never heard of visual spatial neglect
but then in July of 2012 along with
about 60,000 other Australians that year
my mum suffered a stroke she was only 51
at the time her mum stroke was
substantial it affected a large portion
of the right hemisphere of her brain and
as a result she’s been living with a
disability of a sense now at the time I
didn’t know a lot about strokes I was
only 19
I’d only recently finished my first year
of university I knew that in some
instances strokes could be fatal and I
was vaguely familiar with the idea that
many people have had a stroke often have
some form of paralysis but that’s it
that’s all I knew I was about to have a
very steep learning curve with my
brother and sisters our mum lives with
the more common or recognisable effects
of stroke hemiparesis which is the
paralysis or loss of sensation on one
side of the body mobility difficulties
as a result of this paralysis and
significant memory and attention
difficulties but she’s also been left
with a really common post stroke
condition but one that I had never heard
of until she had a stroke it’s called
visual spatial neglect or VSN for short
visual spatial neglect is believed to
acutely affect about two-thirds of
stroke patients who suffer damage to the
right hemispheres of their brains in
particular damage to the parietal lobe
which is the center of our brain that
helps us manage
Sections sensory input and helps us
understand the layout of spaces now
while the majority of people who have
VSN have acquired it as a result of a
stroke it’s important to note that it’s
not a condition that is confined to
stroke patients VSN can occur after any
significant brain trauma think anything
and everything from extreme sports
accidents to car crashes slipping over
and hitting your head on the floor too
hard violent assaults and anything in
between it can also occur as a result of
Alzheimer’s so it’s really very common
but if you’re anything like I was at the
time you’re probably wondering so what
exactly is visual spatial neglect
broadly speaking neglect is a series of
disorders which removes your ability to
properly process stimuli or sensation in
the case of visual spatial neglect it’s
an inability to process visual stimuli
more specifically it’s an inability for
the brain to process what the eyes are
seeing on one side of the world all of
the data is coming in through your eyes
but the brain just can’t process it as a
result people with visual spatial
neglect lose the ability to be
consciously aware of one side of the
world around their bodies most commonly
this is the left-hand side now the way
that VSN works it’s not like you’ve got
a split down your visual field it’s not
a blindness your eyes are working
perfectly fine imagine instead that
you’ve got a perfectly good working
camera and you take a picture but when
you try to print that picture out your
printer only spits out half a page the
brain doesn’t recognize the data coming
in from the left hand side of the world
and it assumes
that all of the data coming in from the
right hand side of the world is the
entirety of your vision
in severe cases this can lead to people
literally avoiding one side of the world
now this can be a pretty tricky concept
to grasp but on a day to day basis
somebody with visuospatial neglects may
only eat food off one side of their
plate they may only wash or shave one
side of their face and they’ll tend to
read text from the middle of the page
rather than from the left-hand edge
their brains completely failing to
provide data that the other side of the
world is there in order for them to
engage with it now this can escalate to
being a serious and very dangerous issue
pretty quickly potentially the most
dangerous aspect of esm is the tendency
for patients to overlook obstacles in
what’s referred to as their neglected
side so as a result they can have a lot
of difficulty learning the layout of
spaces and how to move through those
spaces effectively dramatically
increasing the risks of Falls and
associated injuries as if this wasn’t
difficult enough it’s further
complicated by what’s referred to as a
body imaging deficit somebody with a
visual spatial neglect can have a lot of
trouble understanding the physical
dimensions of their own body they’ll
tend to neglect 1/2 so whilst I
understand that I’m this wide and I can
fit through a space this way somebody
with a visual spatial neglect may only
understand one half of their bodies as a
result they’ll often misjudge the kind
of spaces that they can move through or
they will greatly overcompensate for
what they can see as you can imagine
visual neglect patients will often run
into doorways or furniture on their
neglected side and if you couple this
with the common physical aspects of a
brain injury
mobility difficulties issues with
balance you can start to see how
everyday tasks and movements that would
otherwise be quite common and mundane
now start to present a very real
potential danger now I’d like to start
telling you that at this point things
get better but unfortunately it gets
worse an enormous associated difficulty
with visual spatial neglect is that it’s
often accompanied by a condition called
anis Ignazio which makes the patient
unable to recognize that they have an
issue at all so they’ll have a lot of
trouble actively compensating for their
neglect because their brains will be
telling them that nothing is wrong as we
saw it treatment and support for mum I
quickly came to realize that the
treatment methods for visual spatial
neglect were both limited and pretty
time-consuming in their execution the
most common form of treatment is through
what’s called behavioral mitigation
strategies intensive one-on-one therapy
a therapist will go through a number of
activities to try to teach a patient to
disregard their brain telling them that
there’s nothing else to see and to look
over into their neglected side and as
many scenarios as possible
commonly therapists will teach patients
that as they approach a doorway they
need to remember to look over to the
left they’ll teach them that as they
approach a step they need to make sure
that they look down and to the left to
avoid being caught up or tripped and
