"Neglect" is the inattention to, or lack of awareness of visual space to the right or left and is most often associated with a hemianopsia. The lesion in the brain causing neglect usually occurs in the right frontal-parietal lobe, resulting in a left side neglect. Some patients just have a hemianopsia with no neglect, but others may experience a lot of "neglect" and may be unaware that they can not see to the affected side.

Signs and Symptoms of Neglect

• Can not or does not readily/spontaneously scan into the area of the hemianopsia.
• No awareness that a hemi field loss exists
• Says doesn't see out of the eye (on the side of the neglect)
• Bumps into things on side of the hemianopsia but doesn't learn to compensate for the problem
• Misses parts of words on the side of the neglect when reading
• Misses parts of eye chart line on the side of the neglect
• Tendency to orient head or body turned away from the neglect, and the patient may ambulate/drift in direction away from the neglect.

• Encourage eye and head movements to the neglected side, including scan board exercises.
• Teach the patient touse closed eye movements toward the neglected side, (if the patient has difficulty with open eye movements in that direction).
• Have the patient ambulate around the room in a direction toward the neglected side to reinforce the lack of a visual map of space on the neglected side
• Have the patient use a flashlight aimed alternately toward each foot while walking, to enhance vision with motor reinforcement on the neglected side
• Encourage the playing of games like crossword puzzles and real playing card (not computer) games, because these non-computer games involve tactile/sensory input.
• Teach the patient to read while using the "Rummel Eye Care Hemianopsia Reading Guide". These guides are available at no charge from Rummel EyeCare to appropriate rehabilitative professionals.
• Use "Rummel Hemianopsia Buttons" to instruct the patient's family to learn to sit on the side of the neglect, in order to encourage the patient to attend to space on the side of the neglect. These buttons are available at no charge from Rummel EyeCare to appropriate rehabilitation professionals.
• Increase the patients sensory awareness in the area of the neglect: Have them squeeze a ball using either hand, but on the side of neglect. Have the patient trace a line that extends into the side of the neglect. Have the patient put their finger at the far side of the line in the area of the neglect, and then the therapist rubs the finger to stimulate sensory awareness on the neglected side.
• Have the patient look toward the area of neglect with their eyes closed. Then when the patient thinks they are looking toward the neglected side, have the patient open the eyes, so that both the patient and the therapist can see how far toward the neglect the patients eyes are actually postured.
• Tell the patient to forcibly/rapidly move their eyes as far toward the neglect while sensing the feeling of their eyes at the extreme gaze. Then see how far toward the neglect they actually moved their eyes. Encourage the patient to become aware of the "feel" of their eyes when gazing as far toward the neglect as possible.
• Have the patient wear a "beeper-timer" wristwatch to beep at intervals to remind them to scan toward the neglected field at regular intervals.
• Once the patient has awareness of their hemi field loss, teach the patient to ocularly scan about 20 degrees toward the field loss, and then to use head turning with ocular scanning when viewing past 20 degrees laterally.
• Use tactile reinforcement to help the patient find the margin of the page on the neglected side by having the patient feel a Velcro or sandpaper strip at the margin.
• Use therapies to stimulate movement into the area of neglect like balloon catching/tossing, and also searching for predictive (and later non-predictive) stimuli in the neglected field.
• Turning a page at a 45 degree angle will help reading ability for some patients with neglect who do not respond to other treatments.
• Do not train with "screen" activities use (TV, computer, Gameboy, etc). Screen activities do not have a wide field of view and are not spatially stimulating activities

Dr. Rummel is on the of the few eye doctors in the United States with Level III Clinical Skills Certification (FNORA) in Neuro-Optometric Rehabilitation.

He is Director of the Neuro-Optometric Rehabilitation Clinic at the Bacharach Institute for Rehabilitation, Pomona, N.J., and additionally consults in neuro-optometric rehabilitation at 4 other respected N.J. rehabilitation hospitals.

Dr. Rummel has successfully treated hundreds of patients with hemianopsia side vision loss, and has written a protocol for hemianopsia scanning therapy which is used by many occupational therapists.

The care side of vision loss (hemianopsia) requires two simultaneous treatments:

Side Vision Awareness Glasses will be designed and prescribed by Dr. Rummel. These custom made glasses allow an immediate increase of about 15 degrees in side vision awareness. This reduces hemianopsia related safety issues, and enhances the patient's performance of many activities of daily living.

Vision Restorative Therapy is an innovation of Nova Vision, and is used simultaneously to treatment with Visual Field Awareness Glasses designed and prescribed by Dr. Rummel. Vision Restorative Therapy can neurologically improve side vision by about 5 degrees or more.

Fees:
The cost of Side Vision Awareness Glasses is under $2500.

The initial cost of Visual Restorative Therapy, which takes about 3 months for signs of improvement to show, is also under $2500. Treatment is done at home with special equipment loaned to you. The fee includes a $500 refundable deposit which is returned to you when Visual Restoration Therapy is completed (further VRT, if needed, is $650 per month).

The winning combination of Dr. Rummel's Visual Field Awareness Glasses, and Nova Vision's Vision Restorative Therapy, is the best way to treat hemianopsia vision loss.