Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. Results: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

The frequency of occurrence of right neglect was, as expected, much lower than that reported in a study using the same assessment battery in right brain damage stroke patients. Nevertheless, neglect was found in a substantial proportion of patients at a subacute stage, suggesting that it should be considered in the rehabilitation planning of left brain damage stroke patients.

Background and Purpose-To evaluate the effect of prism adaptation (PA) on spatial neglect signs. Methods-Ten patients (hemianopia in 6) and 8 control subjects were included. Tasks were reading single words, nonwords, and a text, bell cancellation, line bisection, and scene drawing, before and after adaptation, with either deviating or neutral prisms. Results-Errors were more frequent in patients but without any specific effect of PA. We found partial improvement at the late sessions, independent of prisms. Conclusions-We did not confirm the efficacy of PA on spatial neglect. (Stroke. 2006;37:542-543.)

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Background and Purpose-Patients with right hemispheric stroke usually present an anticlockwise deviation of the subjective visual vertical (SVV) in the frontal (roll) plane. However, the occurrence of a similar disorder in the sagittal (pitch) plane has never been assessed. We investigated the subjective visual vertical in both planes in those patients. Methods-Eight patients, 4 with spatial neglect (Nϩ) and 4 without neglect (NϪ), were compared with 4 healthy participants (C). They sat facing a luminous bar adjustable in rotation, either in the roll or in the pitch plane, and had to orient it in a vertical position, in the dark. Results-Compared with NϪ (Ϫ0.1°) and C (ϩ1.1°) groups, Nϩ patients presented with a significant backward deviation (Ϫ4.5°) of the SVV in pitch. In accordance with other studies, they also showed a significant anticlockwise deviation (Ϫ8.8°) of the SVV in roll, as compared with NϪ (Ϫ1.9°) and C (ϩ0.4°) subjects. This was associated with an opposite trunk deviation in both planes. Conclusions-While confirming the anticlockwise deviation already reported in the frontal plane, we showed for the first time to our knowledge a backward deviation of the SVV in neglect patients, which has to be put in relation with their balance disorders. (Stroke. 2005;36:588-591.)

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We investigated the subjective straight-ahead (SSA) projection of body-midline parts (head and trunk) in patients with neglect and patients with nonneglect, using a method disentangling lateral shift and lateral tilt components of the bias. Patients with neglect showed a similar counterclockwise SSA tilt for each body part and an ipsilesional lateral shift, more severe for the trunk than for the head. Thus, neglect results in a tilt of the body midline representation.