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- Kerstin Tham, Elisabeth Ginsburg, Anne G. Fisher & Richard Tegnér (2001). Training to Improve Awareness of Disabilities in Clients with Unilateral Neglect. American Journal of Occupational Therapy 55 (1):46-54.
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Unilateral neglect stems from a relatively selective impairment of exogenous, or stimulus-related, orienting of attention. This neuropsychological evidence parallels “change blindness” experiments, in which normal individuals lack awareness of salient details in the visual scene as a consequence of their attention being exogenously attracted by a competing event, suggesting that visual consciousness requires the integrity of exogenous orienting of attention.
We describe some of the signs and symptoms of left visuo-spatial neglect. This common, severe and often long-lasting impairment is the most striking consequence of right hemisphere brain damage. Patients seem to (over-)attend to the right with subsequent inability to respond to stimuli in contralesional space. We draw particular attention to how patients themselves experience neglect. Furthermore, we show that the neglect patient's loss of awareness of left space is crucial to an understanding of the condition. Even after left space has been brought into the patient's consciousness (either by local cueing on the left or by an emphasis on global properties of the scene as a whole), this awareness of left space rapidly declines. We suggest that much of the symptomology of left neglect can be interpreted as a disconnection between brain mechanisms that are relatively specialized for local (detail) visual processing and global (panoramic) processing. This failure of communication between functional (subpersonal) mechanisms then has consequences for how perceptual and representational content enters into awareness. Failure of the local contents of left space to be consciously accessed is, in turn, an important aspect of why left neglect is so difficult to remediate. Patients can ''know'' that they have neglect but are cut off from the perceptual awareness that would enable them to overcome their attentional bias to the right.
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