A few years ago, my great aunt May had a stroke. I was working away from home at the time, but my mother reported going to visit her and noticing that only one half of the makeup on her face was correctly and really “done”. My mother reported that May did not pay attention to one side of her body and had a condition that can occur called unilateral neglect.

Unilateral neglect, also known as hemispatial neglect, spatial neglect, visuospatial neglect, visuospatial agnosia, and hemispatial agnosia, is a common occurrence after a stroke (Chan and man, 2013, p. 126). “Unilateral neglect is more common in right-hemisphere lesions 6 and is associated with lesions of the inferior parietal lobe and thalamus, basal ganglia, internal capsule, and paraventricular white matter in the temporal lobe or superior temporal cortex” (Chan and Man, 2013, p. 127). It affects the side opposite a brain lesion.

Unilateral neglect involves a reduced ability to perceive, respond, or orient to stimuli on one side. There are three presentations of unilateral neglect; personal, peripersonal and extrapersonal neglect based on the area the patient is unable to perceive (Chan and Man, 2013, p. 130). Unilateral neglect also often occurs in conjunction with other behavioral features that are typically associated with right-hemisphere damage, such as denial of illness, constructional deficits, and apraxia and is most often resolved one month following the stroke (Chan and Man, 134).

“Traditionally, the assessment of ULN in the clinical setting has involved the use of “pen-and-paper” tests such as line bisection, cancellation tasks, copying, and drawing” (Plummer, Morris, and Dunai, 2003, p. 732).  Another method is to assess the patient while they attempt daily life skills such as shaving and dressing. Physical therapy and occupational therapy are the recommended treatment ((Plummer, Morris, and Dunai, 2003, p. 739).

If a relative or person you know is suffering from unilateral neglect, is it important to remember that each person will present differently. Try to approach the person from the affected side to help them recall that side. A good technique is to put objects on the affected side and encourage the person to look for them or find other ways of incorporating the neglected side (3).

In conclusion, unilateral neglect is a condition that occurs after stroke. It is associated with longer hospital stays and recovery times Chan and Man, 2013, p. 134). There is at this time no prevention.

1. Chan, D.Y.W., and Man, D.W.K., (2013), “Unilateral Neglect in Stroke: A Comaparative      Study”, Topics in Geriatric Rehabilitation 29:2, April/June 2013, p 126–134.
2. Plummer, P.;Morris, M., E, Dunai, J., (2003), “Assessment of unilateral neglect”, Physical   Therapy 83, 8; ProQuest Nursing & Allied Health Source, pg. 732-740.
3. http://www.stroke-rehab.com/unilateral-neglect.html

Many people have the wrong idea of autism. Despite the widespread prevalence of the autism and the celebrities that try to bring awareness to the condition, many people still picture Dustin Hoffman in Rainman. The reality is that autism is a complex diagnosis that runs a gauntlet of behaviors and symptoms and is characterized by a “spectrum” as opposed to a single concrete diagnosis. However, one particularly consistent behavior in patients with autism is differences in eye gaze.

Autism is a developmental disorder characterized by three main clusters of symptoms; impairment in social interaction and communication, and ritualized behavior or unusual adherence to routines. (Rutherford and Krysko, 2008, p.1958). In children with autism, gaze following develops late and does not follow the general pattern. Autistic children are less inclined to look when other people look, (gaze following) and use eye gaze to regulate talking in turn in conversation (Rutherford and Krysko, 2008, p.1958).

Joint attention is a “triadic relationship between self, other, and object” (Leekam, Lopez, and Moore, 2000, p. 261). “Autistic impairments in joint attention are related to a variety of behaviors, including problems in looking, touching, pointing, and showing behaviors” (Kylliainen and Hietanen, 2005, p.435).  The problem seems to lie in attentional processing abilities of people with autism. Studies have shown that there is less of a reaction of reflexive attention in response to eye gaze in people with autism, but that this decreases with age (Rutherford and Krysko, 2008, p.1959). Normal developing babies develop this ability by age one, while children with autism respond closer to age four (Kylliainen and Hietanen, 2005, p.436).

There is neurophysiological evidence that suggests specialized brain mechanisms are cued by the visual system in respect to gaze direction (Kylliainen and Hietanen, 2005, p.437).  However the jury is still out on whether or not people with autism use the same parts of the brain to process information regarding visual cues and eye gaze. Studies have shown that autistic people fluctuate in their ability to respond to visual and auditory stimulus, and that they have difficulty changing attention from a main focus to a peripheral stimulus (Leekam, Lopez, and Moore, 2000, p. 265). All of these concepts and studies are made all the more difficult by the wide range of the Autism Spectrum Disorder.

