AIM:Neuropsychological tests of visuo-spatial exploration, line bisection, and drawing are typically employed for diagnosing unilateral spatial neglect (USN), but updated norms, including those for left and right biases, are still lacking. This study aims to standardize administration and scoring of the most widely used USN tests, providing regression-based norms and equivalent scores (ES) of a comprehensive set of old and new visuo-spatial indexes. These include asymmetry in the allocentric and egocentric spaces, execution times, as well as measures of productive symptoms (e.g., perseverations) and constructional apraxia in an Italian sample. METHODS:A sample of 270 neurologically healthy participants (139 females, mean age: 60.57 ± 12.79 years) completed a neuropsychological battery including line bisection, line/star/geometrical item cancellations, copy of simple and complex drawings, the clock drawing test, and a new representational neglect test. Multiple regressions estimated the effects of age, education, and gender. Non-parametric tolerance limits and ES were calculated on ranked adjusted scores. RESULTS:Regression analyses showed significant influences of age and education across tasks; both predicted execution time and spatial asymmetry in cancellations, constructional apraxia in drawings, and clock drawing accuracy. Education specifically predicted perseverations in cancellations, while age specifically predicted cancellation accuracy and perseverations in drawing tasks. Gender only influenced line bisection and, along with age and education, accuracy in the butterfly memory test. DISCUSSION:This work provides updated norms for standard and novel visuo-spatial indexes in the assessment of USN and associated disorders, with standardized procedures to guide clinical assessment and support neglect rehabilitation.

This study examines the demographic, temporal, and spatial patterns of traumatic brain injury (TBI) hospitalizations in the canton of Geneva, Switzerland, between 2012 and 2024. Particular attention is given to differences between seniors (≥60 years) and the younger or working-age population (15–59 years). Hospital discharge data were analyzed in combination with geographic information systems (GIS) to explore incidence, severity, and clinical outcomes. Temporal trends were assessed across seasons and days of the week. Spatial distribution was investigated using Join Count and SPARR methods to detect clustering. Multivariate clustering further integrated socio-clinical characteristics, including age, autonomy, residential setting, and hospital trajectory. Seniors accounted for more than half of all TBI hospitalizations. Advanced age and institutional residence were strongly associated with reduced likelihood of returning home post-discharge (statistical values). Temporal analyses showed a marked increase in TBI incidence among seniors during autumn and at the beginning of the week, patterns not observed in the working-age group. Spatial analyses revealed non-random clustering of cases, with high-risk zones concentrated in specific areas, particularly for older adults. Multivariate clustering identified distinct socio-clinical profiles in both age groups, shaped by residential environment, autonomy level, and care pathways. The findings underscore the dual clinical and territorial dimensions of TBI, highlighting significant age-related and spatial disparities. Tailored prevention strategies, safer environmental design, and integrated care pathways are needed to reduce inequalities and improve outcomes. Addressing TBI through both a medical and public health lens is essential to support at-risk populations, particularly seniors.

Introduction: The preservation of the human self—a fundamental yet underexplored aspect of neurosurgical practice—has gained increasing attention in recent years. Research question: How can neural correlates of self-consciousness be identified, monitored, and protected during brain tumor surgery, and how might this reshape the concept of “onco-functional balance”? Material and methods: This review synthesizes emerging evidence from neuroimaging, neuropsychology, and intraoperative neurophysiology to build a framework for integrating the concept of self into modern neurosurgical practice. Results: We describe the anatomical and functional basis of bodily and cognitive self-awareness, highlighting the roles of interoception, multisensory integration, and higher-order cortical networks such as the medial prefrontal cortex, insula and temporoparietal junction. We outline perioperative tools for clinical assessment, including validated scales for anosognosia and disownership, as well as the Self-Other Voice Discrimination (SOVD) paradigm and Heartbeat-Evoked Potentials (HEPs), which offer quantifiable markers of self-processing. Discussion and conclusion: We argue for a reconceptualization of “eloquent” cortex to include regions critical for the preservation of self. As neurosurgery advances toward precision-guided, patient-centered care, protecting the self must become an explicit goal alongside motor, sensory, and language preservation. Future directions include real-time intraoperative monitoring of HEPs, development of functional risk maps for self-related structures, and broader implementation of personalized, neurocognitive surgical planning.Ultimately, this work proposes a shift from an “onco-functional” to an “onco-functional-identity” paradigm—where the integrity of the patient's personality, agency, and awareness becomes a measurable, preservable endpoint of neurosurgical care.

