1.Sensory input
Superficial sensation: Cold, heat and touch stimulation to the skin of the neglected limb.
Deep sensory: Promote the perception of the affected limb through deep sensory input such as joint position sensation and kinesthesia.
Visual: Train the patient to consciously scan the neglected side. Self-portrait facing the mirror, grooming, etc.
2.Cross promotion training
The upper limb on the able-bodied side crosses the midline to work on the affected side. For example, transfer the pegs from the healthy side to the affected side in the sitting position and other training.
3.Attention training
Such as deleting homework, crossing out homework, reading training.
4.Right eye shielding
Masking the right eye of a left-sided neglector can improve the patient’s level of attention to objects on the left side. The reason may be that the right eye masking weakens the inhibitory effect of the left suprachiasmatic nucleus on the right suprachiasmatic nucleus.
5. Cueing
The form of cueing must be consistent with the way the task is performed to achieve maximum effect. Give visual cues when reading an article, marking it with colored lines on the ignoring side or pointing to it with your finger. Give motor cues when writing, moving the left hand intermittently (actively or passively) on the desk or on the knee.
6.Torso rotation
Some scholars have studied the effect of torso rotation on the subject of dichotomization with line segments. The results showed that torso rotation improved the dichotomous offset. In order to improve the attention of left-sided spatial neglecters to the left, the method considered in the past was to turn the head to the left, but this method was not as effective as torso rotation to the left. This method can be used for basic movement training and walking training.
7.Change the environment
Stand on the neglect side when talking to the patient. Put daily necessities, TV sets, etc. on the ignore side to make him pay attention.
8.Stimulate alertness
A buzzer can be used to sound once every 5 to 20 seconds to remind the patient to focus on the left side, which can increase the alertness of the whole body.
9.Early walking
Early use of long lower limb devices to improve alertness in people with low arousal levels. One study divided the patients into early walking group and control group, and the results showed that the sitting self-reliance improved in the early walking group and the overall ADL self-reliance improved, but there was no difference in walking ability between the two groups.
10. Drug treatment
The dopamine receptor agonist apomorphine reduced neglect symptoms, while the dopamine receptor blocker spiroperidol reversed this therapeutic effect; suggesting that agonists of dopamine may be effective in treating neglect. The hemi-lateral activation method and compulsory use therapy (CIT): Recently, CIT is a technique that has received much attention for hemi-lateral neglect, in which an immobilization device is used on the healthy limb to reduce the use of the healthy limb, while the patient is induced to use the affected limb for several weeks during 90% of the waking hours, and the motor potential of the affected limb can be fully realized by concentrated and repeated training. However, this technique requires active extension of the hand and wrist, which may limit its use in some patients with severe hemiplegia. Eye patch and half-space masking glasses: Masking the right eye of patients with left-sided neglect can improve their level of attention to left-sided objects, and it has been demonstrated that wearing an eye patch on the right eye can significantly improve the attention to the left side.
11. Repetitive transcranial magnetic stimulation (TMS).
In the 1990s, it was recognized that TMS could regulate the excitability of the central nervous system and was applied in Parkinson’s disease, hemiplegia, depression, and lateral neglect, etc. The theoretical basis of TMS for lateral neglect: the directional attention hypothesis – bilateral cerebral hemispheres achieve balanced directional attention by mutually inhibiting attention in the contralateral space. promising emerging treatment method, its clinical application is being studied in many countries around the world. When TMS is used to treat neglect, the timing of its effects should be considered, and the corresponding mechanisms should be evaluated and explored, and how to enhance its long duration effects and achieve the expected results of longer duration should be a concern in clinical application. In addition, in the application, attention should be paid to the issue of safety parameters and to its possible adverse effects.