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Ipsilesional intentional neglect and the effect of cueing

From the Institute of Neurology and Neurosurgery (Dr. Schwartz), Saint Barnabas Medical Center, Livingston, NJ; Department of Neurology, University of Florida Health Science Center, and the Neurology Service, Department of Veterans Affairs Medical Center (Drs. Barrett and Heilman), Gainesville, FL; and Massachusetts General Hospital (Dr. Kim), Boston, MA.

Address correspondence and reprint requests to Dr. Kenneth M. Heilman, P.O. Box 236, University of Florida, Gainesville, FL 32610-0236.

BACKGROUND: Contralesional hemispatial neglect may be induced by an attentional deficit where patients are inattentive to or unaware of stimuli in contralesional hemispace, an intentional deficit where patients are unable to act in or towards contralesional hemispace, or both. The deficits associated with ipsilesional neglect have not been as well chararacterized. Because cueing may be used as a rehabilitative assistive device, we wanted to learn whether the efficacy of an attentional or intentional cue was related to the type of bias.

METHODS: We studied a patient with a right frontotemporal stroke who had ipsilesional neglect by using a video apparatus that dissociates sensory-attentional and motor-intentional systems. We also performed a cueing experiment with primarily sensory-attentional cues (i.e., read the letter at the end of the line) and primarily motor-intentional cues (i.e., touch the end of the line). Results and

CONCLUSIONS: Ipsilesional neglect was primarily a motor-intentional deficit with a motor-action bias to the left and a secondary sensory-attentional bias for stimuli to the right. With cueing we found a double dissociation: the rightwards motor-intentional cue improved the primary left-sided intentional bias and the leftwards sensory-attentional cue improved the secondary right-sided attentional bias. Effective rehabilitation strategies need to address both sensory-attentional and motor-intentional deficits in patients with neglect.

Key words: Neglect—Attention—Intention—Cueing.

This article has been cited by other articles:

				A. M. Barrett, B. L. Peterlin, and K. M. Heilman Ipsilateral neglect versus hemianopic compensation Neurology, July 8, 2003; 61(1): 120 - 123. [Abstract] [Full Text] [PDF]