147

NeuroRehabilitation 38 (2016) 147–154
DOI:10.3233/NRE-161304
IOS Press

Functional cerebral space theory: Towards
an integration of theory and mechanisms
of left hemineglect, anosognosia,
and anosodiaphoria
Andrew J. Smith, Ransom W. Campbell, Patti Kelly Harrison and David W. Harrison∗
Behavioral Neuroscience Laboratory, Department of Psychology, Virginia Polytechnic Institute, Blacksburg,
VA, USA

Abstract.
BACKGROUND: The current case study presents a 43 year old African American woman admitted to a Tertiary Care
Rehabilitation unit at a major medical center for concerns over left-sided anesthesia and weakness. Head scans indicate a
right middle cerebral arterial distribution infarct altering blood flow in temporal, parietal, and occipital regions in the right
cerebral hemisphere.
OBJECTIVE: Physician and therapist reports (i.e., speech and occupational therapists) referred the patient for a neuropsychological evaluation for concerns over the patient’s capacity to recognize the severity of her deficits and self-care, with potential
rule-outs indicated by the extant literature on right CVA for anosognosia, anosodiaphoria, and left hemibody/hemispace
neglect.
METHODS: The current case integrates interdisciplinary physician notation, magnetic resonance imaging and magnetic
resonance angiogram, observations and reports from speech and occupational therapy, and neuropsychological assessment
via standardized tests and neurobehavioral syndrome analysis.
RESULTS: Evidence was found for co-occurring syndromes of moderate anosognosia, anosodiaphoria, and left hemibody/hemispatial neglect derived from shared functional cerebral space with overlapping temporal, parietal, and occipital
damage.
CONCLUSIONS: Clinical implications are discussed, including recommendations for therapy approaches based on functional cerebral space theory that may indicate the use of known techniques (e.g., for left hemibody neglect) that may also
have therapeutic implications for treating other, more mercurial co-occurring syndromes of anosognosia and anosodiaphoria.
Keywords: Left hemineglect, anosognosia, anosodiaphoria, middle cerebral artery, insight, cerebrovascular accident, stroke,
neglect, neglect disorders, emotion, cerebral hemisphere

1. Introduction

∗ Address for correspondence: David W. Harrison, Director,
Behavioral Neuroscience Laboratory, Department of Psychology,
Williams Hall, Virginia Polytechnic Institute & State University,
Blacksburg, VA 24061-0436, USA. Tel.: +1 540 231 4422; E-mail:
dwh@vt.edu.

Originating with Babinski’s (1914) initial descriptions of a patient with left hemiplegia following
cerebrovascular lesions to the right cerebral hemisphere, anosognosia is categorized as one of several
syndromes belonging to the family of agnosias (a
general lack of knowledge or failure of recognition)

1053-8135/16/$35.00 © 2016 – IOS Press and the authors. All rights reserved

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A.J. Smith et al. / Left hemineglect, anosognosia, and anosodiaphoria

known as the asomatagnosias (the loss of knowledge of a person’s sense of bodily condition) and is
described as a lack of awareness of deficit, denial of
illness or a failure to recognize and assign implication to personal deficits or afflictions (Bauer, 2012;
Kolb & Whishaw, 2008; Orfei, Robinson, Bria, Caltagirone, & Spalletta, 2008; see also Harrison, 2015).
Modern clinical definitions describe the phenomenon
as a failure to maintain awareness of neuropsychological dysfunction resulting from impairment or
disruption of cortical networks necessary for the
operation of a particular function (Prigatano, 2010).
Although often accompanied by a nearly delusional
denial of deficit (Sandifer, 1946) and the corresponding presence of somatoparaphrenia (denial of
ownership or ascribing ownership, of a body part, to
another; see Critchley, 1957; Cutting, 1978; Gerstmann, 1942; Karnath & Baier, 2010), anosognosia
may manifest in isolation as simply the patient’s
apparent lack of awareness of deficit.
This failure to recognize functional disabilities is
often accompanied by minimal or absent emotional
reaction by the patient with respect to the functional
loss or acquired disability. Babinski (1914) describes
this anosodiaphoria in his initial report as a lack of
concern for the acquired deficits (Adair & Barrett,
2012; Critchley, 1957; Cutting, 1978; Heilman &
Harciarek, 2010; McGlynn & Schacter 1989; see
Harrison, 2015). Anosodiaphoria (the emotional disorder) is functionally and manifestly distinct from
anosognosia (the recognition of the disabilities) with
evidence suggesting that anosodiaphoria may persist
beyond the resolution of the anosognosia (Bisiach
et al., 1986; Critchley, 1957; Heilman & Harciarek,
2010; see Harrison, 2015).
In the practical sense, patients with anosodiaphoria
may be able to acknowledge the disorder in speech
(e.g. “I can’t use my left arm.”) via the linguistic
and logical analyzers of the intact left cerebral hemisphere. In the rehabilitation setting, this basic aspect
of awareness of deficits might be addressed in therapies as an initial compensatory technique, through
the provision of rationale and active verbal rehearsal
focused on prompting the patient to verbally recognize deficits. However, this logical linguistic analysis
may fall well short of the safety requirements for the
patient to be capable of caring for him- or herself,
as the emotional disorder persists as a function of
the damage to the nonlinguistic emotional analyzers
of the injured right cerebral hemisphere. Although
the patient may acknowledge the disorder verbally,
the patient remains a safety risk for initiating routine

