Acute Occupational Therapy for a Patient with Unilateral Spatial Neglect and Difficulty in Tool Manipulation: A Case Report

BACKGROUND: There are no reports on the therapeutic application of perceptive exploration activity in patients with unilateral spatial neglect (USN). This study monitored the course of acute occupational therapy using perceptive exploration activities in a patient with USN who had difficulty in manipulating tools for daily living after a stroke. CASE: A 70-year-old man was admitted to our hospital for conservative treatment of hemiparesis and USN caused by stroke. He was previously diagnosed with cerebral infarction due to middle cerebral artery occlusion. His main symptoms were hemiparesis, egocentric spatial neglect in personal space and peripersonal space, and allocentric neglect, which made it difficult to use tools for daily living. Within 24 h of admission, perceptive exploration activities were initiated as the main therapy in addition to preparatory therapies, such as the facilitation of selective movement of limbs affected by paralysis. These therapies were provided over a 30-day period in 40-min sessions, 5 days a week. This treatment resulted in improved test results for the Fugl-Meyer Assessment, Bisiach’s body neglect and anosognosia scales, and the Behavioral Inattention Test. The Functional Independence Measure scores also improved with the improvement of neglect symptoms. DISCUSSION: This case study monitored the improvements of egocentric spatial neglect and allocentric neglect during therapy using perceptive exploration activities in a patient with USN who had difficulty manipulating tools for daily living. The effectiveness of the therapy should be confirmed by increasing the sample size in future studies.