Self-awareness can be impaired in different forms, including bodily features, following brain lesions. Such as other complex symptoms, these disorders seem not being localized in one brain area but may occur following the impairment of different parts of a network. One of the most disrupting body awareness disorder for people's functioning is the feeling that one or more body parts do not belong to the person anymore, the so-called 'body part disownership'. This symptom can be undetected, with recent findings suggesting that subtle signs of body disownership are revealed using an assessment with a non-verbal response, instead of a verbal interview. In the present study, by exploiting a large clinical dataset and state-of-the art analyses of lesion-induced disconnectivity, we have investigated this newly detected entity, called covert disownership, in the early phase post-stroke. 105 hospitalized stroke patients and 55 healthy controls were recruited over 2 years. Patients underwent a neurological and cognitive evaluation, including various measures of body ownership. We also assessed upper limb functions, using routine occupational therapy measures such as hand dexterity, strength, sensitivity and proprioception. To unveil its neural correlates, we ran innovative and robust region- and network-based lesion analyses. Our results indicate that about 30% of our sample exhibited covert disownership, involving either hands, arms, legs or face portions contralateral to the lesion, which affected the right- or the left-hemisphere. Lesion analyses confirmed the key role of structures such as the right insula, and basal ganglia, for upper limb ownership. Network-based structural connectivity data highlighted disconnections between temporo-occipital and parietal bilateral networks associated with disownership for the upper limb, as well as bilateral disconnections between fronto-basal and occipital parcels. Damage affecting the left superior longitudinal fasciculus was also linked to the right hand disownership. Altogether, we shed new light on the neural interconnections that, when perturbed, lead to body awareness disorders. Large-scale bilateral disconnections at the level of temporo-parietal and fronto-occipital networks explain covert disownership, with specific pathways as a function of the body part involved. We demonstrate that in the early phase of a brain damage this disorder may be underestimated but still affect patients' self-perception. This underscores the importance of sensitive tools to overcome the limitations of standard clinical examination, as well as of modelling brain damage in terms of networks rather than focal lesions. A better understanding of post-stroke disownership disorders may improve rehabilitation programs and predict optimal clinical outcome.

Patients with acute hemispheric stroke exhibit various visuospatial impairments. While many recover rapidly, others remain impaired. Better defining which symptoms characterize the acute and chronic phases and which brain areas and connections are implicated could help to improve diagnostic and rehabilitation tools and inform effective rehabilitation strategies. Here, we report a systematic anatomo-functional study of two populations of acute and chronic hemispheric stroke patients (cross-sectional design). Patients were examined by a series of neuropsychological tests assessing different post-stroke clinical manifestations in the visuospatial domain. We first performed a statistical factorial analysis of patients' behavioural performance across tests to break down symptoms into coherent profiles of co-varying deficits and determine whether any factors may be specific to each post-stroke phase. We then conducted voxel- and atlas-based lesion-symptom mapping, as well as disconnection-symptom mapping in the two populations. We found different patterns of behavioural impairment across groups, with acute symptoms mostly characterized by lateralized attentional deficits and chronic symptoms manifesting as constructional spatial impairments. Lesions to and/or disconnections of frontal and precentral gyri correlated with lateralized visuospatial symptoms in the acute but not chronic phase, whereas lesions to and/or disconnections of temporoparietal areas correlated with constructional deficits in the chronic phase. Our results indicate that constructional spatial deficits and damage/disconnection of dorsoventral higher-order visual areas most pervasively impair stroke patients in the long term. Such deficits might be overlooked or disregarded by rehabilitation strategies focusing on the (mainly acute) lateralized component of their visuospatial deficits and ignoring concomitant, more object-based deficits. This work may help design more specific diagnostic tests and guide future rehabilitation strategies, ultimately promoting better and more extensive recovery beyond lateralized deficits in attention and spatial awareness.

