Assessment and Management of Unilateral Neglect in Stroke Patients

Understanding the NIH Stroke Scale

The NIH Stroke Scale (NIHSS) is a standardized, validated instrument used to assess stroke severity with scores ranging from 0 to 42, where higher scores indicate more severe strokes 1
The American Heart Association recommends using the NIHSS to assess stroke severity, with item 11 specifically evaluating extinction and inattention (formerly known as neglect) using the following scoring criteria:
- 0 = No abnormality 3
- 1 = Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one sensory modality 2
- 2 = Profound hemi-inattention or extinction to more than one modality 1, 2

Unilateral neglect is the lack of awareness of a specific body part or external environment contralateral to the site of the brain lesion and usually occurs in patients with right (nondominant) cortical strokes 3
When a patient does not recognize touch on their left arm or leg, this represents profound hemi-inattention affecting the tactile sensory modality, indicating severe neglect that warrants the maximum score of 2 points on item 11 1, 2
Neglect is a significant contributor to poor prognosis after stroke and substantially impacts an individual's ability to function safely within their environment 3

The American Stroke Association recommends several approaches for treating neglect, including strategy training, gesture training, task practice with and without mental rehearsal 2
Interventions such as half-field eye patching, visual scanning training, prism adaptation, limb activation, and various forms of brain stimulation have shown efficacy in improving performance on standard neglect tests 2