Further to the excellent review of neurovisual rehabilitation by Kerkhoff1, we think that it is prudent to communicate our experience in the management of a patient with Balint's syndrome after traumatic brain injury. This was seen in a 41 year old right handed manual worker whose initial cranial CT showed right extradural haematoma. Subsequent scans demonstrated left posterior occipital infarct. Brain MRI 3 months after the injury showed high signal in the right occipitoparietal and left occipitotemporal regions. His physical recovery was satisfactory in that he was fully mobile unaided. However, he presented with simultunagnosia, optic ataxia, and psychic paralysis of gaze.2 This had an adverse impact on his functional independence; he had difficulty in route finding—crashing into furniture and walls—and other activities of daily living including dressing and toileting. He failed most subtests in the Rivermead perceptual assessment battery (RPAB).

We agree with the author that effective treatment strategies are poorly developed and evaluated. We have identified three approaches for the rehabilitation of the perceptual deficits including those seen in Balint's syndrome.

• The adaptive (functional) approach,3 which involves functional tasks utilising the person's strengths and abilities, helping them …

georg.kerkhoff{at}extern.lrz-muenchen.de