The cerebellum, long regarded as a motor structure, is increasingly recognized for its role in higher-order cognitive and socio-emotional functions. Its contribution to vocal emotion decoding, however, remains insufficiently understood. While prior work has linked the cerebellum to attentional control and predictive coding, direct evidence for its role in modulating prosody recognition under explicit versus implicit attentional demands is lacking. This study investigated how cerebellar stroke, controlled for time since stroke in months, and with an equal number of left- and right-lateralized lesions, alters vocal emotion processing depending on attentional focus. We aimed to disentangle sensory encoding and integration from decisional contributions of the cerebellum by combining behavioral analyses, drift diffusion modeling (DDM), and functional MRI in cerebellar stroke. Fifteen patients with chronic, isolated cerebellar stroke and fifteen matched controls performed two tasks on vocal stimuli expressing anger, happiness, or neutrality. In the explicit task, participants categorized the expressed emotion; in the implicit task, they categorized speaker gender while ignoring emotional tone. Behavioral performance was analyzed using mixed-effects logistic regression and DDM (angle model). Functional MRI analyses included conventional contrasts as well as model-based regressors derived from behavioral and computational parameters. Patients showed lower accuracy than controls, with deficits particularly pronounced in the explicit task. Performance also varied by emotion: gender recognition for angry voices (implicit processing) was relatively preserved, whereas happy and neutral voices were more vulnerable. Contrary to predictions, DDM parameters did not differ between groups. Instead, task effects dominated: implicit processing yielded higher drift rates, larger boundary separation, faster non-decision times, and stronger attentional focus compared to explicit recognition, suggesting that explicit evaluation imposes additional cognitive costs. At the neural level, patients recruited extended networks during explicit processing, including orbitofrontal cortex, amygdala, anterior insula, and cerebellar lobule IX, alongside cerebello-cortical tracts. Implicit processing was associated with more restricted activations, particularly in frontal opercular and cerebellar regions (lobule IX). Model-based analyses further revealed that successful categorization in patients relied on the left inferior frontal gyrus, inferior parietal lobule, and pre-supplementary motor area, although these effects were not significant when controlling for time since stroke. Our findings demonstrate that the cerebellum does not primarily shape decision dynamics but optimizes sensory representations of prosodic cues for downstream evaluation. When predictive tuning is compromised, patients maintain intact decision processes yet rely on compensatory cortical recruitment, particularly during explicit tasks. This pattern supports predictive coding accounts of cerebellar function in socio-emotional communication and highlights the need to consider subtle socio-affective deficits in cerebellar patients. ### Competing Interest Statement The authors have declared no competing interest.

The reported rate of the occurrence of unilateral spatial neglect (USN) is highly variable likely due to the lack of validity and low sensitivity of classical tools used to assess it. Virtual reality (VR) assessments try to overcome these limitations by proposing immersive and complex environments. Nevertheless, existing VR-based tasks are mostly focused only on near space and lack analysis of psychometric properties and/or clinical validation. The present study evaluates the clinical validity and sensitivity of a new immersive VR-based task to assess USN in the extra-personal space and examines the neuronal correlates of deficits of far space exploration. The task was administrated to two groups of patients with right (N = 28) or left (N = 11) hemispheric brain lesions, also undergoing classical paper-and-pencil assessment, as well as a group of healthy participants. Our VR-based task detected 44% of neglect cases compared to 31% by paper-and-pencil tests in the total sample. Importantly, 30% of the patients (with right or left brain lesions) with no clear sign of USN on the paper-and-pencil tests performed outside the normal range in the VR-based task. Voxel lesion-symptom mapping revealed that deficits detected in VR were associated with lesions in insular and temporal cortex, part of the neural network involved in spatial processing. These results show that our immersive VR-based task is efficient and sensitive in detecting mild to strong manifestations of USN affecting the extra-personal space, which may be undetected using standard tools.

Measuring implicit associations of self-concept with health or illness attributes may offer valuable insight into the mechanisms entailing the perception of one's own health, as explicit measures of self-reported health are usually influenced by social desirability or response bias. In this study, healthy participants performed a modified version of the implicit association test (IAT) investigating implicit associations between the self and either health or illness related representations. Behaviorally, implicit associations dominated for self-health pairing, and their strength was inversely correlated with depressive traits. Neurally, concomitant EEG recording showed significant modulations of the P1, LPP, and N4 components evoked by such pairings, suggesting a facilitation of sensory responses to self-related stimuli and differential emotional processes engaged to integrate health versus illness information into self-related representations. These data offer new clues to better understand the cognitive and affective mechanisms underlying unrealistic optimism and pathological awareness of health conditions in various clinical populations.

