UNILATERAL NEGLECT
AND
RECLAIMING LOST LANDSCAPES:
An Overview
(Artist, Melanie Elliott,)
(please excuse spelling and grammar errors - artist/author is visually impaired)
OBJECTIVES:
- to introduce an innovative approach to effectively identify problems arising from the cognitive
deficit of unilateral neglect,
- to lead a self-awareness exercise for the purpose of demonstrating how the "mind's eye" can
fail to function and how that which is neglected can be reclaimed,
- to address the need to adapt and apply compensatory techniques,
- to address attitudes and behaviour necessary to successfully cope with unilateral neglect,
- to illustrate practical compensatory strategies, and
- to portray how insight and the application of compensatory strategies can enable a person living
with the effects of unilateral neglect to live a safe, quality, independent life.
1. INTRODUCTION
Addressing issues of:
a) What is Unilateral Neglect? a non-clinical definition and sample
b) Seeing with the "minds eye" - a self-awareness exercise for audience/individual participation,
c) Recognizing unilateral neglect issues, and,
d) the role compensatory strategies to memory loss play in the identification of unilateral neglect-
related problems.
2. ATTITUDES and BEHAVIOURS: taking responsibility, need to adapt and self-discipline.
3. HOW CAN LOST LANDSCAPES BE RECLAIMED? - presentation of practical solutions to
unilateral-neglect related concerns.
CONCLUSION: The following presentation describes how a systematic analytical approach can effectively serve in the identification of problems arising from the cognitive deficit of unilateral neglect. Individual participation in a self-awareness exercise will demonstrate how a neglected picture can be recovered. A slide presentation (not presently available on Internet) and handouts demonstrate innovative and practical compensatory strategies which have successfully enabled the presenter to reclaim lost landscapes in everyday living.
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PRESENTATION:
RECLAIMING LOST LANDSCAPES
Coping with Unilateral Neglect
by Melanie Elliott (Nightingale)
My story begins one warm August day when I joined friends at their country home for a barbecue. One neighbour arrived proudly displaying an old, small dirt-bike that he had found in a shed and had restored it to working condition. He enthusiastically invited everyone to share in his fun and have a ride on dirt-bike through a newly cut hay field at the back of the property - a perfect playground for his new toy.
I was excited to join in the fun and waited my turn to go for a ride. I waited in the unannounced line-up and looked forward to this experience. My moment of fun however was short-lived, I neglected to see an electrically-charged barbed wire fence enclosing the field and drove the dirt-bike into that brutal barrier. My injuries were extensive. Exposure to the electric current set off a pre-existing seizure disorder. Multiple lacerations, contusions and a severe burn to my leg presented an ugly picture. Almost two years earlier I had sustained brain damage and fortunately, this nasty accident spared me further insult to the brain.
As I lay in a hospital bed, I searched for an answer to why I did not see the fencing. I could not understand or explain what went so wrong. To make matters worse, only days after the accident and while still in hospital, I tripped over a bed stand, fell to the floor and broke my nose. One concerned friend proclaimed, "Melanie, you are an accident waiting to happen," Her words added intensity to the mystery of why accidents were occurring.
One year later an answer evolved which presented a solution to the unsolved mysteries that haunted me. A cognitive deficit or brain dysfunction termed "unilateral neglect" gave credence to three years of unexplained struggles and life-threatening injuries.
The following paragraphs which address the subject of unilateral neglect are not written from a clinical point of view. I trust this non-researched article, written from a personal perspective, will assist you in appreciating how those individuals with unilateral neglect can independently create strategies to overcome obstacles which arise from this deficit.
What is "unilateral neglect"?:
The most meaningful, non-clinical definition that I have encountered is that unilateral neglect is the inability to interpret the use, sensation and information from one half of the body and environment.
