Psychometric Evaluation of Neglect Assessment Reveals Motor-Exploratory Predictor of Functional Disability in Acute-Stage Spatial Neglect

Abstract

Objective Spatial neglect is a failure or slowness to respond, orient, or initiate action towards contra-lesional stimuli, associated with functional disability that impedes stroke recovery. Early identification of specific neglect deficits may identify patients likely to experience chronic disability. However, psychometric evaluation of assessments has focused on subacute/chronic populations. We addressed this gap by assessing two neglect measures – the Behavioral Inattention Test (BIT) and the Catherine Bergego Scale (CBS) – in acute neglect. Design Correlational/Psychometric study. Setting Inpatient rehabilitation hospital. Participants Screening identified 51 consecutive right-hemisphere stroke patients with left neglect (BIT conventional score < 129 or CBS > 11) that tested an average of 22.3 days post-stroke. Interventions Not applicable. Main Outcome Measures We obtained BIT, CBS, and Barthel assessments for each participant, and clinical and laboratory measures of perceptual-attentional and motor-intentional deficits. Results The BIT demonstrated good reliability and loaded onto a single factor. Consistent with our theoretical prediction, principal components analysis of the CBS identified two underlying factors: “Where” perceptual-attentional items (CBS-PA) and embodied, motor exploratory items (CBS-ME). The CBS-ME uniquely predicted ADL deficits (Barthel Index), but did not predict clinical and laboratory assessments of motor-intentional bias. More severe neglect on CBS-PA correlated with greater “Where” perceptual-attentional bias on clinical and laboratory tests, but did not uniquely predict deficits in activities of daily living (ADLs). Conclusions Our results indicate that assessments of spatial neglect may be used to detect specific motor-exploratory deficits in spatial neglect. Obtaining CBS-ME scores routinely might improve detection of acute stage patients with spatial action deficits requiring increased assistance that may persist to the chronic stage.

Presence of Motor-Intentional Aiming Deficit Predicts Functional Improvement of Spatial Neglect With Prism Adaptation

“…It is possible that the CBS may be more sensitive to detect neglect (and neglect improvement), especially body-based, motor-exploratory or functional deficits, as compared to paper-and-pencil tests. 24,36 Consistent with this argument, the quadratic component on assessment session approached significance for the BIT, but not CBS. This pattern suggests those with Aiming deficits were still improving on the CBS, but that participants’ improvement on the BIT was plateauing.…”

Ipsilesional neglect: Behavioral and anatomical correlates.

“…Participants in this dataset had unilateral right hemisphere brain damage, with no history of dementia, uncontrolled glaucoma, or previous head trauma with loss of consciousness (data on subsets of the patients with contralesional neglect in this dataset have previously been published; Chen et al, 2012; Goedert et al, 2012, 2013). All 132 patients were evaluated with the Mini-Mental Status Examination (MMSE; Folstein, Folstein, & McHugh, 1975), Behavioural Inattention Test (BIT; Wilson, Cockburn & Halligan, 1987), Catherine Bergego Scale (CBS; Azouvi, Olivier, Montety, Samuel, Louis-Dreyfus & Tesio, 2003) and Barthel Index (Mahoney & Barthel, 1965).…”

Processamento comunicativo em adultos com AVC unilateral de hemisfério direito : avaliação através de bateria breve.

“…Tal resultado pode ter ocorrido em função da presença de heminegligência visual em 20% dos adultos com LHD. A heminegligência visual é uma falha ou lentidão em responder, orientar ou iniciar ações para estímulos contralaterais à lesão cerebral (Goedert et al, 2012), ocorrendo com maior frequência em pacientes com LHD , principalmente quando o lobo parietal é atingido (Molenberghs & Sale, 2011), podendo afetar o processo de leitura e de escrita.…”