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Post-stroke Spatial Neglect: Case Study

Mr. B is an 89-year-old Caucasian stroke survivor. After a CT-scan, it was determined that Mr. B had an infarct in the region of the right parietal and occipital lobes. He has a family history of stroke, he is a retired engineer, and was independent prior to his injury.

In acute rehab, Mr. B presented with left facial droop, right gaze preference, left-hemi sensory neglect, dysphasia and confusion. He was alert and oriented x 2.

Mr. B's rehabilitation goals included increasing his independence in activities of daily living and functional mobility, as well as improving vision and cognitive functioning. The primary impairment or barrier affecting his improvement in all goals was spatial neglect.

The patient identified shaving as a goal. Initially during this task, he would "forget" to shave the entire left side of his face despite verbal cues. However, when provided with verbal cueing and use of prisms throughout the entire task, he was then able to complete it successfully. 

He was involved in the CRCC spatial neglect research program for three weeks of his four -week stay, and continues to be followed by the research team. His treatment results have not been fully analyzed, and because the research is designed to analyze group performance we cannot divide the contribution of natural recovery from prism adaptation treatment in improvement of his symptoms. However, we (his therapists), the patient and his daughter (who is a physical therapist) were very satisfied with his progress. 

ADL improved, with significantly better transfers (improved from maximal assistance lateral transfer to minimal assistance for a stand pivot transfer). His daughter reports from her casual observation that his gains appear to be well maintained several months post-treatment. As a participant in our research Mr. B was reassessed at three months post-stroke, and it appears that his gains have been retained.

Kimberly Hreha, OTR, has worked at Kessler Institute for Rehabilitation in West Orange, NJ, for four years and has been involved in research studies with the Kessler Foundation for the last two years. She is currently the public relations chair for the New Jersey Occupational Therapy Association. Monika Eller, OTR, is the Severe Disorders of Consciousness (SDOC) Program Manager at the Kessler West Orange campus. She has 25 years of experience in acute rehabilitation, and holds specialty certifications in NDT and the A-ONE assessment. Anna M. Barrett, MD, is a neurologist and clinician-researcher at the Kessler Foundation and is president-elect of the American Society of Neurorehabilitation. Her academic teaching, clinical practice and research program focus on "hidden disabilities" after stroke.


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