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1. Bangladesh Health Professions Institute
Department of Occupational Therapy
Masters of Science in Occupational Therapy
Occupational Therapy in Adult Neurology
The mechanism of unilateral neglect is complex and not fully understood, but it is generally associated
with damage to certain areas of the brain, particularly the right hemisphere. The brain regions most
commonly implicated in unilateral neglect are the parietal lobe, temporal lobe, and the right hemisphere
of the brain. The left hemisphere can also be affected, but it is less common.
Here are some key components that contribute to the mechanism of unilateral neglect:
1. Attentional Processing: Unilateral neglect is primarily a disorder of attention. The brain's attentional
system is responsible for selecting, processing, and integrating sensory information from the
environment. Damage to the right parietal lobe disrupts the brain's ability to attend to and process
information on the left side of the body or in the left side of the environment.
2. Spatial Awareness and Representation: The right parietal lobe is involved in spatial awareness and the
representation of space. It helps us build a mental map of our surroundings and the location of objects
relative to ourselves. Damage to this region can lead to difficulties in perceiving and processing
information from the left side of space.
3. Cross-Activation Theory: The right hemisphere is dominant for processing both the left and right sides
of space. However, the left hemisphere is only dominant for processing the right side of space. When
there is damage to the right hemisphere, the left hemisphere is not able to fully compensate for
processing the left side of space, leading to neglect of that side.
4. Disconnection Syndrome: In some cases, unilateral neglect can be related to a "disconnection
syndrome" between different brain regions. Damage to white matter tracts that connect different areas
of the brain can disrupt the flow of information between them, leading to neglect of one side of space.
5. Inattention to Sensory Inputs: Individuals with unilateral neglect may also exhibit inattention to sensory
inputs from the neglected side. For example, they may not respond to touch, sound, or visual stimuli
presented on the affected side, further contributing to their neglect.
6. Attentional Bias: Unilateral neglect can lead to an attentional bias towards the intact side, causing the
individual to over-rely on the unaffected side and neglect the affected side.
It's important to note that unilateral neglect can manifest in different ways and to varying degrees,
depending on the location and extent of brain damage. While it is most commonly associated with right
hemisphere lesions, it can also occur due to damage in other brain regions or even in the left hemisphere.
The specific neural mechanisms underlying the condition are still an active area of research, and ongoing
studies aim to deepen our understanding of unilateral neglect to improve its management and treatment.
Unilateral neglect, also known as hemispatial neglect, is a neurological condition in which an individual
fails to attend to or acknowledge one side of their body or the space around them. It is most commonly
associated with brain injuries, typically involving the right hemisphere of the brain, resulting from strokes,
traumatic brain injuries, or other neurological disorders.

2. Occupational therapists (OTs) play a crucial role in the management of unilateral neglect. Their goal is to
improve the individual's functional independence and quality of life by addressing the specific challenges
caused by neglect. Here are some key strategies and interventions from an OT perspective for managing
unilateral neglect:
1. Environmental Modification: OTs assess the individual's home and work environments to identify
potential hazards or obstacles on the neglected side. They may rearrange the furniture, move objects to
the unaffected side, or use visual cues to draw attention to the neglected side.
2. Compensatory Techniques: OTs teach compensatory techniques to help individuals become more
aware of the neglected side. These techniques might include scanning the environment from left to right,
using a mirror to view the neglected side, or incorporating specific head or eye movements to redirect
attention.
3. Perceptual Training: OTs may use various exercises and activities to improve the individual's awareness
of their neglected side. This might involve tasks like drawing or coloring, reaching for objects on the
neglected side, or engaging in activities that require cross-midline movements.
4. Mirror Therapy: In some cases, mirror therapy can be beneficial. This involves using a mirror to create
an illusion of the neglected side as the unaffected side, which encourages the brain to attend to the
neglected space.
5. Constraint-Induced Movement Therapy (CIMT): CIMT is a technique where the unaffected limb is
constrained while the individual is engaged in therapeutic activities using the neglected limb. This helps
promote the use and awareness of the neglected limb.
6. Visual Scanning Training: OTs work with individuals to improve their visual scanning abilities, helping
them learn to actively search the neglected side and compensate for their lack of awareness.
7. Occupational Engagement: Engaging individuals in meaningful and purposeful activities on the
neglected side can improve their attention and motivation to use that side. OTs choose activities that are
relevant and interesting to the individual, increasing their likelihood of participation.
8. Dual-Task Training: This involves combining cognitive tasks with motor tasks, encouraging the individual
to focus on both sides of their body and space simultaneously.
9. Technology-Assisted Interventions: OTs may use virtual reality, computer-based programs, or
smartphone apps to provide engaging and interactive training for improving unilateral neglect.
It is important to note that the specific interventions will vary depending on the individual's unique needs
and the severity of their neglect. Occupational therapists work closely with other healthcare professionals,
such as neurologists, physical therapists, and speech therapists, to create a comprehensive rehabilitation
plan that addresses all aspects of the individual's condition. The goal is to maximize functional
independence and promote overall well-being in daily life activities.