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

Abstract

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.

Increasing cognitive demand in assessments of visuo-spatial neglect: Testing the concepts of static and dynamic tests

“…The simulated driving test (Spreij et al, 2020) consisted of a straight road without intersections or oncoming traffic projected on a large screen (2.13 m × 3.18 m). A steering wheel was fixed on a table at a distance of 90 cm from the projection screen.…”

“…To improve ecological validity, dynamic tests have been developed to relate to the level of cognitive demand of daily life (Blini et al, 2016;Bonato, 2012;Bonato et al, 2010). In this study, we consider tests to be "dynamic" when stimuli change as a patient moves through an environment, when performance is timebound, and/or when a patient is required to multitask (Bonato, 2012;Spreij et al, 2020;Ten Brink et al, 2018). When patients are moving, there is more attentional competition between stimuli at the ipsilesional versus the contralesional side of space than in a motionless situation (Bonato, 2012).…”

“…Finally, Virtual Reality has been used to assess VSN in a controlled environment that simulates daily life situations (Pallavicini et al, 2015;Tsirlin et al, 2009). For example, we have used a simulated driving test to assess VSN (Spreij et al, 2020).…”

“…It is not simply the case that dynamic tests are more challenging than static tests, as extensive research has showed dissociations between performances on static versus dynamic tests (Azouvi, 2002;Azouvi et al, 2006;Grattan & Woodbury, 2017;Hamilton et al, 2008). For example, patients may show VSN on the MAC or a Virtual Reality test, but not on a cancellation test, and vice versa (Azouvi et al, 2006;Grech et al, 2017;Peskine et al, 2011;Spreij et al, 2020;Ten Brink et al, 2018). These dissociations suggest a conceptual distinction between static and dynamic tests -two concepts that are often used by clinicians and researchers to describe VSN assessments (e.g., Deouell et al, 2005;Smit et al, 2013;Spreij et al, 2020;Ten Brink et al, 2018;Toglia & Cermak, 2009).…”

“…For example, patients may show VSN on the MAC or a Virtual Reality test, but not on a cancellation test, and vice versa (Azouvi et al, 2006;Grech et al, 2017;Peskine et al, 2011;Spreij et al, 2020;Ten Brink et al, 2018). These dissociations suggest a conceptual distinction between static and dynamic tests -two concepts that are often used by clinicians and researchers to describe VSN assessments (e.g., Deouell et al, 2005;Smit et al, 2013;Spreij et al, 2020;Ten Brink et al, 2018;Toglia & Cermak, 2009). However, these concepts have not been systematically investigated in a large cohort of VSN patients with multiple tests.…”