The assessment of hemineglect syndrome with cancellation tasks: a comparison between the Bells test and the Apples test

Abstract

Unilateral spatial neglect (USN) is a frequent consequence of acquired brain injury, especially following right hemisphere damage. Traditionally, unilateral spatial neglect is assessed with cancellation tests such as the Bells test. Recently, a new cancellation test, the Apples test, has been proposed. The present study aims at comparing the accuracy of these two tests in detecting hemispatial neglect, on a sample of 56 right hemisphere stroke patients with a diagnosis of USN. In order to evaluate the agreement between the Apples and Bells tests, Cohen's kappa and McNemar's test were used to assess differences between the two methods of evaluation. Poor agreement and statistically significant differences emerged between the Apples and Bells tests. Overall, the Apples test was significantly more sensitive than the Bells test in detecting USN. Based on these results, the use of the Apples test for peripersonal neglect assessment is therefore highly recommended.

Current clinical practice in the screening and diagnosis of spatial neglect post-stroke: Findings from a multidisciplinary international survey

“…The various approaches to measuring neglect require clarification for clinicians and researchers alike, with the ultimate goal of forming a consensus on the best approaches to use. We acknowledge there is also a considerable psychometric literature comparing the sensitivity and specificity of cognitive versus functional tests of neglect and comparing tests within a category (e.g., cancelling bells or stars versus cancelling apples (Basagni et al, 2017;Bickerton et al, 2011)). Before exploring the psychometric literature we aimed to take the first of several steps in an international, multidisciplinary, multi-stage consensus process beginning by scoping clinical practice across a range of professionals, countries and clinical settings.…”

Dual-Task in Large Perceptual Space Reveals Subclinical Hemispatial Neglect

“…There have been various attempts to improve traditional tests' sensitivity. These include, for example, increasing the number or similarity of target and distractor stimuli (Aglioti, Smania, Barbieri, & Corbetta, 1997;Basagni et al, 2017;Kaplan et al, 1991;Rapcsak, Verfaellie, Fleet, & Heilman, 1989;Sarri, Greenwood, Kalra, & Driver, 2009), using time limits in visual searching (Priftis, Di Salvo, & Zara, 2019), or requiring counting backward while performing the task (Robertson & Frasca, 1992).…”

Spatial Neglect Subtypes, Definitions and Assessment Tools: A Scoping Review

“…Auditory neglect had eight different labels (Refer to Figure 5 ). A uditory neglect was the most frequently used label (47%) with the majority of the studies describing it simply as “neglect of the auditory sense” ( 45 , 49 , 55 , 56 ). The behaviors of auditory neglect were described by Pavani, Làdavas & Driver (p. 181) ( 57 ) as a failure “to detect or identify contralesional sounds under bilateral presentation”, and may include poor position discrimination of contralesional sounds and an ipsilesional bias when pointing to contralesional sounds.…”

“…The label of egocentric neglect was the most frequently used ( n = 20) (Refer to Figure 8 ). The majority of the studies described this subtype as egocentric (viewer-centered) neglect ( n = 11), with some additionally describing that contralesional stimuli from a body centered/egocentric viewpoint are neglected ( 40 , 55 , 95 , 96 ). Some descriptions reported the contralesional side of the spatial environment is neglected ( 97 , 98 ), while others reported the contralesional side of the body is neglected ( 99 , 100 ) or the “boundaries of the neglected space are not constant” ( 101 ).…”