Prior to experiencing this cognitive deficit, the word "neglect" was an everyday word I used to indicate a disregard or omission of something by carelessness or design. It is now my experience that the scope of this word is much more complex and has indeed taken on a different perspective and dimension as I move about my environment with an inability to assimilate and attend to half of my landscape.
What is the cause of unilateral neglect and who does it affect?
Damage to a specific area of the right side of the brain can leave an individual with a unilateral neglect problem. Damage can be caused by a traumatic blow to the head, a stroke, an aneurysm, a tumor, lesions associated with multiple sclerosis and various other conditions and diseases affecting the brain.
Seeing with the mind's eye (for participation by the reader).
The purpose of this exercise is to provide some understanding of how the mind's eye of those with unilateral neglect can fail to function and how that which is neglected can be reclaimed. Throughout this exercise you will be using the power of your own mind's eye, in other terms, your visual imagination.
To begin using your mind's eye, envision yourself standing at your kitchen door and looking into the kitchen. This is a place we all know well and can quickly see using visual imagery. To continue, allow your mind's eye to scan the right side of your kitchen and attempt to see the order and structure of that landscape. As you continue to scan that location, take a moment and reflect on how vividly you picture this area. Likely you can easily list the order of the items you see. This completes the fist step of our exercise.
Now, in the second step, return to that same kitchen door-- to that same location you were moments ago, and allow your mind's eye to view the left side of your kitchen. Scan that landscape as you did the right side of our kitchen. Can you, again, vividly see and identify that space? Slowly follow it with your mind's vision and try to identify a few of the items along that side. In all likelihood, participants who do not experience a left-sided neglect are able to picture that landscape as easily as they did in the first step.
The outcome of this second portion of the exercise however is quite different for those with a left-sided unilateral neglect. As they stand at the kitchen door with the intent of viewing the left side of the kitchen, there is a void - the mind's eye cannot reproduce an image; it is blind to the left side. This unfortunate outcome, however, does not mean that it is lost entirely. By taking this exercise one step further these people can reclaim the left side of this landscape.
My participation in this exercise for the first time was a memorable moment and, as a memory-impaired individual, this is significant since it appears that only profound occurrences seem to be remembered. The outcome of the exercise we just walked through, opened a window to my mind - a window I was not aware was closed. It was a vision of landscapes I wasn't aware I was missing. Finally, I had some meaningful explanations to so many mishaps since my brain injury.
Excited by this new discovery, my mind raced to explore how I could incorporate this new development into my everyday activities. Over a period of time, reclaiming landscapes in the manner we just explored now plays a significant role in my everyday living. It continues to challenge my creativity to create coping strategies to the obstacles and barriers I face.
It had been only weeks after having an accident while riding a small dirt-bike in a country field surrounded by a barbed wire fence. My enjoyable moments of riding through the grasses ended when I neglected to see the fence and drove into it.....injuries were extensive. It was my great fortune that I did not sustain yet another brain injury as I didn't even have a helmet on.
Unilateral neglect awareness. You might ask how an individual with unilateral neglect can know and recognize he is not attending to one side, especially when the brain has failed to interpret information on the affected side? From years of personal experience, the only reasonable answer I can give is that a systematic analytical approach to repeated unexplained incidents serves to prov ie me with information needed to determine if it is related to unilateral neglect. When I use the phrase "a systematic analytical approach." I refer to the process we more commonly relate to as "solving a mystery". Applying a Sherlock Holmes quality to solving the mystery of an unexplained incident can add intrigue and an element of play to the potentially frustrating exercise.
Attitudes and behaviours essential to copying with unilateral neglect. Taking responsibility to reclaim identified lost landscapes is the sole responsibility of those individuals who experience unilateral neglect. No one else can identify and make the changes necessary to overcome this deficit. Excusing recurring mishaps by saying they are caused by carelessness is unacceptable and unsafe. Avoiding the responsibility to cope with the problem places everyone at risk The issue of neglecting traffic came to my attention when I barely escaped being struck down by a car as I crossed a street. I can attribute my participation in life today to the quick reaction of the drive of the care - a care that I had neglected to attend as it approached from the left. The car came to a grinding halt to avoid me, and in doing so was rear-ended by the car behind him. I was spared injury, however I suspect that the driver suffers chronic pain to this day from a whiplash injury he sustained.
