How to detect visual neglect in acute stroke

Jehkonen, Mervi; Ahonen, Jukka-Pekka; Dastidar, Prasun; Koivisto, Anna‐Maija; Laippala, Pékka; Vilkki, Juhani

doi:10.1016/s0140-6736(05)78497-x

Cited by 46 publications

(41 citation statements)

References 3 publications

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“…Our result might lend at least partial support to these arguments, but caution is needed when interpreting rightward bias as a sign of pathological performance (Jalas et al, 2002) in one type of cancellation task only. We also found that the star cancellation task was the only task in which all the VN patients showed a result at or below the cut-off score, confirming earlier suggestions that star cancellation might be particularly sensitive to identifying VN (Halligan et al, 1989;Jehkonen et al, 1998;Lindell et al, 2007). The VNþ group showed stronger rightward bias than the VNÀ group in all three cancellation tasks at baseline.…”

Section: Discussionsupporting

confidence: 88%

“…In our study we found a significant correlation between starting point in the star cancellation task and BI in VN patients, suggesting that residual VN has a possible impact on daily functioning. An association between BI and rightward starting point was seen only in the star cancellation task, which has been previously described as the most sensitive cancellation task (Agrell, Dehlin, & Dahlgren, 1997;Halligan et al, 1989;Jehkonen et al, 1998;Lindell et al, 2007).…”

Section: Discussionmentioning

confidence: 68%

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Recovery From Visual Neglect After Right Hemisphere Stroke: Does Starting Point in Cancellation Tasks Change After 6 Months?

Kettunen¹,

Nurmi²,

Dastidar³

et al. 2012

The Clinical Neuropsychologist

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In the acute phase of stroke, patients with left visual neglect (VN) automatically orient to the right hemispace. This study examined the presence of rightward bias after right hemisphere stroke within 10 days of stroke onset and after 6 months. Our sample comprised 43 patients and 49 healthy controls. Presence of VN was evaluated with the six conventional subtests of the Behavioral Inattention Test (BITC). Starting points were determined in three BITC cancellation tasks by measuring the distance between the starting point and the median line of the stimulus sheet in centimeters. Activities of daily living (ADL) were assessed with the Barthel Index. At baseline VN patients showed more robust rightward bias than patients without VN. The magnitude of rightward bias decreased clearly in the VN patients at follow-up. A favorable ADL outcome was observed in 90% of the patients with VN and in all of the patients without VN. The magnitude of rightward bias differed clearly between the patient groups and controls. Our result implies that VN was likely to have improved as measured by BITC sum scores, but symptoms of rightward attention bias were still detected. We therefore suggest that, for clinical purposes, it is important that attention bias is measured accurately after right hemisphere stroke.Keywords: Rightward bias; Recovery; Stroke; Visual neglect. INTRODUCTIONVisual neglect (VN) is a disabling disorder that frequently occurs after right hemisphere stroke (Bowen, McKenna, & Tallis, 1999;Ringman, Saver, Woolson, Clarke, & Adams, 2004), suggesting a special role for the right hemisphere in spatial attention (Halligan, Fink, Marshall, & Vallar, 2003; Heilman, Watson, & Valenstein, 2003;Shulman et al., 2010). Neglect refers to failure to report, respond, or orient to stimuli on the contralesional side of space that cannot be accounted for by primary sensory or motor deficits (Halligan, Cockburn, & Wilson, 1991; Heilman et al., 2003;Robertson & Halligan, 1999). One prominent theory of this asymmetry in VN is that the left hemisphere controls shifts of attention in the rightward direction, while the right hemisphere controls shifts of attention in either direction (Mesulam, 1981). In the acute phase of stroke, patients with left visual neglect (VN) automatically orient to the right hemispace. This study examined the presence of rightward bias after right hemisphere stroke within 10 days of stroke onset and after 6 months. Our sample comprised 43 patients and 49 healthy controls. Presence of VN was evaluated with the six conventional subtests of the Behavioral Inattention Test (BITC). Starting points were determined in three BITC cancellation tasks by measuring the distance between the starting point and the median line of the stimulus sheet in centimeters. Activities of daily living (ADL) were assessed with the Barthel Index. At baseline VN patients showed more robust rightward bias than patients without VN. The magnitude of rightward bias decreased clearly in the VN patients at follow-up. A favorable ADL outcome was...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 68%

Recovery From Visual Neglect After Right Hemisphere Stroke: Does Starting Point in Cancellation Tasks Change After 6 Months?

Kettunen¹,

Nurmi²,

Dastidar³

et al. 2012

The Clinical Neuropsychologist

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“…We relied on Jehkonen et al's test suite (line bisection, line cancellation and letter cancellation [21]) and their cut-offs from the literature for neglect classification. A positive outcome in one of the three test classified participants as having neglect.…”

Section: Participantsmentioning

confidence: 99%

“…EBP * Corresponding author. Email: hk@create.aau.dk requires digital versions of standard tests based on paper and pencil [11,33], which are slow, expensive to administer (Jehkonen et al 1998), and less precise. Additionally, digital tests can record valuable temporal data to improve diagnostics and monitoring of chronic patients.…”

Section: Introductionmentioning

confidence: 99%

Self-rehabilitation of acquired brain injury patients including neglect and attention deficit disorder with a tablet game in a clinical setting

Knoche¹,

Hald²,

Richter³

et al. 2017

EAI Endorsed Trans Perv Health Tech

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We designed and evaluated a whack-a-mole (WAM) style game (see Figure 1) in a clinical randomized controlled trial (RCT) with reminder-assisted but self-initiated use over the period of a month with 43 participants from a post-lesion pool. While game play did not moderate rehabilitative progress indices of standard neuropsychological control tests, it did significantly improve in-game performance when compared to the control group. Its performance indicators and interaction data were highly accurate in predicting neglect and which hand the patients used for input. Patients found playing beneficial to their rehabilitation and attributed gains in the attention training properties of the game. The game showed potential for bedside assessment, insight support, and motivation by providing knowledge about rehabilitative progress.

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“…In addition, they are time-consuming to perform for the staff. Therefore, condensed versions of the BIT have been presented, for example an 8-item version (m-BIT) (5) and a 3-item version (s-BIT) (6). The disadvantage with the m-BIT is that it is still an extensive and demanding test.…”

Section: Introductionmentioning

confidence: 99%

Unilateral neglect: further validation of the baking tray task

Appelros¹,

Karlsson²,

Thorwalls³

et al. 2004

Journal of Rehabilitation Medicine

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Figure copying; the 2 lastmentioned being a part of the 8-item Behaviour Inattention Test. Conclusion: Multi-item tests detect more cases of neglect than do single tests. However, it is tiresome for the patient to undergo a larger test battery than necessary. It is also time-consuming for the staff. Behavioural tests seem more appropriate when assessing neglect. The Baking Tray Task seems to be one of the most sensitive single tests, but its sensitivity can be further enhanced when it is used in combination with other tests.

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How to detect visual neglect in acute stroke

Cited by 46 publications

References 3 publications

Recovery From Visual Neglect After Right Hemisphere Stroke: Does Starting Point in Cancellation Tasks Change After 6 Months?

Recovery From Visual Neglect After Right Hemisphere Stroke: Does Starting Point in Cancellation Tasks Change After 6 Months?

Self-rehabilitation of acquired brain injury patients including neglect and attention deficit disorder with a tablet game in a clinical setting

Unilateral neglect: further validation of the baking tray task

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