Body Neglect of an affected limb is a real challenge in stroke recovery. Stroke Recovery starts from using proper position, facilitating awareness of affected extremity, and use it in a functional task. Along with proper positioning challenge, another challenge that we, as rehab professionals, usually face, is facilitating the use of neglected/affected side after hours in stroke patients. It can start by talking and having a casual conversation with the patient on providing some cues to use that affected limb during evenings or weekends. When we in-service the non-rehab staff regarding how to facilitate the use of an affected limb, we need to make sure that we convey the important message that it may not be for all stroke patients. A patient needs to be ready to use that paretic limb during non-rehab hours. Otherwise, just facing constant failures while attempting to use a paretic limb, will only cause more aggression, depression and no motivation to use that affected limb.
In my previous article, I discussed in-servicing non-rehab professionals regarding proper positioning. This article is another area that is important in stroke recovery, this article discusses body neglect. Here I am going to describe some easy strategies for family members and caregivers to help a stroke patient use that paretic and neglected extremity. You can either provide this as an in-service topic or print out few points from this article and hang it on patient’s bulletin board for family members.
How to Avoid Neglect:
Improving body awareness of the neglected area is crucial in stroke patients. Research demonstrates that improvement in upper extremity strength is associated with severity of neglect. Moreover, visuospatial neglect is also associated with poor motor recovery, higher disability and poor responses to rehabilitation services. With proper positioning and body awareness, we can encourage a patient to use the affected (neglected) arm or leg.
Strategies to use the affected area during the non-rehab time:
The best way to encourage the use of paretic limb during the non-rehab time is to utilize that limb during regular day to day interactions. A method that works best is to make environmental changes and educate family as well as the caregiver. Every little thing that a family or friends do to improve the awareness helps a stroke survivor “tune in” to the neglected side. This can be as little as just sitting beside them, holding/ gently touching/rubbing that paretic hand or standing on the neglected side and engaging them in a conversation.
Below are some examples of minor environmental changes that we can do during their inpatient stay.
Environmental Changes to facilitate the use of affected limb:
- Television, remote control, a glass of water on the neglected side
- Nightstand on the neglected side
- Stand on the paretic side and encourage conversation with the patient
- Wall decoration with family pictures on the paretic side
- Sometimes, just written instruction on the non-affected side that reminds patients to use the affected side also helps.
- Playing video games with affected side when appropriate.
- Emergency equipment like call bell or phone on the non-affected side. This is to make sure patient is able to reach them in an emergency.
When to Educate family to use Affected limb:
As rehab professionals, we have to be careful in deciding when to educate the families. The patient may not be successful in using the paretic limb without skilled interventions when they are not ready. That is why in acute cases, I will encourage the use of affected limb only in rehab. Once the patient is able to use the affected limb for 50% of the time, then use the strategies described above. You will still need to encourage the use of the affected area.
Also, we need to educate the family as well as caregivers about what not to say and how not to react in front of a stroke patient. We are only adding to their frustration by saying, “did you forget that again? Or scolding them. Rather, helping them find or locate an item from neglected side. Using words like “here is your remote control or spoon etc” will help.
Lastly, here is a print out of the main points that you can provide for in-service.
References:
- Klinke ME, Hafsteinsdottir TB, Hjaltason H, Jonsdottir H. Ward-based interventions for patients with hemispatial neglect in stroke rehabilitation: A systematic literature review. International Journal Of Nursing Students. 215; 52 (8): 1375-1403.
- Pierce SR, Buxbaum LJ. Treatments of unilateral neglect: A review. Archives of Physical Medicine and Rehabilitation. 2002; 83 (2): 256-268.
- Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:e98–e169. DOI: 10.1161/STR.0000000000000098.
- Nijboer TCW, Kollen BJ, Kwakkel G (2014) The Impact of Recovery of Visuo-Spatial Neglect on Motor Recovery of the Upper Paretic Limb after Stroke. PLoS ONE 9(6): e100584. https://doi.org/10.1371/journal.pone.0100584.
- Pierce SR, Buxbaum L. Treatments of Unilateral Neglect: A Review. Arch Phys MEd Rehabilitation. 2002; 83: 256-268.