.

7. The patient will start all activities on the right side and not make it all the way to the left. As example, a patient may play Connect 4 and only place chips on the right half of the board.  The patient may also be seen squeezing all his or her writing onto the right side of a page while leaving the left side of the page entirely blank.  When drawing a picture, the patient may leave a similarly barren left side of the page upon completion.

8. The patient complains that he or she is losing hearing in a left ear even though audiological testing shows no hearing loss.

9. In extreme cases, a patient may not recognize a left arm or leg as being his or her own body part.  When the patient sees this limb but does not recognize it, he or she may even make a complaint such as that a stranger has joined him or her in bed.

I hope this post helps everyone understand some of the more common signs of left neglect that rehabilitation professionals often observe!

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

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The Overlooked Release

One of the most important factors in providing quality care is for a health care provider to have all information pertinent to a patient’s health.  For instance, knowing that a patient has a history of seizures may influence the type of attention medication that a doctor would prescribe.  Similarly, knowing that a patient has a history of learning disabilities will affect the interpretation of neuropsychological and speech pathology testing.  On the surface, it would seem pretty obvious that a health care provider would need all available information on a patient under his or her care.  In reality though, providers all too often have access to surprisingly limited information which makes assessment and treatment more difficult than it needs to be.

Many patients and their families simply assume that each health care provider they see knows what every other provider in the chain of care is doing or has done.  Unless the health care providers in question all work for the same facility, the providers do not have this full and free access to one another’s information.  Patients (or loved ones that have the legal right to do so) must request that the information from one health care provider be sent to any other health care provider.  This will always be done with a written form called a Release of Information or Release of Records.  This release allows the providers specified on the form to share information.  So if you want your family care physician to have a sufficiently comprehensive understanding of what happened to you in the hospital, you want to make sure that you have signed a release of information authorizing the hospital to send information to that physician.

There will often be check boxes on these forms specifying what information is being sent.  Certain information such as psychological records have added legal protections so they cannot simply get sent automatically with other records (consider, do you really want your insurance company to have the same access to session notes from marital therapy sessions as they do to those from physical therapy sessions?).  Moreover, doctors/facilities will only send the records from their own offices, and not the records from other offices.  For example, if you are requesting that notes from a rehabilitation facility be sent to your family doctor, the rehabilitation facility will only send their records to that doctor.  They will not send the notes from the hospital you were at prior to the rehabilitation facility even if the facility has those hospital records.  Each doctor/facility will require a release of information to be signed and often they will insist that it be on a release form from their office.  Though this may seem like a bit of an inconvenience, having a full set of records greatly improves the ability of health care providers to give the best possible treatment to their patients and reduces the likelihood of wasted time and costly errors.

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