Altitudinal neglect is an atypical form of spatial neglect where brain-damaged patients neglect the lower, or sometimes the upper, part of the space. Our understanding of this phenomena is limited, with unknown occurrence across different reference frames, such as distance (peripersonal vs. extrapersonal) and system of reference (egocentric vs. allocentric). Two patients with acute bilateral (P1) or right hemispheric (P2) stroke, with signs of bottom altitudinal neglect, underwent an extensive evaluation of neglect within 10 days post-stroke. Assessments involved altitudinal neglect and unilateral spatial neglect (USN) in peripersonal space, exploring egocentric and allocentric signs and in extrapersonal space. Compared to a control group of 15 healthy age-matched subjects, patients showed allocentric and egocentric left USN in peripersonal space, and mostly allocentric signs of altitudinal neglect. No signs of neglect were evidenced in extrapersonal space. Altitudinal neglect could thus present as an allocentric form of spatial neglect, suggesting that allocentric representations may not only affect the deployment of attentional resources along horizontal dimensions but also operate along vertical dimensions. Future studies should deepen our understanding of altitudinal neglect, eventually leading to further unravel spatial processes that control attention, their corresponding brain mechanisms, and implications for patients' rehabilitation and functional outcome.

Unilateral spatial neglect (USN) can have severe functional consequences for patients. Many rehabilitation tools have been proposed in the literature, but only a few well-controlled systematic studies are available. Also, there is no consensus on the effectiveness of these rehabilitation techniques. Yet, left USN is one of the most common neuropsychological symptoms after right hemispheric stroke. This article reviews the main tools available to clinicians, their limitations, and prospects for the development of new rehabilitation options.

Unilateral Spatial Neglect (USN) is a frequent, very debilitating cognitive syndrome, in which patients fail to pay attention, perceive, and represent a part of the space in the side contralateral to the brain lesion [...].

Unilateral spatial neglect (USN) can have severe functional consequences for patients. Many rehabilitation tools have been proposed in the literature, but only a few well-controlled systematic studies are available. Also, there is no consensus on the effectiveness of these rehabilitation techniques. Yet, left USN is one of the most common neuropsychological symptoms after right hemispheric stroke. This article reviews the main tools available to clinicians, their limitations, and prospects for the development of new rehabilitation options.La négligence spatiale unilatérale (NSU) est un déficit qui peut avoir de lourdes conséquences fonctionnelles pour les patients qui en sont atteints. De nombreux outils ont été proposés dans la littérature mais peu d’études systématiques bien contrôlées sont disponibles. Aussi, il n’existe pas de consensus dans la littérature à propos de l’efficacité de la rééducation. Pourtant, la NSU gauche est un des symptômes les plus fréquents après un AVC de l’hémisphère droit. Cet article fait le point sur les principaux outils à disposition des cliniciens, leurs limites et les perspectives de développement de nouvelles alternatives de rééducation.

BackgroundUnilateral spatial neglect (USN) is a debilitating neuropsychological syndrome that often follows brain injury, in particular a stroke affecting the right hemisphere. In current clinical practice, the assessment of neglect is based on old-fashioned paper-and-pencil and behavioral tasks, and sometimes relies on the examiner's subjective judgment. Therefore, there is a need for more exhaustive, objective and ecological assessments of USN.MethodsIn this paper, we present two tasks in immersive virtual reality to assess peripersonal and extrapersonal USN. The tasks are designed with several levels of difficulty to increase sensitivity of the assessment. We then validate the feasibility of both assessments in a group of healthy adult participants.ResultsWe report data from a study with a group of neurologically unimpaired participants (N = 39). The results yield positive feedback on comfort, usability and design of the tasks. We propose new objective scores based on participant's performance captured by head gaze and hand position information, including, for instance, time of exploration, moving time towards left/right and time-to-reach, which could be used for the evaluation of the attentional spatial bias with neurological patients. Together with the number of omissions, the new proposed parameters can result in lateralized index ratios as a measure of asymmetry in space exploration.ConclusionsWe presented two innovative assessments for USN based on immersive virtual reality, evaluating the far and the near space, using ecological tasks in multimodal, realistic environments. The proposed protocols and objective scores can help distinguish neurological patients with and without USN.

