Some people with RHD may experience a rather confusing phenomenon known as unilateral (one-sided) neglect or left neglect in which they appear not to see the left side of their world. In fact, what is happening is that they have difficulty paying attention to objects and/or people on their left. Because of the damage to the right side of their brain, they have difficulty directing their attention to the left side of their environment. In severe cases, it is almost as if the left side of the world has ceased to exist! Fortunately, for many people with RHD, this problem can improve significantly in the early days after their brain injury. But, for a large minority, the problem can persist and can cause great difficulty in safely navigating their environment. It is useful to think about neglect in three separate categories. RHD can cause one, two or all three forms of neglect in any individual.

  1. Personal neglect – This is a problem attending to the left side of one’s own body. This can cause a person to shave only the right side of his face, brush only the teeth on the right side, or dress only the right side of their body. It can result in risk of injury, such as when a person lets their left arm dangle down into their wheelchair wheel or bumps into objects or doorframes on the left side.

  2. Peripersonal neglect – In this case, it is difficult to pay attention to items within an arm’s reach. A person with peripersonal neglect may only eat food on the right side of their plate or only look at the right page of an open book. When asked to write they may begin in the middle of the page.

  3. Extrapersonal neglect – This form of neglect affects a person’s ability to attend to and locate items in the left side of their environment, beyond arm’s reach. They may not look at someone who is sitting on their left side or they may not turn toward a sound or voice on their left. They may not look out the window if it is to their left or look at the TV.

When neglect affects reading and writing, it can be called neglect dyslexia and neglect dysgraphia. Neglect dyslexia is an impairment of reading due to difficulty attending to the left side of words, sentences or paragraphs. As a result, the person may not read words on the leftmost side of a line. Every word has a left side, so the person may neglect those, as well. For example, the word “peanut” may be read as “nut” or the word “pancake” may be read as “cake”. Making sense of printed material can, therefore, be extremely challenging. Neglect dysgraphia affects writing. A person may write only on the right side of the page, may angle their writing on the page and may omit or repeat letters.  

In all forms of neglect, it is useful to remember that it is not a problem with the person’s eyes or vision; rather, it is a problem of attention resulting from the damage to their brain. They now have difficulty aiming their attention to the left side to perform daily tasks. This is a challenging problem to tackle if it doesn’t improve on its own in the early days after the injury or stroke. It is often complicated even more by anosognosia, or reduced awareness of the neglect; people with RHD may not be aware that they are missing things. Unilateral neglect can also seem to wax and wane depending on the person’s fatigue, how difficult a task is, or how many things are in the environment.

What you can do

The person with RHD’s entire rehabilitation team will work on this issue and will help identify strategies that can help. Some examples might be to sit on the person’s left and place important items on their left to encourage their brain to direct attention to that side. Reminders to look to turn their head and scan the environment to the left can also help. Most importantly, ensuring the people with RHD’s safety is critical. Help them avoid running into obstacles, falling, burning or otherwise injuring themselves on the left side.