Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations

Abstract

Background and purpose: Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time-limited clinical environments.Methods: Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations.Results: 512 articles were screened with 42 included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copy, reading/writing, and behavioural. Cancellation tasks were most frequently used (97.6% of studies) followed by bisection, copy, behavioural, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible.Conclusions: This study provides consensus recommendations for rapid bedside detection of neglect in real-world, clinical environments.

No Immediate Treatment Effect of Prism Adaptation for Spatial Neglect: An Inclusive Meta-analysis

“…We therefore combined evidence from papers using BIT-C with those of papers using cancellation-only outcomes. Cancellation tasks are widely regarded as the single best clinical measure for neglect (Ferber & Karnath, 2001;Moore et al, 2022), so at least one cancellation task is usually included in any study of neglect, even if the main focus is on other behaviours. Focusing on cancellation tasks, in combination with BIT-C results, enabled us to include many more studies than any previous meta-analysis, potentially allowing a more reliable overall estimate of prism treatment effects.…”

Spatial Neglect in Stroke Patients

“…Tradičními a nenáročnými nástroji k posouzení přítomnosti PN v klinické praxi bývají testy "tužka-papír" či úkoly založené na vyškrtávání, půlení či kopírování obrazců. Tabulka 1 přináší stručný přehled "tužkapapír" testů pro hodnocení PN a doporučených screeningových testů (Moore et al, 2022).…”