Unilateral spatial neglect is a neuropsychological syndrome, more frequent after damage to the right cerebral hemisphere, featuring an impaired ability to orient toward the contralateral left side of space and the body, and the inability to detect and report events from that side, of which patients are not aware. In addition to these defective manifestations, patients may show gratuitous behaviors, which include additional productions, unrelated to the task's demand, such as drawings and repeated marks (perseveration) in exploratory target cancellation tasks. Neglect is a multi-component deficit, whose diverse manifestations share a divide between the attended ipsilateral and the neglected contralateral sides of space. Different pathological mechanisms contribute to neglect, including perceptual and premotor impairments, that may be specific to sensory modality, sector of space, and mental images. Neglect may manifest in different coordinate frames with reference to the body and body parts, and objects (egocentric and allocentric neglect). Spatial neglect is a severely disabling disorder, which interferes with functional recovery from stroke. The neural correlates of neglect include cerebral cortical regions surrounding the sylvian fissure: the posterior inferior-parietal cortex, the temporo-parietal junction, the posterior-superior temporal and the frontal premotor cortices, subcortical gray nuclei and white matter fiber tracts connecting these regions. Neglect is independent of, and cannot be traced back to, sensory and motor deficits, and may be interpreted as a derangement of multiple networks, primarily based in the right hemisphere, supporting spatial attention and representation of space and objects in it.

Spatial neglect is a neuropsychological syndrome characterized by a failure to orient, perceive, and act toward the contralesional side of the space after brain injury. Neglect is one of the most frequent and disabling neuropsychological syndromes following right-hemisphere damage, often persisting in the chronic phase and responsible for a poor functional outcome at hospital discharge. Different rehabilitation approaches have been proposed over the past 60 years, with a variable degree of effectiveness. In this point-of-view article, we describe a new rehabilitation technique for spatial neglect that directly targets brain activity and pathological physiological processes: namely, neurofeedback (NFB) with real-time brain imaging methodologies. In recent proof-of-principle studies, we have demonstrated the potential of this rehabilitation technique. Using real-time functional MRI (rt-fMRI) NFB in chronic neglect, we demonstrated that patients are able to upregulate their right visual cortex activity, a response that is otherwise reduced due to losses in top-down attentional signals. Using real-time electroencephalography NFB in patients with acute or chronic condition, we showed successful regulation with partial restoration of brain rhythm dynamics over the damaged hemisphere. Both approaches were followed by mild, but encouraging, improvement in neglect symptoms. NFB techniques, by training endogenous top-down modulation of attentional control on sensory processing, might induce sustained changes at both the neural and behavioral levels, while being non-invasive and safe. However, more properly powered clinical studies with control groups and longer follow-up are needed to fully establish the effectiveness of the techniques, identify the most suitable candidates, and determine how the techniques can be optimized or combined in the context of rehabilitation.

In recent years, there has been increasing evidence of cerebellar involvement in emotion processing. Difficulties in the recognition of emotion from voices (i.e., emotional prosody) have been observed following cerebellar stroke. However, the interplay between sensory and higher-order cognitive dysfunction in these deficits, as well as possible hemispheric specialization for emotional prosody processing, has yet to be elucidated. We investigated the emotional prosody recognition performances of patients with right versus left cerebellar lesions, as well as of matched controls, entering the acoustic features of the stimuli in our statistical model. We also explored the cerebellar lesion-behavior relationship, using voxel-based lesion-symptom mapping. Results revealed impairment of vocal emotion recognition in both patient subgroups, particularly for neutral or negative prosody, with a higher number of misattributions in patients with right-hemispheric stroke. Voxel-based lesion-symptom mapping showed that some emotional misattributions correlated with lesions in the right Lobules VIIb and VIII and right Crus I and II. Furthermore, a significant proportion of the variance in this misattribution was explained by acoustic features such as pitch, loudness, and spectral aspects. These results point to bilateral posterior cerebellar involvement in both the sensory and cognitive processing of emotions.

Unilateral spatial neglect is a neuropsychological syndrome commonly observed after stroke and defined by the inability to attend or respond to contralesional stimuli. Typically, symptoms are assessed using clinical tests that rely upon visual/perceptual abilities. However, neglect may affect high-level representations controlling attention in other modalities as well. Here we developed a novel manual exploration test using a touch screen computer to quantify spatial search behaviour without visual input. Twelve chronic stroke patients with left neglect and 27 patients without neglect (based on clinical tests) completed our task. Four of the 12 "neglect" patients exhibited clear signs of neglect on our task as compared to "non-neglect" patients and healthy controls, and six other patients (from both groups) also demonstrated signs of neglect compared to healthy controls only. While some patients made asymmetrical responses on only one task, generally, patients with the strongest neglect performed poorly on multiple tasks. This suggests that representations associated with different modalities may be affected separately, but that severe forms of neglect are more likely related to damage in a common underlying representation. Our manual exploration task is easy to administer and can be added to standard neglect screenings to better measure symptom severity.

