Definition and Neurological Etiology
Neglect in general refers to the inability to pay attention, be aware of, and explore one side of contralesional space. Researchers have identified three different spaces in which neglect can occur: extrapersonal (far space); peripersonal (near space); and personal (body space) (Bartolomeo, Thiebaut de Schotten, & Doricchi, 2007). It is important to understand that although these forms of neglect are related to each other, each is a separate and disassociated condition. This means that a person with neglect can exhibit inattention in one, or two, or all three of those spaces (Commiretti et al., 2006). Though this is the case, the majority of research has focused on the phenomenon of extrapersonal and peripersonal neglect, with very few studies noting findings exclusively on personal or body neglect.
Body neglect, like all other forms of neglect, usually occurs on the side that is contralateral to the area where an individual has experienced trauma to the brain. Such damage is most commonly caused by stroke. Neglect after stroke is frequently spoken about in the literature as a "left-sided neglect" due to injury of the right hemisphere of the brain (Ching-Yi Wu et al., 2013) and is explained by the theory that one side of the brain will control function towards the opposite side. Neglect has typically been associated with cortical damage to the areas of right hemisphere that play important roles in attentional processes. There is however, disagreement as to which specific areas are associated with specific types of neglect.
One study used statistical analysis of brain lesion mapping to highlight the involvement of the right prefrontal lobe to visual-motor neglect, the temporal lobe to object centered neglect, and the parietal lobe to perceptual neglect (Verdon, Schwartz, Lovblad, Hauert, & Vuilleumier, 2010). Research by Ortigue. Me´gevand, Perren, Landis, & Blanke (2006) did not find neurological etiology to have sharp distinctions and suggested that although perceptual, motor, and representational neglects are disassociated through assessment, they share areas of brain involvement.
Other research asserted that the neurological etiology of personal neglect is different than that of extrapersonal neglect (Committeri et al., 2006). Committeri et al. (2006) analyzed the plotted graphs of brain lesions in individuals with neglect and found that those with extrapersonal neglect had damaged ventral frontal lobes, while those with personal neglect had damaged inferior parietal lobes. On the other hand, a lesion study conducted by Zeller, Gross, Bartsch, Johansen-Berg, and Classen (2011) found that the ventral prefrontal lobe was implied in being aware of and feeling ownership over one's body parts, which is a particular issue for individuals with body neglect. Still, they concluded that this kind of body awareness likely arose from the communication between several brain areas instead of just one main area (Zeller, Gross, Bartsch, Johansen-Berg, & Classen, (2011).
Occupational Performance Problems
The dysfunction caused by neglect due to right sided brain damage is devastating to occupational performance. Individuals with body neglect don't attend to their left body parts. They will not respond to stimuli placed on their left limbs, may sometimes not move the left limbs, and in other cases may not even recognize the left limbs as their own. These issues impact functional performance in everyday life to such an extent that researchers agree that the mere presence of neglect itself is linked with low functional outcomes after stroke. Individuals who experience neglect typically do not recover as well as stroke patients without neglect (Bartolomeo, Thiebaut de Schotten, & Doricchi, 2007).
People with body neglect have definite issues with successful completion of activities of daily living (ADL) because it is particularly difficult for them to attend to both sides equally during