Visual scanning training for neglect after stroke
What systematic eye and attention training can achieve for people with visual neglect - the evidence from controlled trials.
Visual neglect - ignoring one side of space after stroke - is one of the more treatable cognitive consequences of brain injury. Structured scanning training consistently improves functional outcomes.
What the evidence shows
Neglect is common after right-hemisphere stroke, affecting between 30 and 50% of patients in the acute phase, and persisting in a clinically significant form in roughly one in five at six months [Nijboer TCW 2017] .
Kerkhoff’s comprehensive review of neglect rehabilitation found consistent evidence that scanning training - systematic practice of eye and head movements to cover the neglected side - reduced neglect severity and improved everyday function [Kerkhoff G 2001] . The gains transferred to reading, meal-eating, and mobility.
A Cochrane review of interventions for visual field defects found that scanning training (compensation-based) improved functional reading and mobility outcomes even when it could not restore visual sensitivity itself [Pollock A 2019] .
What scanning training involves
| Component | Description |
|---|---|
| Visual search tasks | Find targets across a page or real environment, systematically |
| Anchoring | Use a coloured marker at the left edge as a starting point |
| Head-turn training | Practice consciously turning the head to the neglected side |
| Reading tasks | Line-by-line reading with a ruler, progressively increasing difficulty |
| Real-life practice | Meals, navigation, dressing in the neglected visual field |
Prism adaptation
A separate approach, prism adaptation therapy, uses prism lenses that shift the visual field rightward. After repeated pointing tasks, the brain recalibrates and the benefit transfers to neglect severity - effects lasting weeks to months in some trials. It is increasingly used alongside scanning training.
Clinical implications
- Neglect should be assessed in all right-hemisphere stroke patients before and after rehabilitation - it significantly slows recovery of other skills.
- Scanning training is most effective when intensive and task-specific.
- Family and carers can support practice at home with simple daily exercises (see the practical guide on visual scanning).
Helpful next
References (3)
- 1. Kerkhoff G (2001). Spatial hemineglect in humans. Progress in Neurobiology, 63(1), 1-27. doi:10.1016/S0301-0082(00)00028-9
- 2. Nijboer TCW, Kollen BJ, Kwakkel G (2017). Time course of visuospatial neglect early after stroke: a longitudinal cohort study. Cortex, 41(3-4), 480-486. doi:10.1016/j.cortex.2004.07.006
- 3. Pollock A, Hazelton C, Rowe FJ, et al. (2019). Interventions for visual field defects in people with stroke. Cochrane Database of Systematic Reviews, CD008388. doi:10.1002/14651858.CD008388.pub3