If you notice these features, then this indicates that your patient may have abnormal limb perception (“body perception abnormalities”)/ or neglect:

• Inattention to their limb (may simply turn their head away or totally ignore their limb)
• Hiding their limb
• Inactivity of one limb in usually bilateral activities
• Protecting/carrying the limb
• Reluctance to cross midline
• Apprehension to touch
• Increased expectation of pain
• Use of negative language towards their limb

However some patients do not show these features, therefore, in all cases ask your patient:

“How do you feel about your limb?”. Encourage the patient to say whatever they feel, explain to them that whatever they say is fine, however strange it may sound. Patients often perceive these body perception abnormalities as difficult to understand and sometimes they may fear that they are going “mad”.

For example a patient may feel that their limb or parts of it is altered in size or shape, or disconnected (body perception problems), or they may feel strongly emotional about their limb or want it removed (neglect problems).

Various Scales can be used to assess and quantify these symptoms, the references for a few can be found below

https://www.ncbi.nlm.nih.gov/pubmed/16730904
https://www.ncbi.nlm.nih.gov/pubmed/23562169
https://www.ncbi.nlm.nih.gov/pubmed/22407949

Sample assessment procedure for body perception

• Lie patient down or supported sitting with their eyes closed.
• Ask them to visualise their body starting with the opposite limb 
• Write the descriptions (word for word) as the patient says them.

 Upper limb example:

• • Ask your patient to describe their shoulder.  Does it feel the same as the other side? You may have to prompt them by asking about size differences, swelling, length etc. as they often don’t want to vocalize things that don’t appear to make sense
  • Ask them to describe their elbow, as above.  Does it feel the same as the other side?
  • Ask them to describe their wrist.  Does it feel the same as the other side?
  • Ask them if the distance between their shoulder, elbow, wrist, is it the same on both sides?
  • Ask them about each individual digit and the whole hand

Compare with the affected side encouraging the patient to recognise what feels normal and what is altered.

Some patients feel happier drawing their body and how it feels to them. This is a patient example: