After a stroke, patients may experience decreased awareness of their side, such as the left side of either themself or their environment. One way to increase awareness, which is quite intuitive actually, is to place objects, environment, basically stimuli (this includes sounds, lights, etc.) on the side of their deficit. This is often their left side such as with left inattention or left neglect. However, one thing to note is that for safety reasons, important objects such as the call bell in a hospital should be placed on the side so that the patient can easily find it.
Non-deficit side:
- Call light remote
- Smartphones & Tablets (patients tend to misplace these quite often)
- Signage posted by staff
Deficit side:
- Bed adjustment control remote
- Food
- Beverages (cups & water bottles)
- Radio
- TV
- Remotes
- Amazon alexa and other smart devices
- Lights and lamps
- Aromatherapy emitters
- Glasses
- Books & newspapers
- Mirrors
- Clocks & watches
- Toothbrushes and other grooming supplies
- Medications
- Theraputty
Another key consideration is the direction to orient the bed and chair that the patient sits on.
For example, if the patient has left neglect, and the left side of the bed is a wall, the patient could benefit from having the bed flipped around 180 degrees so that the left is no longer a wall, but instead the rest of the world. This may seem very extreme, especially in places like a hospital where things are pretty set up the way they are, such as the oxygen behind the bed, doorways, etc. So every case is different and each facility is different. But think about how much of a difference this could make. If such a change is not possible or considered “safe” for your facility, it is worth educating the patient and their family about this trick for settings such as their own home.
From my experience, left inattention and neglect are difficult to overcome and take time. So in settings such as acute care and acute rehabilitation, you probably are not going to “fix” the patient’s left inattention or neglect. As occupational therapists play an important role in education, practitioners should highly consider passing on this information to the patient and their caregivers. You might even want to consider placing this in your discharge recommendation checklist after evaluation of the patient’s home environment.
Because it is likely very possible for the patient to have their bed flipped in their home environment. This can have a significant positive impact on their recovery for left inattention and left neglect.
Of course, this is not a one-size fits all answer. The environment and the patient’s ability as well as their activities are worth considering as well right. For example, does the spouse have any limitations? Is the environment even feasible to flip the bed? Which side is the stroke on? What objects such as furniture may be in the way?
Oftentimes, in addition to re-arranging the bed, having the chair oriented in the same way as to promote attention to the deficit side should be part of the team’s plan. So if re-arranging the bed is impossible or not practical, at the very least, the patient should have their chair oriented in this manner throughout all stages of the stroke recovery: in the hospital, at a SNF, and at home.
But why not take this even a step further? Why stop at bedside chairs? How about dining chairs, e.g., placing everyone at dinner to the left of the patient? Or furniture in the living room. Where the patient sits in the car. The shower chair being flipped around so the water is on the patient’s left side. Or even where the patient stands relative to what they are working within their environment (it doesn’t just have to be sitting).
We often place objects in a certain way that seems natural or intuitive either as a patient or therapist, but as awkward as it may seem, try to think outside of the box and flip the script for the benefit of their recovery. Encourage your patients and their caregivers to problem-solve and do the same. This can have an exponential impact on the patient’s recovery, not only for attention to one side but also the use of their body such has their arms for functional tasks and to decrease the chances of learned non-use.