Neuroimaging studies suggest that understanding emotions in others engages brain re- gions partially common to those associated with more general cognitive Theory -of -Mind (ToM) functions allowing us to infer people 's beliefs or intentions. However, neuropsy- chological studies on brain -damaged patients reveal dissociations between the ability to understand others ' emotions and ToM. This discrepancy might underlie the fact that neuropsychological investigations often correlate behavioural impairments only to the lesion site, without considering the impact that the insult might have on other inter- connected brain structures. Here we took a network -based approach, and investigated whether deficits in understanding people 's emotional and cognitive states relate to damage to similar or differential structures. By combining information from 40 unilateral stroke damaged patients, with normative connectome data from 92 neurotypical individuals, we estimated lesion -induced dysfunctions across the whole brain, and modeled them in relation to patients ' behavior. We found a striking dissociation between networks centered in the insular and prefrontal cortex, whose dysfunctions led to selective impairments in understanding emotions and beliefs respectively. Instead, no evidence was observed for neural structures shared between the two conditions. Overall, our data provide novel ev- idence of segregation between brain networks subserving social inferential abilities.

The disownership of body parts, that most frequently occurs on the left side of the body, contralateral to right-hemispheric lesions, is an infrequent disorder, as usually assessed by interviews asking for dichotomic "yes/no" responses. This observational study in right-brain-damaged stroke patients investigated the efficacy of a continuous Visual Analog Scale (VAS) to detect body disownership after right brain damage, compared to dichotomic questions. Thirty-two right-handed right-brain-damaged stroke patients were given a Standardized Interview (SI), asking "Whose hand/arm/leg is this?", followed by a VAS (asking patients to mark on a vertical line their agreement with the statement that a body part belonged to them). The neural correlates of this disorder and measures of extra-personal and personal spatial neglect were also assessed. Control data were recorded from 18 neurologically unimpaired right-handed participants. During the interview, no patient showed disownership of body parts. Conversely, on the VAS eight out of 32 (25%) patients' scores, but none of the controls' scores, indicated a judgement of disownership for left body parts, with a left-right difference larger than that of control participants. VAS-detected disownership was not systematically associated with extra-personal and personal unilateral spatial neglect. Lesion sites associated with disownership of left body parts included the caudate nucleus and the anterior part of the internal capsule. To conclude, the VAS task, compared to the interview, is a novel tool to detect disownership of left body parts in right brain-damaged patients. A revised classification of body-ownership disorders is proposed. The present variant, assessed and detected by the VAS task, is termed Covert disownership and distinguished from the Overt disownership assessed by a SI.

Spatial neglect is a debilitating disorder frequently observed after damage to the right cerebral hemisphere. Previous investigations have revealed that prism adaptation (PA) therapy can lead to improvements in neglect-related symptoms. In the typical PA protocol patients repeatedly point toward a visual target while wearing prism goggles. A few years ago, a novel PA procedure, involving a variety of more "ecological" visuo-motor activities during adaptation, less repetitive than a sequence of pointings, was introduced by our research group, and shown to be able to improve neglect-related symptoms to the same extent as the standard pointing task. The ecological procedure was easy to administer and pleasant for the patients. In all previous studies, patients were treated by specialized personnel during hospitalization. In the current study, we investigated the effectiveness of the ecological PA method when performed in a home-based setting, with the help of caregivers and family members. Seven right-brain-damaged patients with chronic left spatial neglect underwent a two-week ecological PA treatment, extended, for two extra weeks, in 6 patients, who were available for this additional rehabilitation session. As a control treatment, patients performed the same activities while wearing neutral goggles, before the PA procedure. Two weeks of ecological PA training proved to be able to significantly improve performance in neuropsychological tests (BIT, Cancellation tasks), a neurological scale (NIH), and functional abilities (CBS), when compared to both the baseline and the neutral control treatment, with improvements being maintained over 6 months. The ecological home-based PA training is effective in alleviating signs of spatial neglect. Importantly, this training is affordable, pleasant, and feasible to be performed in the comfort of the patient's home. Easily extendable to larger patient populations and prolonged periods, this method has a real potential to benefit the quality of life of brain-damaged patients with left spatial neglect.