Once an individual has adequate information to understand the concept of unilateral neglect and is committed to applying himself to overcome the obstacles through compensatory strategies, the successes become self-motivating.
The need to adapt and consistently apply compensatory strategies is imperative. This requires a great deal of self-discipline. Avoiding the work that is required to cope with this deficit is irresponsible.
How can lost landscapes be reclaimed? Once an individual has identified a lost landscape, the process of reclaiming it becomes a test of one's creativity. I will proceed to describe some solutions that have been developed to address problems which have arisen from a left-sided unilateral neglect. These strategies may not be appropriate for everyone, however they may serve as a foundation to which variations can be applied.
Problem: Neglecting to brush teeth on the left side and omitting to apply make-up to the left side of the face.
Solution: The key to this problem is a modified, monthly calendar placed on the bathroom countertop of the sink area. Calendar modification includes a blue and red coloured sticker placed on each day of the month. The blue sticker is used to give a clue to attend to the left side of the mouth when brushing. After teeth are brushed on both sides, the blue sticker is removed.
Problem: Losing articles carried on the affected side. Frantically trying to back-track a series of events to find a suspected missing over-the-shoulder camera, a briefcase or a purse can be a harrowing experience. This scenario has a happy ending when an observer informs a stressed, frantic person in this situation that the items he is looking for are merely hanging over his very own shoulder. There is an immediate sense of relief, but this is very quickly followed by devastation as the futility of this stressful experience is realized.
Solution: It is essential that persons with unilateral neglect consistently place items of such importance over the should of the non-affected side. If appropriate, the over-the-shoulder portion of the item can be pinned or velcro'd to the shoulder section of a garment and can be concealed under the collar.
Problem: The omission of utensils and food items at meal time.
Solution: Placing all utensils and glassware on the non-affected side offers a solution to this problem. This strategy should be applied to all items we would commonly find on the table at meal time - salt, pepper, butter etc. Personally, difficulty of omitting food on the affected side came to my attention when, all too often, someone would ask if they could have the dessert that I had not touched. For one with a sweet tooth, I was quick to solve that problem and place desserts on the right side.
For some individuals, there is the need to rotate a dinner plate a one-half turn before the end of the meal. This strategy insures the entire meal is viewed and nutritional needs met.
If a meal is served on a pre-organized type tray, as happens in a health care institution, the latter strategy is not suitable. The alternative solution is to attend to that which is in "slight" and before considering the meal complete, turn the tray a half-turn to ensure nothing has been unknowingly omitted.
Problem: Becoming disorientated and unable to identify landmarks when travelling by public transit.
Solution: As a passenger with left-sided neglect, sitting on the right side of the bus ensures buildings and other landmarks are identified as the bus travels on its route. This compensatory strategy enables one to travel about the city with the certainty of knowing at which bus stop to disembark and therefore arriving at the desired location.
Problem: Failing to engage elevators. Waiting for an elevators are situated can pose a confusing landscape for an individual with this deficit. The confusion arises from an inability to track the sequence of the movements of the elevators on the affected side.
Solution: Placing oneself so that all elevators are in view from the non-affected side will ensure all elevators are in the total landscape.
Problem: Major obstacles are presented to persons with unilateral neglect in grocery stores. These stores are designed so that a shopper can attend and retrieve a wide range of food stuffs as he/she walks down each aisle and views displays on both sides. This design presents a tremendous hindrance for an individual with a unilateral neglect as he/she can attend only those items on his/her affected side.
Solution: Walking down the right side of the aisle and selecting food items from only the non-affected side and then turning oneself and grocery cart around to attend to items of the opposite side on the same aisle enables one to view items on each side of the aisle.
