Assessing unilateral neglect: shortcomings of standard test methods

Appelros, Peter; Nydevik, Ingegerd; Karlsson, Gunnel M; Thorwalls, A; Seiger, Åke

doi:10.1080/0963828031000071714

Cited by 34 publications

(5 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are in contrast to the abundance of literature suggesting a superiority of functional and more demanding tasks over conventional paper-and-pencil neglect tasks ( 21 , 26 , 27 , 31 , 56 , 57 ). An explanation for the discrepancy is that the current study investigated test accuracy by combining the task’s sensitivity and specificity into one measure.…”

Section: Discussioncontrasting

confidence: 99%

The Mobility Assessment Course for the Diagnosis of Spatial Neglect: Taking a Step Forward?

Grech

Stuart²,

Williams

et al. 2017

Front. Neurol.

View full text Add to dashboard Cite

Spatial neglect after stroke can be a challenging syndrome to diagnose under standard neuropsychological assessment. There is now sufficient evidence that those affected might demonstrate neglect behavior in everyday settings despite showing no signs of neglect during common neglect tasks. This discrepancy is attributed to the simplified and unrealistic nature of common pen and paper based tasks that do not match the demanding, novel, and complex environment of everyday life. As such, increasing task demands under more ecologically valid scenarios has become an important method of increasing test sensitivity. The main aim of the current study was to evaluate the diagnostic utility of the Mobility Assessment Course (MAC), an ecological task, for the assessment of neglect. If neglect becomes more apparent under more challenging task demands the MAC could prove to be more diagnostically accurate at detecting neglect than conventional methods, particularly as the time from initial brain damage increases. Data collected by Guide Dogs of SA/NT were retrospectively analyzed. The Receiver Operating Characteristic (ROC) curve, a measure of sensitivity and specificity, was used to investigate the diagnostic utility of the MAC and a series of paper and pencil tests in 67 right hemisphere stroke survivors. While the MAC proved to be a more sensitive neglect test (74.2%) when compared to the Star Cancellation (43.3%) and Line Bisection (35.7%) tests, this was at the expense of relatively low specificity. As a result, the ROC curve analysis showed no statistically discernable differences between tasks (p > 0.12), or between subacute and chronic groups for individual tasks (p > 0.45). It is concluded that, while the MAC is an ecologically valid alternative for assessing neglect, regarding its diagnostic accuracy, there is currently not enough evidence to suggest that it is a big step forward in comparison to the accuracy of conventional tests.

show abstract

Section: Discussioncontrasting

confidence: 99%

The Mobility Assessment Course for the Diagnosis of Spatial Neglect: Taking a Step Forward?

Grech

Stuart²,

Williams

et al. 2017

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…For instance, the mere introduction of trials where no response is required can increase the left-right asymmetry in RBD patients without neglect (Bartolomeo, 2000). This suggests that apparently intact RBD patients tested by previous studies often presented hidden neglect and were able to compensate for their spatial bias through the task (Plummer et al, 2003; see also Appelros et al, 2003; Behrmann et al, 2004). …”

Section: Computer-based Testing and Increased Task Demands Results In mentioning

confidence: 88%

Neglect and Extinction Depend Greatly on Task Demands: A Review

Bonato

2012

Front. Hum. Neurosci.

126

124

View full text Add to dashboard Cite

This review illustrates how, after unilateral brain damage, the presence and severity of spatial awareness deficits for the contralesional hemispace depend greatly on the quantity of attentional resources available for performance. After a brief description of neglect and extinction, different frameworks accounting for spatial and non-spatial attentional processes will be outlined. The central part of the review describes how the performance of brain-damaged patients is negatively affected by increased task demands, which can result in the emergence of severe awareness deficits for contralesional space even in patients who perform normally on paper-and-pencil tests. Throughout the review neglect is described as a spatial syndrome that can be exacerbated in the presence and severity by both spatial and non-spatial tasks. The take-home message is that the presence and degree of contralesional neglect and extinction can be dramatically overlooked based on standard clinical (paper-and-pencil) testing, where patients can easily compensate for their deficits. Only tasks where compensation is made impossible represent an appropriate approach to detect these disabling contralesional deficits of awareness when they become subtle in post-acute stroke phases.

show abstract

“…Previous research emphasized the need for divers dynamic tasks, resembling real life, because paper-and-pencil tasks are often not sensitive enough to detect mild and/ or well-compensated VSN (Appelros, Nydevik, Karlsson, Thorwalls, & Seiger, 2003). In dynamic tasks, there is (moving) interference of stimuli or time pressure, in which stimuli are presented for a short period of time.…”

Section: Discussionmentioning

confidence: 99%

“…Another reason to extend the traditional assessment of VSN with dynamic tasks is the heterogeneity of the VSN syndrome and its divers manifestation (Appelros et al, 2003;Corbetta, 2014). Some patients may perform within normal range with respect to the primary outcome measures on paper-and-pencil tasks, but show VSN when measured with dynamic tasks, and vice versa.…”

Section: Discussionmentioning

confidence: 99%

Simulated driving: The added value of dynamic testing in the assessment of visuo‐spatial neglect after stroke

Spreij

Brink

Visser‐Meily

et al. 2018

Journal of Neuropsychology

View full text Add to dashboard Cite

Background Visuo‐spatial neglect (VSN) is generally assessed with neuropsychological paper‐and‐pencil tasks, which are often not sensitive enough to detect mild and/or well‐compensated VSN. It is of utmost importance to develop dynamic tasks, resembling the dynamics of daily living. Objective A simulated driving task was used to assess (1) differences in performance (i.e., position on the road and magnitude of sway) between patients with left‐ and right‐sided VSN, recovered VSN, without VSN, and healthy participants; (2) the relation between average position and VSN severity; and (3) its diagnostic accuracy in relation to traditional tasks. Methods Stroke inpatients were tested with a cancellation task, the Catherine Bergego Scale and the simulated driving task. Results Patients with left‐sided VSN and recovered VSN deviated more regarding position on the road compared to patients without VSN. The deviation was larger in patients with more severe VSN. Regarding diagnostic accuracy, 29% of recovered VSN patients and 6% of patients without VSN did show abnormal performance on the simulated driving task. The sensitivity was 52% for left‐sided VSN. Right‐sided VSN was not well detected, probably due to the asymmetric layout. Conclusions Based on these results, the simulated driving task should not be the only task to assess VSN, especially in its current form. Given the heterogenic nature of VSN, the assessment should always consist of several tasks varying in nature and complexity and include a dynamic task to detect mild and/or recovered VSN. A symmetric design should be used when designing novel tasks to assess right‐sided VSN.

show abstract

Assessing unilateral neglect: shortcomings of standard test methods

Abstract: Standard neglect tests do not cover all clinical forms of neglect. It is therefore important not to rely completely on test instruments when diagnosing neglect. More versatile test instruments are desired.

Cited by 34 publications

References 33 publications

The Mobility Assessment Course for the Diagnosis of Spatial Neglect: Taking a Step Forward?

The Mobility Assessment Course for the Diagnosis of Spatial Neglect: Taking a Step Forward?

Neglect and Extinction Depend Greatly on Task Demands: A Review

Simulated driving: The added value of dynamic testing in the assessment of visuo‐spatial neglect after stroke

Contact Info

Product

Resources

About