behaviors (e.g., driving, cooking and, for some, even
heavy or inherently dangerous equipment operations)
without caution. In this clinical example, language is
just that: an isolated functional domain that is potentially devoid of the deeper emotional conveyance or
“gist” for the content, which is more attributable to the
damaged right cerebral regions (see Harrison, 2015),
wherein patients may express no cause for concern
or inhibition of activities that he or she was involved
in prior to, for example, a cerebrovascular accident
(CVA).
The manifest similarities between anosognosia and
unilateral left hemineglect may also present difficulties for the clinician in distinguishing whether
or not the patient is unaware of a left side hemiparesis or hemianesthesia, or whether the patient is
presenting with a neglect of the left side of the body.
The argument has been made for double dissociation
as patients presenting with hemispatial neglect may,
despite being inattentive to the contralesional side of
space, be aware of the basic functional impairments
(e.g. hemiparesis or hemianesthesia of a limb; Bisiach
et al., 1986). Conversely, the patient with anosognosia
following right CVA, but presenting without a neglect
syndrome, can be capable of attending to the contralesional side of space, while also failing to recognize
their corresponding deficits (Bisiach et al., 1986).
Thus, from this accounting anosognosia and unilateral spatial neglect may be distinguished based upon
the behavior of the patient and functional presentation
of the specific syndrome (Berti et al., 2005; Bisiach
et al., 1986; Marcel, Tegner, & Nimmo-Smith, 2004).
Alternatively, the allocation of these right sided
brain regions may function for multiple concurrent
tasking demands (see Functional Cerebral Space Theory; Kinsbourne & Hicks, 1978; Harrison, 2015).
In this proposal, the parietal and temporal regions
often are found to process the attentional and/or
sensory components of left hemispace, with their
dysfunction/deactivation underlying an attentional or
sensory left hemineglect syndrome. However, these
same brain regions are most intimate to discussions
of arousal components underlying emotion and with
particular relevance for negative emotional states
(Heilman, Schwartz, & Watson, 1978). The evidence
on negative emotional states extends in a multidimensional fashion to findings on the autonomic nervous
system with these right cerebral systems contributing in a differential fashion to sympathetic tone (see
Harrison, 2015, pp. 441-454).
Now extending the discussion to the constructs of
anosognosia, anosodiaphoria, and unilateral neglect,

A.J. Smith et al. / Left hemineglect, anosognosia, and anosodiaphoria

damage to these systems may indeed result in component loss of left hemispace and the negative emotional
analysis of one’s condition (akin to anosodiaphoria)
with a failure to implement caution or to attribute
negative emotional bias to one’s state of affairs (akin
to anosognosia). If the proposed theoretical integration were to be found to have merit, then evidence
based interventions for neglect disorder, itself, might
convey import to the treatment of anosodiaphoria.
Also, the location of the deficient neural systems
would provide alternatives for remediation through
the homologous and presumably intact systems in
the other brain. This would be evident in the initial recovery of anosognosia prior to anosodiaphoria,
through the implementation of logical verbal analysis
and learning to verbally express one’s deficits, based
on therapist’s rationale.

