The Lighthouse Strategy: Improving the Functional Status of Patients with Unilateral Neglect After Stroke and Brain Injury Using a Visual Imagery Intervention

Abstract

This study extends the work of J. Niemeier (1998) by using visual imagery for amelioration of the devastating impact of visual inattention or neglect on recovery from stroke or other brain injuries. Ten individuals with unilateral visual neglect who were undergoing acute physical rehabilitation after brain injury were cued by their interdisciplinary treatment team members to "be like" horizon-illuminating lighthouses and turn their heads left and right during functional and therapy training tasks. These treatment group patients, in comparison with waiting list controls, performed significantly better and more safely on route finding (p <.001), walking or wheelchair (p <.05), and problem solving (p <.05) tasks. The use of visual imagery techniques in rehabilitation of brain injuries is discussed.

Comparison of Virtual Wheelchair Driving Performance of People With Traumatic Brain Injury Using an Isometric and a Conventional Joystick

“…Studies have shown that one strategy to improve task efficiency of people with visual neglect is to cue them in using a light house visual imagery strategy while performing functional tasks. (17,18) A horizon illuminating light house typically has a light at its top that sweeps left to right to guide ships at sea to safety. The light house visual imagery strategy encourages users to scan the environment around them by turning their heads as and when required.…”

Occurrence and measurement of transfer in cognitive rehabilitation: A critical review

“…Patients are instructed to start scanning from the anchor cue. In one study, this strategy was internalized by teaching the patient to turn his head until the tip of his chin was in line with the top of his left shoulder and to move his head until the tip of his chin was in line with the top of his right shoulder (51).…”

“…Therefore, little change in cognitive deficits is expected in cognitive strategy training (2). However, the 13 studies we included in our review did evaluate transfer effects of strategy training to neuropsychological test results in addition to one of the other types of transfer we distinguished (22,23,26,27,29,31,34,36,47,48,(50)(51)(52). Eleven studies did report transfer to neuropsychological test results.…”

Prism adaptation for spatial neglect after stroke: translational practice gaps

“…Other spatial neglect treatment approaches are available and used in the USA, but most of these also utilize top-down (goal-driven) strategies to enrich visual perception and monitoring, and are intended for self-implementation. These strategies include training of visual awareness, 22 therapist-coached use of mental imagery (the ‘lighthouse strategy’ 23 ), and review with a therapist of videotaped feedback of task performance. 24 …”