Sequential Gaze-Shifting Approach to Reconstruct Self-portrait and Daily Activities in Hemispatial Neglect After Stroke: A Case Report.

OBJECTIVES: The aim of this study was to demonstrate the use of a sequential gaze-shifting approach to complete a self-portrait in a patient with hemispatial neglect after stroke as a means of rehabilitation to restore skills to perform activities of daily living (ADL).

METHODS: This case report describes a 71-year-old amateur painter who presented with severe left hemispatial neglect after stroke. Initially, he drew self-portraits omitting the left side. Six months poststroke, the patient was able to complete well-composed self-portraits by sequentially shifting his gaze and intentionally directing his visual attention from the right non-neglected space to the left neglected space. Then the patient was instructed to repeatedly practice a serial movement of each ADL using this sequential gaze-shifting technique.

RESULTS: Seven months poststroke, the patient achieved independence in ADL such as dressing the upper body, grooming, eating, and toileting although moderate hemispatial neglect and hemiparesis were still present.

DISCUSSION: The effects of existing rehabilitation approaches can be difficult to generalize and apply to the performance of each individual ADL in patients with hemispatial neglect after stroke. Sequential gaze shifting may be a viable compensation strategy in directing attention to the neglected space and restoring the ability to perform each ADL.