Recovery from hemiparesis and unilateral spatial neglect after neonatal stroke. Case report and rehabilitation of an infant

Primary objective: To report rehabilitation of neglect in a child through task contexts. Methods and procedures: A 7-month-old boy with hemiparesis and neglect following neonatal stroke was evaluated with standard assessments during the first year of intervention. The intervention included timely training of each upper limb's movement (reaching, grasping, lifting, rotating, releasing, etc.), balance training and Constraint-Induced Movement Therapy (CIMT). We promoted the storing of spatial representation through enriched environment by meaningful sensory inputs engaging spatial localization/orientation and eye movements. Main outcomes: During intervention the child developed reaching and grasping and other new motor behaviours (holding, releasing, lifting, rotating, transferring, pulling, manipulating objects, gesturing, self-feeding, walking). In parallel he also exhibited a decrease of neglect. Conclusion: Infants with stroke should be routinely checked for neglect. Especially those with hemiparesis and neglect challenge the rehabilitation team for the complexity of the treatment directly focused on addressing integration at more conscious levels of upper limb paresis and neglect.