Successful return to professional work after neglect, extinction, and spatial misperception - Three long-term case studies.

Spatial neglect is a frequent, disabling syndrome and is associated with a poor rehabilitation outcome. Return to work seems almost impossible and has not been reported so far. Here, three cases with extensive right-hemisphere lesions after stroke are reported, who all showed residual left visuospatial neglect, left visual extinction on double simultaneous stimulation (DSS), and marked spatial-perceptual deficits. After early inpatient rehabilitation all three patients received specific, successive neuropsychological therapy as outpatients in four domains: (1) Optokinetic stimulation with pursuit eye movements and saccadic eye-movement training to reduce left-sided neglect and improve visual exploration; (2) Anti-extinction training to reduce left-sided visual extinction; (3) Spatial-perceptual feedback training to improve spatial-perceptual disorders and visuoconstruction; and (4) Job-related visual and cognitive treatments. All three cases were treated in sequential single-subject baseline designs. Significant improvements were obtained in all treated domains during therapy, which persisted at follow up. After a period of graded vocational re-integration, all three patients worked successfully in their prior job, two part-time (50%), one full-time (100%). These results show that return to professional (paid) work is possible despite initially severe neglect, hemianopia, visual extinction, and spatial-perceptual disorders after stroke.