Prism adaptation for spatial neglect

Domain IX · Biomedical, neuro & digital · Rossetti · 1998

What it is

Spatial neglect is a syndrome, most often after right-hemisphere stroke, in which a person fails to notice, attend to, represent or act in one side of space, usually the left, and often does not realise this. In PA the person wears goggles fitted with prism lenses that shift the visual field to one…

Format

• PA is delivered as part of a rehabilitation programme, not as a stand-alone therapy. The phases below are how the published clinical pathway is organised; the session format and course length are set by the protocol and the treating team.
• Format: all stroke patients screened for visual and visual-perceptual deficits as part of routine rehabilitation assessment, with validated tools for suspected deficits (Canadian guideline, Evidence Level C). Tools named include the Behavioural Inattention Test, line bisection and the Comb and…

Who practises it, and how they are trained or regulated

• Who delivers it and regulatory context. In the KF-PAT implementation network, OTs delivered both the neglect assessment and the treatment after a formal training course run by the protocol developers, with a mandatory manual, video tutorials and graded competency levels, the highest of which qualified a therapist to train colleagues. The Italian recommendations name neurologists, physiatrists, neuropsychologists and…
• Goal: carry gains into self-care, mobility, reading and safety, alongside other neglect treatments (scanning training, limb activation, mirror therapy and others; see section 4).
• Phase 4: Discharge and community. Neglect may persist; families need guidance on home hazards, cueing and their own wellbeing. Driving after stroke with perceptual deficits is handled under separate guideline sections and licensing rules.

Evidence status, as the guide reports it

• Format: all stroke patients screened for visual and visual-perceptual deficits as part of routine rehabilitation assessment, with validated tools for suspected deficits (Canadian guideline, Evidence Level C). Tools named include the Behavioural Inattention Test, line bisection and the Comb and…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• under-reporting because of reduced awareness. Ask carers and staff too.
• missed sessions linked to low mood; an early discharge cutting the course short.
• a drop in hope once formal therapy stops; carer exhaustion; new safety incidents.
• families chasing a single cure or unregulated programmes; bring questions back to the team.
• splitting (the client telling different professionals different things); duplicated or contradictory advice.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.