In conclusion, “Autism is a neurodevelopmental disorder characterized, among other things, by impairments in reciprocal social interaction and communication” (” (Kylliainen and Hietanen, 2005, p.435). One issue that autistic individuals struggle with is following eye gaze and using it appropriately to gage situations. Early studies showed that children with autism failed to use eye gaze to determine visual cuing. Further studies have demonstrated that this effect is eliminated as they age.

Source:

Rutherford, M.D., Krysko, K.M., (2008), Eye Direction, Not Movement Direction, Predicts Attention Shifts in Those with Autism Spectrum Disorders, Journal of Autism and Developmental Disorders 38.10, p. 1958-1965.

Kylliainen, A., Hietanen, J.K., (2004) Attention orienting by another’s gaze direction in children with autism, Journal of Child Psychology and Psychiatry 45:3, pp 435–444

Leekam, S.R., Lopez, B., Moore, C., (2000), Attention and Joint Attention in Preschool Children With Autism, Developmental Psychology 36.2, p. 261-273.

After high school, I worked in a tobacco store. The store was in a moderately busy area in a city with high crime. The owner of the store had been robbed in the past and he had installed security measures to deter crime and help identify criminals. One of the devices that was installed was an adhesive-backed strip that indicated height along the doors. “Height markers are used in banks, police departments, retail markets and medical institutions” to help eyewitnesses gauge the height of suspects (http://www.usbanksupply.com/index.cfm/go2/view/pID/779/n/height-markers-for-banks). Why do these strips work? How do people judge height?

According to the textbook, the perceptual system takes depth into account to help people more accurately perceive the size of objects that are far away (Goldstein, 2008, p.53). People judge size based on a person or thing in relationship to the surrounding environment (Goldstein, 2008, p.53). But how we perceive things is a mixture of what our receptors show us combined with “expectations, intent, and effort” (Clerkin, Cody, Stefanucci, Proffitt, Teachman, 2009, p. 382). What does this mean for the perception of height during robberies?

Forensic sociologist Dr. Rosemary Erikson, stated that the reason height strips were seen as necessary was that clerks frequently overestimate the height of criminals when giving descriptions (http://www.slate.com/blogs/browbeat/2012/09/17/height_strips_in_convenience_store_what_are_they_for_.html). “Anyone can look tall when they’re pointing a gun at you” (http://www.slate.com/blogs/browbeat/2012/09/17/height_strips_in_convenience_store_what_are_they_for_.html). Fear is thought to create biases in visual perception potentially associated with the anxiety of events such as robberies and assaults (Clerkin, Cody, Stefanucci, Proffitt, Teachman, 2009, p. 381).

The reality of the height marker is that it works more as a deterrent then an identification tool. Employers are responding to extensive studies by training their employees to deter would-be robbers by making eye contact and establishing a relationship (Alitzio and York, 2007, p.27). After a robbery is in progress, clerks are most often trained to cooperate and give whatever they can and not appear to attempt to identify assailants (Alitzio and York, 2007, p.27). Surveillance cameras can record a suspect’s height and description more accurately, watching them run out the door is no longer advisable (http://www.slate.com/blogs/browbeat/2012/09/17/height_strips_in_convenience_store_what_are_they_for_.html). If fact, it is most likely that the height strips are now positioned in reference to the camera and not the clerk.

The way that humans perceive the height of individuals involves the data that stimulates their receptors, the context, and the knowledge and expectations of the perceiver (Goldstein, 2008, p.53). In cases of stress, anxiety, and fear, humans have a tendency to fail or inaccurately judge heights. In stores, height markers were believed to help eyewitnesses more accurately gage the height of suspects. In reality, these height strips function as a deterrent more than a perception aid.

Sources:

http://www.slate.com/blogs/browbeat/2012/09/17/height_strips_in_convenience_store_what_are_they_for_.html

http://www.usbanksupply.com/index.cfm/go2/view/pID/779/n/height-markers-for-banks).

Clerkin, E. M., Cody, M. W., Stefanucci J.K., Proffitt, D. R., Teachman, B.A., 2009, Imagery and Fear Influence Height Perception, Journal of Anxiety Disorders, ISSN 0887-6185, 2009, Volume 23, Issue 3, pp. 381 – 386.

Altizio, A., York, D., 2007, Responses to the Problem of Robbery of Convenience Stores, Problem-Oriented Guides for Police Problem-Specific Guides Series No. 49, U.S. Department of Justice, Office of Community Oriented Policing Services