they’ll teach them that every time they
enter a room they need to visually scan
that space to get in as much visual
information as possible so they can
better understand how to move through
that space effectively now most commonly
this treatment is delivered in a
clinical rehabilitation setting now
clinics set up to be safe the patient
they’ve generally got nice big open
spaces flat carpeted floors there’s a
very little low set furniture and there
are always therapists on hand if
something was to go wrong now
unfortunately back in the real world in
particular in a patient’s home things
typically are not set up like this back
at home
you might have uneven floorboards or
carpet you’ve got a coffee table
you’ve got your couch you might have
pets you may have children or even
grandchildren and there can be a lot of
visual distraction around which can make
trying to apply what a patient has
learned into a in a clinic into their
home a pretty difficult task and if you
couple this with memory and detention
difficulties and the fact that many
patients may not even be aware of their
own deficit you can quickly start to see
a real problem now I can’t stress enough
that the way that therapists deal with
visual spatial neglect now is absolutely
fantastic they’re using the best methods
we know of to treat a really difficult
condition and trying to teach patients
strategies to overcome their neglect and
then trying to get them to retain that
knowledge and apply it outside a clinic
that’s a really really tricky task to
achieve treatment has its limitations
depending on where you live the level of
universal health care available your
personal access to private health
insurance you may only be eligible for a
few months of treatment post brain
injury in some instances you may get
none at all surely there had to be a
better way to deal with this so I asked
myself how could I use my skills as an
industrial designer to in the simplest
manner possible replicate the
actions of a therapist enhance treatment
techniques and do this with an automated
system that could be taken directly from
so I took the most basic principle of
VSM treatment reminding patients via
verbal cues to look into their neglected
side in as many scenarios as possible
and I applied this to a simple wearable
system VSM patients will get a pair of
glasses fitted with a discreet camera
and a bone conduction speaker and the
other aspect of the system is a series
of small infrared tags which are to be
fitted throughout a patient’s home in
locations where their therapists or
carers or their family members think
that they’re most needed whether that’s
on the ends of your coffee table on the
left-hand side of every doorway maybe
it’s just on the inside of the left-hand
side of your pantry when you approach
one of these tags they’ll start to glow
to try to capture your attention and the
camera in the glasses will pick up the
location of the tag and you will be
given clear verbal instructions through
the bone conduction speaker to search
for that tag in your neglected space our
bone conduction is ideal for this
scenario because it transmits sound
directly through the skull it makes the
system a lot more discreet because
nobody else around you can hear the
verbal cues also many patients who have
a visual spatial neglect often have an
auditory neglect which is an inability
to properly process sound on one side of
the world bone conduction helps to
in simple terms all we want to do is to
alert patients to what’s outside their
visual field and get them to look in
that direction in as many scenarios as
possible whether that means knowing
where a piece of furniture is knowing
that you’re too close to one side of a
doorway or maybe it’s just being able to
find something that you would otherwise
miss now the idea is that the system
would be used initially in a
rehabilitation clinic therapists could
use the system for neglect training
activities so immediately
patients are made aware of exactly what
they have to do find these tags in every
required scenario and that exact same
task is translated directly from a
clinic into a patient’s home and this
direct transfer between clinic and home
can help avoid any issues around trying
to apply a learned task to what may now
seem like a bit of an unfamiliar
environment hopefully leading to greater
functional outcomes and a much faster
recovery now the system is designed to
be taken home so that your treatment can
continue I sat down and I worked out
that the cost of fitting out mums entire
house with the infrared tags was still
less than what we were spending for just
one week of therapy now for patients
with a mild neglect the system might
only be used until they’ve built up a
good habit around looking into their
neglected site at which point the system
for patients with a much more severe
neglect the system might be used
constantly as long as they need it as
long as it’s helping because visual
spatial neglect is such a pervasive
condition for some this system might be
the difference between whether they need
a live-in carer for others it could mean
the difference between whether they get
to stay at home or whether they need to
go to a living care facility it’s
designed to streamline the recovery
process in a manner that doesn’t require
you to rearrange your lifestyle brain
injury does enough of that as it is now
this is a treatment for just one aspect
of brain injury recovery it’s not rocket
science
and we haven’t reinvented the wheel I’ve
taken a relatively simple and
cost-effective design solution and have
applied it to a significant problem now
prior to 2012 I had never even heard of
visual spatial neglect if my mum had not
had her stroke I probably never would
have ever heard of it and I would have
never come up with a design solution to
help to treat it let’s not wait for
designers and engineers to have such
personal connections with these problems
to start turning their attention and
their talents toward finding solutions
if you have a problem tell a designer if
you are a designer or an engineer go out
and find a hidden problem you never know
the solution you create might one day
help someone you love [Applause]