149

Understanding differences and similarities
between anosognosia, anosodiaphoria, and unilateral
neglect is not merely a problem for intellectuals over
which to split hairs. Understanding patient insight to
deficits (anosognosia), concern for deficits (anosodiaphoria), and the failure to attend to the left half of
experience (unilateral neglect associated with right
cerebral lesion) carries important implications across
a number of domains, including public health policy,
health care costs, provision of efficacious patient
care/treatments, and decision making regarding
patient capacity for self-care upon discharge from
medical settings.
In the current report, we present the case of a
female patient at evaluation, following acute right
CVA in the middle cerebral artery territories. The
patient presents with left upper limb hemiplegia and

Fig. 1. MRI depicting right middle cerebral artery distribution parietotemporal cerebrovascular accident in this patient with left hemineglect,
anosognosia, and anosodiaphoria.

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A.J. Smith et al. / Left hemineglect, anosognosia, and anosodiaphoria

Fig. 2. MRA images from coronal section (left) and horizontal section (right) depicting arterial distribution in this patient with left
hemineglect, anosognosia, and anosodiaphoria.

hemianesthesia, left hemispatial neglect, and an
anosognosic/anosodiaphoric state of awareness. The
patient is an active participant in a multidisciplinary
team approach to her rehabilitation for her brain
disorders, with each discipline working collaborating
in her care. The current case takes an interdisciplinary
approach to assessment and rehabilitation through
a review of the medical history and physician notes;
neuroradiological findings via magnetic resonance
imaging (MRI; see Fig. 1) and magnetic resonance
angiography (MRA; see Fig. 2); the behavioral
observations and evaluations of her therapists from
speech and occupational therapy disciplines; and the
integrated neuropsychological evaluation combining
the standardized test battery assessment with the
neurobehavioral status examination and syndrome
analysisbytheclinicalneuropsychologist.Altogether,
the current case highlights the importance of patient
assessment and patient care through interdisciplinary
collaboration.
1.2. Patient information and history
The patient is an actively employed 43 year old,
right-handed, African-American female who initially
presents to the medical center by a friend with complaints of acute onset left sided weakness. Following
emergent care, she is seen for neuropsychological
evaluation and multidisciplinary team treatment in
the rehabilitation unit of a major medical center.
Imaging with head scans conducted and interpreted
upon admission reveal a large middle cerebral artery
(MCA) distribution infarct within the right tempo-

ral lobe which extends into parietal and occipital
regions (see Fig. 1). The MRA of the head more
specifically shows irregularity in the initial M1 segment along with diminished right middle cerebral
arterial branches extending into the insular region.
The patient has a prior history of a small infarct
about 4 years prior to this admission with an area
of encephalomalacia evident within the distribution
of her acute CVA. Her medical history is remarkable
for hypertension, hyperlipidemia, hypokalemia, and
tobacco use (1.5 packs per day).
1.2.1. Review of physician notes documented
upon admission
Initial reports from her attending physician provide the first observations of difficulty with neglect
in the left hemispace and the potential for the presence
of diminished insight (anosognosia) and/or concern
(anosodiaphoria) to her deficits. Medical notation
indicates that “the patient was in no distress.” Physicians noted that she “intends more to the right
hemispace and demonstrates a right gaze bias that
she is able to overcome voluntarily when prompted.”
Physician notation also documented left hemifacial
weakness, increased tone at her left shoulder with
decreased tone at her left elbow, decreased strength
in her left upper extremity, and decreased sensation in
her left lower extremity. Further, as of her second day
of admission, notations indicate that she is “feeling
better” and requesting to be discharged so that she
could return home.
Follow-up notes from the attending physician evaluation conducted 4 days post-admission show that

