We report evidence that visual representations of space close to the body can be extended when a patient uses a tool to explore the environment. HB had severe neglect of left and far spatial regions which was determined more by how locations were visually perceived than by how they were represented tactilely or through proprioception. His ability to detect visual targets in left and far space was improved, however, when he held a tool. He also had limited tactile/proprioceptive knowledge about the location of his hand. These data suggest that by holding a tool, HB's more intact representation of near, visual space could be extended to include stimuli presented at a distance from his body. This extension of space improved his detection of visual stimuli. We discuss the implications of the results for the nature of our internal representation of space.
People who have strokes suffer a variety of problems, depending on the site and severity of brain damage. A particularly unpleasant and dangerous one is dysphagia which, if not properly assessed and managed, can prevent the patient receiving adequate nutrition to enable him or her to participate fully in a rigorous rehabilitation programme, or which may even cause his or her death through aspiration of food. The authors describe an appropriate nursing response to the problem, and advocate a multidisciplinary approach to the management of nutrition in the care of patients with strokes.
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