The role of imagery in the rehabilitation of neglect in severely disabled brain-injured adults.

Two single case studies are presented examining the effects of imagined limb activation in participants with unilateral visual neglect and severe physical disabilities. The first study employed a standard ABBABBA design where the participant was asked to imagine making movements with his left arm during the intervention conditions. Neglect was systematically assessed at each stage on the following measures: line bisection, star cancellation, and a scanning task. Performance during intervention conditions was compared to baseline conditions. The results suggest that imagined activation of the left arm may significantly reduce the severity of left neglect. The second study used an ACCABBACCABBA design. The participant was asked to imagine making movements with his left arm during the intervention conditions and with his right arm during the control conditions. The measures used in this study were line bisection, star cancellation, and letter cancellation. The results showed that there was no reduction in neglect symptoms associated with imagined left arm movements, but there was an increase associated with imagined right arm movements. This was thought to represent either a specific difficulty imagining left arm movements or a difficulty in combining left arm imagined arm movement with task completion. Overall, the results support the hypothesis that imagined movement can affect the presentation of neglect, and that the effects are specific to the arm that is used. This technique may prove useful to the clinical practitioner working with severely disabled brain-injured adults with neglect for whom conventional intervention techniques are inappropriate.