Hemineglect and sensory deficits

1. Case. A 67-year-old right-handed woman, 3 weeks post-large right-MCA stroke. Left hemiparesis. She does not eat food on the left side of her tray, bumps her left shoulder on doorframes, and shaves only the right side of her face. Star cancellation: omits 8 of 27 left-sided targets.

2. CPG section. AHA/ASA 2016 recommends screening for unilateral spatial neglect early in stroke care (Class I). Evidence for intervention: prism adaptation has the most consistent acute and short-term effect on standard neglect measures (Rossetti Y et al. *Nature*. 1998;395:166–169). Visual scanning training, limb activation, and mirror therapy are commonly used; effect on functional ADL outcomes is less robust (Bowen A, Hazelton C, Pollock A, Lincoln NB. *Cochrane*. 2013, CD003586).

3. Reasoning walkthrough. Screen with star cancellation (Halligan PW, Marshall JC, Wade DT. *Lancet*. 1989;2:908–911) and a functional anchor — meal observation or the Catherine Bergego Scale (Azouvi P, Olivier S, de Montety G, et al. *Arch Phys Med Rehabil*. 2003;84:51–57, which established the psychometrics of the CBS). Combine cognitive/perceptual interventions with task-embedded therapy: position items leftward during meals, station the affected side toward the active environment, build leftward scanning into gait and ADLs. Prism adaptation produces effects on paper-and-pencil measures; transfer to function is less robust (Bowen 2013). Sensory loss management: combine sensory re-education with active task practice; passive stimulation alone has weak evidence.

4. Outcome measure. Star Cancellation Test, Catherine Bergego Scale (CBS), and a functional measure. Star Cancellation cutoff for neglect = omission of >2 contralesional targets (Halligan 1989). CBS observation-rated 0–30 across 10 ADL items (Azouvi 2003 psychometric paper).