A.J. Smith et al. / Left hemineglect, anosognosia, and anosodiaphoria

the patient is describing returned sensation in the
left hemibody. The physician notation continues to
highlight the patient’s preference for using her right
hemibody for functional actions and that she continues to maintain a right gaze preference, albeit that her
gaze is able to cross midline, thus marking a second
time that the physician suggests that when prompted,
the patient is able to attend to the left hemispace.
Further, notation 4 days post-admission continues to describe the patient’s left lower extremity
weakness, left hemi-anesthesia, and left hemifacial
weakness.
1.2.2. Neuropsychological evaluation
Several facets of the patient’s history and
presentation led to evaluation for anosognosia, anosodiaphoria, and left hemi-neglect. In addition to
physician note review, the extant literature on the
location of the infarct in the distribution of the right
MCA and extending into the temporal, parietal and
occipital regions was suggestive for anosognosia
as a right brain disorder (see Harrison, 2015, pp.
215-262). This was clinically indicated as a standard rule-out in any neuropsychological assessment
involving damage to these regions. Additionally, her
relative lack of concern over her deficits, as suggested
in physician notes, suggested the possible presence
of anosodiaphoria. Further, physician suggestions of
right hemibody use preference, right gaze bias, left
hemifacial weakness, and left hemibody weakness
and anesthesia all suggested the potential presence
of unilateral left hemispatial neglect.
Further evidence is provided subsequent to consultation by the neuropsychologist among the
multidisciplinary team of therapists. The speech and
occupational therapists generated a list of ‘insight
into deficits’ related comments by the patient. Therapist reports indicate that the patient does not have an
appreciation for the severity of her left sided deficits;
that the patient states that she is ready to leave the
hospital and to return to active employment immediately; that she does not appreciate “any good reasons”
as to why she should not drive; and that she planned
to return to domestic duties (i.e., cooking) upon discharge from the medical center. These comments by
the patient were of concern for the staff, leading to
specific referral to the neuropsychologist. The evaluation of insight to deficits and the ability to appreciate
her capacity for maintaining safety, self-care, and
independent living shed light on seemingly impulsive behaviors in the hospital (e.g., attempting to get
up and out of her wheelchair without assistance).

151

1.2.3. Standardized assessment
Standardized testing for neuropsychological and
mood-related difficulties was conducted using the
Mini-Mental Status Exam, 2nd edition (MMSE-2;
Folstein, Folstein, & McHugh, 1975); the Geriatric
Depression Scale (GDS; Yesavage et al., 1983) and
the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, Tierney,
Mohr, & Chase, 1998). The patient performed in
the impaired range on the MMSE-2 (22/30), demonstrating particular difficulties with recall memory,
construction, and attention (evidence through difficulty with mental calculation on the ‘Serial 7s’
subtest). Administration of the GDS indicated no
presence of depression symptoms, corroborating
physician reports regarding the patient being in ‘no
acute distress.’
The RBANS, which tests neuropsychological
functioning across a number of circuits (immediate and delayed memory, visuospatial/constructional,
language, attention, and an aggregated total score)
indicated overall neuropsychological functioning in
an impaired range (Total Score = 58, 3rd percentile,
impaired range compared to same aged/educated
peers, 95% CI [51–65]). She demonstrated relative strengths in language and logical linguistic
speech (Language = 103, 58th percentile, average
range compared to same aged/educated peers, 95%
CI [89–117]). Conversely, and in accordance with
her right MCA infarct extending from temporal
through parietal and into occipital regions, the visuospatial/constructional index was severely impaired
(visuospatial/ constructional = 62, 1st percentile,
impaired range compared to same aged/educated
peers, 95% CI [49–75]), with evidence for a 90
degree figure rotation during the Figure Copy subtest. She also demonstrated impaired attention (64,
1st percentile, impaired range, 95% CI [52–76]),
immediate memory (49, <0.1st percentile, impaired
range, 95% CI [39–59]), and delayed memory functioning (56,.2nd percentile, impaired range, 95% CI
[44–68]).
1.2.4. Neurobehavioral syndrome analysis
The neuropsychological evaluation provided evidence of mixed left hemineglect syndrome. Sensory
examination yielded visual extinction at the left
upper and lower visual quadrants, as well as left
hemi-anesthesia with omission errors upon tactile
confrontation with light brushing stimuli at the
left hemibody. Motor examination demonstrated left
upper extremity plegia and left lower extremity

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A.J. Smith et al. / Left hemineglect, anosognosia, and anosodiaphoria

