Computer-Based Assessment: Dual-Task Outperforms Large-Screen Cancellation Task in Detecting Contralesional Omissions

Abstract

Objective: Traditionally, asymmetric spatial processing (i.e., hemispatial neglect) has been assessed with paper-and-pencil tasks, but growing evidence indicates that computer-based methods are a more sensitive assessment modality. It is not known, however, whether simply converting well-established paper-and-pencil methods into a digital format is the best option. The aim of the present study was to compare sensitivity in detecting contralesional omissions of two different computer-based methods: a “digitally converted” cancellation task was compared with a computer-based Visual and Auditory dual-tasking approach, which has already proved to be very sensitive.Methods: Participants included 40 patients with chronic unilateral stroke in either the right hemisphere (RH patients, N = 20) or the left hemisphere (LH patients, N = 20) and 20 age-matched healthy controls. The cancellation task was implemented on a very large format (173 cm × 277 cm) or in a smaller (A4) paper-and-pencil version. The computer-based dual-tasks were implemented on a 15′′ monitor and required the detection of unilateral and bilateral briefly presented lateralized targets.Results: Neither version of the cancellation task was able to show spatial bias in RH patients. In contrast, in the Visual dual-task RH patients missed significantly more left-sided targets than controls in both unilateral and bilateral trials. They also missed significantly more left-sided than right-sided targets only in the bilateral trials of the Auditory dual-task.Conclusion: The dual-task setting outperforms the cancellation task approach even when the latter is implemented on a (large) screen. Attentionally demanding methods are useful for revealing mild forms of contralesional visuospatial deficits.

Increased scene complexity during free visual exploration reveals residual unilateral neglect in recovered stroke patients

“…The manipulation of visual content by reducing stimulus saliency ( Aglioti et al, 1997 ), increasing the total number of targets ( Ten Brink et al, 2020 ), using dynamic backgrounds with moving distractors ( Deouell et al, 2005 ) or increasing the complexity of a visual scene ( Ogourtsova et al, 2018 ) significantly exacerbates neglect of and detection time for contralesional targets. Moreover, unilateral neglect has been shown to be more pronounced in dual-than in single-tasks ( Blini et al, 2016 ; Bonato et al 2010 , 2013 ; Villarreal et al, 2021 ) and when concurrent tasks require cognitive control ( Mennemeier et al, 2004 ; Sarri et al, 2009 ). Thus, when the perceptual or attentional demands of a search or cancellation task increase, spatial attention deficits become more pronounced and easier to detect.…”