Spatial neglect is a multifaceted neurological condition characterized by an impaired awareness of stimuli on one side of space, most frequently the side opposite to a brain lesion.

This disorder extends beyond mere sensory loss, involving profound disruptions in attention, perception, and motor behavior.

Dimensions and Subtypes of Spatial Neglect

Spatial neglect is heterogeneous, presenting in various forms depending on the affected neural pathways and spatial reference frames. Clinicians and researchers classify neglect along three principal dimensions: reference frame, processing stage, and spatial sector.

Reference Frame: Neglect can be egocentric, relating to the patient’s own midline and body orientation, or allocentric, involving neglect of one side of an object regardless of its position in space.

Processing Stage: This encompasses perceptual neglect affecting visual, tactile, or auditory stimuli, representational neglect involving mental spatial imagery, and motor neglect characterized by reduced spontaneous movement towards the contralesional side despite preserved motor capacity.

Spatial Sector: Neglect manifests within different spatial zones: personal space (the body itself), peripersonal space (within arm’s reach), and extrapersonal space (the far environment).

Neural Basis and Mechanisms

Spatial neglect primarily results from damage to a right-hemispheric cortical network involving the parietal lobe, temporoparietal junction, and frontal cortex. This network is essential for spatial attention allocation and sensory integration. Lesions disrupt the brain’s ability to scan and attend to contralesional space, leading to a failure in detecting stimuli or initiating movement towards the neglected side.

The condition reflects a disorder of attention rather than sensation; patients can often detect stimuli if explicitly directed but lack spontaneous awareness. This dissociation explains why neglect can be missed without thorough assessment and why patients may pose safety risks despite intact sensory pathways.

Clinical Assessment and Challenges

Accurate diagnosis of spatial neglect poses significant challenges due to its variable presentation and overlap with other deficits. Standardized tests, such as cancellation tasks, line bisection, and copying drawings, help detect visual neglect but may be insufficient for subtle or non-visual subtypes.

Multimodal assessments integrating motor, tactile, and representational tests provide a more comprehensive profile. Detection of extrapersonal neglect is especially important given its impact on mobility and safety but requires specialized evaluation strategies.

Functional Impact and Rehabilitation Considerations

Neglect severely diminishes independence in daily activities across personal hygiene, feeding, mobility, and communication. Individuals with spatial neglect are at a higher risk of falls, prolonged hospitalization, and decreased likelihood of returning home without assistance.

Effective rehabilitation relies on identifying specific neglect subtypes to tailor compensatory strategies and therapeutic interventions. Interventions may include visual scanning training, sensory stimulation, prism adaptation therapy, and cognitive approaches to enhance spatial awareness.

Lindy J. Williams, a prominent researcher in neurorehabilitation, states, "Identifying the precise subtype of spatial neglect is critical to delivering targeted interventions that improve functional outcomes and reduce safety risks for affected individuals. Comprehensive assessment remains essential for optimizing rehabilitation strategies."

Spatial neglect constitutes a complex disorder of spatial awareness following unilateral brain lesions. Its diverse manifestations across different spatial sectors and sensory modalities demand careful, multifaceted evaluation. Understanding the neural underpinnings and recognizing subtype presentations are vital for effective management and improving patients’ quality of life. Focused rehabilitation tailored to individual neglect profiles can significantly enhance recovery and reduce complications related to neglect behaviors.