paresis, right frontal eye field dysfunction/left gaze
impersistence, motor impersistence (to ‘eyes closed’
command), left side drooling, and left lingual paresis/spasticity. Speech examination showed left side
lingual paresis. Dysarthria was present as a function of the left-sided tongue paresis. Further, the
patient’s vocal prosody was blunted with a receptive aprosodia. Observations were also remarkable
for frequent and recurrent involuntary spasm at the
left nasolabial fold (mouth) and muscular spasm at
the left eye. Notably, throughout testing, she demonstrated significant integrity for positive affect and
social engagement using linguistic and languagebased analyzers.
In order to provide a test of insight into neglectrelated deficits (i.e., anosognosia for problems in the
left hemi-space), a multiple reporter strategy was
employed using the Catherine Bergogo Scale (CBS;
see Azouvi, Olivier, De Montety, Samuel, LouisDreyfus, & Tesio, 2003; Azouvi et al., 1996). The
CBS is composed of 10-items referenced to a 4 point
rating scale (0–3). The ‘behavioral assessment’ portion of the CBS is first completed by an independent
assessor with a focus on rating observations of the
extent to which the patient neglects left-hemi-body
objects, both in problematic neglect behaviors for
intra-individual space (e.g., neglect of hygiene at
the left-hemibody) and neglect for objects located in
extra-personal space (e.g., neglect of food on the left
side of one’s plate) on a 0–3 scale (0 = no neglect;
1 = mild neglect; 2 = moderate neglect; 3 = severe
neglect). Example questions include “Forgets to
clean the left side of his/her mouth after eating” and
“Has difficulty paying attention to noise or people
addressing him/her from the left.” An example of the
rating criteria is as follows: “a score of 2 (moderate
neglect) was given if the patient showed clear and
consistent left-sided omissions or collisions; and a
score of 3 (severe neglect) was given if the patient was
totally unable to explore the left hemispace” (Azouvi
et al., 2003, pp. 52).
In the current study, the CBS was completed
independently the by primary speech pathology and
occupational therapists involved in direct care for
the patient. The patient’s occupational therapist completed the CBS, rating the patient’s left hemineglect
behaviors at a 15 out of 30. The speech therapist’s
rating totaled 18 out of 30. Patient-reported left hemineglect difficulties were then assessed through a
parallel version of the CBS. During this ‘self-report’
portion of the CBS, the patient was asked to rate her
perceived difficulty with attending to the left side of

the world (0 = no difficulty to 4 = severe difficulty).
The patient endorsed items and ratings that aggregated into a total score of 9 out of 30.
In order to calculate ‘anosognosia as a function
of left hemineglect insight’ behavioral assessment by
the speech and occupational therapist was compared
to the patient’s report on the same neglect behaviors as rated through a parallel form of the CBS,
specifically by calculating the differences between
the patient report and the behavioral observations
from therapists. The patient demonstrated a clinically significant level of anosognosia for left-sided
neglect/deficits in comparison to the speech therapist’s behavioral rating (18 – 9 = 9), the occupational
therapist’s rating (15–9 = 6), as well as when taking
the average of speech and occupational therapist ratings compared to the patient’ scores (16.5 – 9 = 7.5).
The difference between the patient’s account of her
deficits versus therapist’s ratings of the patient’s leftsided neglect related deficits (average = 7.5) indicates
moderate anosognosia as a function of behavioral
neglect severity (normalized range for moderate
anosognosia as a function of behavioral neglect
severity = 7.38 ± 7.04 [mean ± standard deviation];
see Azouvi et al., 2003).

2. Discussion
Primary findings from this evaluation support
diagnoses of anosognosia, anosodiaphoria, and left
unilateral neglect. The findings of our interdisciplinary evaluation and the clinical diagnoses are
commensurate with the extant literature on the effect
that MCA CVAs may have as the result of altered right
temporal, parietal, and occipital functions (contralaterally controlling the left hemibody and attention to
the left hemispace; see Harrison, 2015).
Regarding the neglect syndrome, the neuropsychological evaluation provided a significant diagnosis
for mixed left hemibody neglect via demonstration of: (a) visual extinction in the left upper and
lower quadrants when presented with concurrent
or stereoscopic visual stimuli in bilateral hemispace; (b) left gaze impersistence, (c) preference for
use of the right hemibody, (d) left-sided drooling,
and; (e) left facial spasticity and paresis. Further, as
per double-dissociation techniques, the neuropsychological evaluation demonstrated (a) relatively intact
lingual analyzers and language systems (RBANS language score = 58th percentile) as part of the preserved
left cerebral hemisphere, alongside left hemiparesis

