What is the recommended treatment for left or right side agnosia?

Treatment for Left or Right Side Agnosia

Scanning training is the recommended first-line treatment for hemispatial neglect (agnosia) to improve functional outcomes and quality of life. 1

Understanding Hemispatial Neglect/Agnosia

• Hemispatial neglect (agnosia) is characterized by lack of awareness of a specific body part or external environment contralateral to the brain lesion site, typically occurring after right (nondominant) cortical strokes 2
• Patients with neglect do not realize they are failing to attend to one side of their world, creating significant safety concerns and negatively impacting daily functioning 2
• Clinical manifestations include patients donning a shirt on only one arm, shaving only half of their face, or failing to notice food on half of their lunch tray 2

Assessment and Diagnosis

• The NIH Stroke Scale (NIHSS) evaluates extinction and inattention (neglect) in item 11, with scoring from 0 (no abnormality) to 2 (profound hemi-inattention) 2
• Testing by trained professionals is necessary to distinguish neglect from visual field cuts, impaired attention, and planning or visuospatial abilities 2
• Proper diagnosis is critical as unilateral spatial neglect has a substantial negative impact on function and is a significant contributor to poor prognosis after stroke 2

Treatment Approaches

First-Line Treatment

• Mirror therapy has shown a large positive effect on activities of daily living performance in patients with unilateral spatial neglect and is recommended as a first-line treatment 2
• Scanning training to compensate for visual field loss is strongly recommended with consideration of individual patient characteristics 1

Additional Effective Interventions

• Prism adaptation therapy - helps redirect visual attention to the neglected side 2, 3
• Half-field eye patching - forces attention to the neglected visual field 2
• Limb activation techniques - increases awareness of the affected side through movement 2
• Non-invasive brain stimulation methods including:
  • Transcranial magnetic stimulation (TMS) 2
  • Transcranial direct current stimulation (tDCS) 2

Rehabilitation Strategies

• Compensatory strategies have proven beneficial in most cases of visual agnosia and hemispatial neglect 3
• Combined approaches (e.g., visual scanning with limb activation) may be more effective than single interventions 2
• Restorative training has produced mixed results but may be considered as part of a comprehensive approach 3

Important Clinical Considerations

• Many patients with mild neglect have spontaneous improvement within weeks of onset, while those with profound neglect may improve over many months 2
• Patient education is crucial, with the goal of teaching the patient to acknowledge the neglect 2
• Safety concerns related to neglect should be addressed early in the rehabilitation process to prevent injuries to the affected side 2
• Reading, writing, drawing, and mobility may all be negatively impacted by the presence of neglect and should be addressed in rehabilitation 2

Treatment Algorithm

1. Initial Assessment: Determine severity of neglect using standardized measures (NIHSS) 2
2. Begin with mirror therapy and scanning training as first-line interventions 1, 2
3. Add complementary approaches based on response:
   • For moderate to severe neglect: Add prism adaptation and limb activation 2, 4
   • For mild neglect with good awareness: Focus on compensatory strategies 3
4. Consider non-invasive brain stimulation for cases resistant to conventional therapy 2
5. Implement safety measures to prevent injury to the neglected side 2
6. Regular reassessment to monitor progress and adjust treatment approach 2