Problem: Repeatedly leaving items behind in a grocery cart when taking items out of the cart and placing them on the cashier's station. This problem came to my attention when I repeatedly found items to be missing as I unpacked groceries at home. A systematic analysis revealed that these forgotten items had been consistently placed in the far left section of a grocery card. By design, grocery cart placement at the cashier station dictates that the cart is positioned on the customers side.
Solutions: Placing a grocery cart on my right side and removing items from that position has successfully eliminated this problem.
Problem: Putting on a newly pressed garment to repeatedly discover only a portion has been ironed.
Solution: This problem can be resolved by ensuring the garment, when being ironed, is placed entirely on the non-affected side. Additionally, all ironing accessories - starch, pressing cloth, etc - must be placed on the attended side.
Problem: We can all identify with the problem of not being able to find a specific item in a drawer when we are so certain it was placed there only hours ago. For a person with a unilateral neglect, this can be an overwhelming frustration as those items placed in the drawer on the affected side are omitted regardless of how hard one looks.
Solution: An individual with this cognitive limitation must make a concentrated effort to be well-organized and place frequently used items on the non-affected side of a drawer. Less commonly used articles can quite adequately occupy that space which is omitted. One effective example that works in my home is placing socks in the right side of a drawer - the non-affected side - and a collection of soaps and sachets on the left. This arrangement works well as sock absorb the pleasant fragrances.
Problem: Dialling wrong numbers and inability to locate pencils, pens and paper while using the telephone.
Solution: Numbers, particularly on a touch-tone telephone, are difficult to visually identify when a telephone is placed on the affected side. Positioning the telephone so that it sits on the non-affected side of the user will dramatically reduce the frequency and frustration of dialling wrong numbers.
The placement of pens and paper placed on the non-affected side will eliminate the frustration of not being able to find writing accessories. Frequently, a telephone user with a left unilateral neglect will need to excuse himself from a telephone conversation to search for a pen elsewhere in the home when one is sitting just a little to his/her left and just out of the boundaries of his/her landscape.
Problem: Injury to the hand of the affected side when using household appliances or industrial equipment.
Solution: Ensuring the hand of the affected side is out of range of hazardous machinery or substances is imperative. The use of a common kitchen appliance - an electric mixer well describes this statement. For example, in the case of left-sided neglect, the hand of the affected side must remain in a safe position as it steadies the base of the bowl, while the right hand controls the appliance.
When the bowl is to be turned, it would be quite natural to do so by using both hands simultaneously - the right hand to continue working the mixer and the left hand used to rotate the bowl. In the situation where a left unilateral neglect is present, this strategy is a dangerous exercise as the operator is uncertain of the whereabouts of the left hand - the risk of fingers getting caught in the blades of the mixer is great. This situation calls for the appliance to be turned off before proceeding to turn the bowl.
This strategy and variations of this are applicable to a great list of situations ranging from the use of a carpenter's tablesaw to the use of a paper- cutter in an office setting.
CONCLUSION: In reflecting back on the compensatory techniques, it is clear that there is a commonality to most strategies. The process of placing items on the non-affected side is imperative whether it be achieved by re-arranging the pre-existing landscape or by manipulating a landscape by repositioning the person.
This article describes a sampling of solutions to problems that arise from unilateral neglect. Other common issues to be addressed when living with the effects of unilateral neglect include the placement of home furniture, design of wheelchairs and other adaptive equipment, alternatives in recreation activities, etc.
The process of identifying problems arising from unilateral neglect has become a curiously fascinating exercise for me. I receive a great sense of self-satisfaction from being able to identify and solve the mysterious problems arising from this deficit. I cannot take personal credit for gaining this insight into the concept of unilateral neglect and for the development of all the strategies you have reviewed. The guidance and encouragement of a team of tenacious, patient and compassionate health care professionals have played a significant role in my successes and wellness
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