A.J. Smith et al. / Left hemineglect, anosognosia, and anosodiaphoria

(likely related to old encephalomalacia in the right
frontal lobe based on a CVA experienced 4 years
prior), juxtaposed to (b) constructional apraxia
(RBANS visuospatial functioning score = 1st percentile). Notably, the patient demonstrated ability to
cross the midline into the left hemispace despite her
right hemibody and rightward gaze preferences, suggesting that she is capable of attending to the left
hemispace when prompted, a finding that has implications for therapy using prompts to attend to left
hemispace and hemibody.
With regard to anosognosia, the patient demonstrates the capability to verbalize her left hemibody
difficulties when prompted (as per her score of 9 out
of 30 on the patient-reported CBS for insight into left
hemineglect), albeit that her capacity to recognize
the severity of left hemibody problems is moderately impaired, as suggested by her ‘anosognosia as a
function of left hemibody neglect’ score, calculated
based on the difference between patient report and
parallel behavioral ratings by the speech and occupational therapists. These findings corroborate concerns
conveyed by the therapists that the client reports her
intentions to return to pre-CVA activities (work, driving, and domestic duties) immediately, and suggest
that she experiences moderate anosognosia, with initial therapies indicated for verbalizing and attending
to left hemibody deficits and left hemispace.
With regard to anosodiaphoria, we based our
diagnosis on interdisciplinary observations, patient
presentation, and administration of the GDS. Based on
interdisciplinary physician report, therapist concerns
(extrapolated from patient presentation), and the neuropsychological evaluation (including administration
of the GDS assessing for depressed mood), the patient
displays a lack of concern and distress over her deficits.
She frequently requests to be discharged, although she
shows no particular distress when this request is not
granted. She shows no signs of depression or sadness
related to her loss of function over the left hemibody.
Notably, her old right encephalomalacia (due to a
CVA 4 years prior to the current right MCA CVA),
which is likely responsible for her prosodic deficits
in speech production, may have implications for how
others responds to the patient; she may in fact be experiencing some emotional lability with regard to her left
hemibody deficits, but her blunted vocal prosody does
not convey this. It could be that observations fail to
detect lack of concern due to sparse affective prosody
in her voice, suggesting that our interpretation of her
apparent lack of distress over her deficits should be
considered with this caution in mind.

153

Examining Kinsbourne’s functional cerebral space
theory (Kinsbourne, 1980; Kinsbourne & Hicks,
1978) as an alternate explanation for the often comorbid nature of anosognosia and unilateral neglect,
patients with space occupying lesions of areas traditionally believed to subserve functions of deficit
awareness may also have corresponding deficits in
attentional modulation due to the overlap of this
function in shared cortical tissue. Thus the right
parieto-temporal regions responsible for attention
and sensation to left hemispace, may have overlap
in the, still unidentified, systems underlying human
self-awareness, particularly of their disabilities or
dysfunction. Because of this, even a very localized
and precise lesion in these areas may result in both
a lack of awareness of left hemispace (anosognosia)
and a failure to attend to left hemispace (hemispatial
neglect). The same theoretical underpinnings could
explain the anosognosia and anosodiaphoria interplay whereby patients seemingly become aware of
deficits but do not seem to express an emotional
reaction to these deficits, being described as unconcerned or even apathetic. This theoretical perspective
remains to be explored in depth, but may pave the
way for explaining the often difficult nature of clinically distinguishing and thereby dissociating among
these various syndromes.
The utility of appreciating the multi-functional role
of any brain region is the implied effect of therapy for
one disorder with overlay that positively translates
to the other. This approach is inherently transdiagnostic in nature. Rehabilitative procedures have been
put forth using various methods for unilateral neglect
syndromes and extrapolating from this perspective
therapies for neglect disorder may be equally effective as therapies for anosognosia and anosodiaphoria.
Substantially more success has been made in the treatment of neglect disorders, with only minimal clinical
impact observed on interventions for anosodiaphoria.
For example, ambient sensory or light therapy at the
left eye-cup has been used to alter left-hemi-spatial
neglect. However, no comparable approach has been
ventured for anosodiaphoria. The rehabilitative treatment of patients with anosognosia has been well
documented and guidelines even exist to detail the
procedures for the clinician faced with the treatment
of anosognosia resulting from different neurological
insult (Prigatano & Morrone-Strupinsky, 2010).
Given the potential for shared functional anatomy
for these syndromes and the transdiagnostic nature
of rehabilitative therapies for neglect and awareness,
it may be important to develop treatment strategies

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A.J. Smith et al. / Left hemineglect, anosognosia, and anosodiaphoria

for use with neglect syndrome and awareness syndromes that produce similar rehabilitative results.
Consequently, it will be necessary to further elucidate
the nature of these syndromes, their shared anatomy
and subtle dissociations, as well as the ways in which
treatment for one dysfunction might also alleviate the
others.

Conflict of interest
The authors are aware of no conflicts of interest.
There are no declarations relevant to this manuscript
or the conduct of this research.

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