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

Figures & data

Table 1. Demographic and clinical characteristics split per group.

	Patients with VSN on tests within static cluster (n = 8)	n	Patients withVSN on tests within dynamic cluster (n = 20)	n	Patients withVSN on tests withinstatic and dynamic cluster (n = 33)	n	Statistics
Sex (% male)	62.5	8	90	20	63.6	33	χ2(2, N = 61) = 4.73, p =.094
Age in years (mean, SD)	62.41 (6.30)	8	59.68 (12.10)	20	59.34 (8.58)	33	H(2) = 0.63, p =.731
Level of education (%)		8		19		32	χ2(4, N = 59) = 0.50, p =.974
Low	37.5		26.3		28.1
Moderate	37.5		36.8		37.5
High	25		36.8		34.4
Stroke Type (%)		5		18		28	Fisher’s = 2.37, p =.684
Ischemic	60		72.2		71.4
Hemorrhage	40		27.8		21.4
Subarchnoid hemorrhage	0		0		7.1
Lesion side (%)		7		20		33	Fisher’s = 7.20, p =.078
Left	28.6		30		6.1
Right	71.4		65		90.9
Both	0		5		3
Days post stroke (mean, SD)	33.13 (15.81)	8	54.55 (29.59)	20	53.61 (29.98)	33	H(2) = 5.09, p =.078
Stichting Afasie Nederland test, 1–7 (mean, SD)	5.25 (1.99)	6	5.25 (1.81)	16	6.00 (1.43)	30	H(2) = 2.98, p =.225
Barthel Index, 0–20 (mean, SD)	13.25 (4.17)	6	6.82 (4.05)	19	7.25 (4.48)	28	H(2) = 8.09, p =.018*
Motricity Index upper, 0–100 (mean, SD)	87.00 (26.83)	5	23.86 (38.74)	14	30.48 (36.84)	27	H(2) = 10.45, p =.005*
Motricity Index lower, 0–100 (mean, SD)	91.40 (10.99)	5	32.69 (41.59)	16	45.52 (36.09)	27	H(2) = 9.09, p =.011*
Functional Ambulation Categories, 0–5 (mean, SD)	3.69 (1.28)	8	2.65 (1.09)	20	2.22 (1.47)	32	H(2) = 7.42, p =.025*
Montreal Cognitive Assessment, 0–30 (mean, SD)	15.32 (7.77)	7	20.55 (4.11)	17	18.87 (4.48)	26	H(2) = 2.82, p =.244
RAVLT Immediate recall 0–75 (mean, SD)	27.40 (9.71)	5	34.06 (11.96)	16	34.30 (8.86)	27	H(2) = 2.21, p =.331
RAVLT Delayed recall 0–15 (mean, SD)	5.20 (2.95)	5	6.20 (4.51)	15	6.41 (3.33)	27	H(2) = 0.81, p =.666
RAVLT Recognition 0–30 (mean,SD)	24.60 (3.36)	5	26.80 (3.95)	15	26.22 (3.61)	27	H(2) =.2.27, p =.322
D-KEFS Tower test 0–30 (mean, SD)	12.50 (2.07)	6	12.27 (5.06)	11	11.06 (4.39)	17	H(2) = 0.97, p =.616
Z-score on static tests (mean, SD)	4.03 (1.85)	8	0.78 (.81)	20	12.69 (7.98)	33
Z-score on dynamic tests (mean, SD)	1.06 (.63)	8	3.97 (1.84)	20	7.13 (2.90)	33

*Significant p-value based on a Benjamini-Hochberg correction (Appendix 1a). Note. that group sizes differ per variable based on the clinical data that was available. Abbreviations: standard deviation (SD); Rey Auditory Verbal Learning Test (RAVLT); Delis–Kaplan Executive Function System (D-KEFS).

Figure 1. On the x-axis the three groups are depicted: (1) patients with visuo-spatial neglect (VSN) on tests within the static cluster alone; (2) patients with VSN on tests within the dynamic cluster alone; and (3) patients with VSN on tests from both the static and dynamic cluster. On the y-axis the average z-scores on each individual VSN test (shape cancellation, line bisection, letter cancellation, CBS, MAC, simulated driving test) is depicted. An average z-score above two (indicated by the dotted line) was used as an indication for VSN. The error bars represent the variability (SD).

Figure 2. A graphical representation of the static-dynamic factor model, supporting our proposed distinction between static and dynamic cluster of tests.

Figure 3. A hypothetical static-dynamic continuum of assessments of VSN with on the one side static tests with low levels of cognitive demands and on the other side dynamic tests with increasing levels of cognitive demand. Examples of tests used in the current study are shown on the continuum.

Appendix 1a. Benjamini-Hochberg correction that is applied to the multiple comparisons of demographic and clinical characteristics between the groups.

Comparisons	p-values	Rank	Benjamini-Hochberg critical value
Motricity Index upper	.005	1	(1/16).10 =.006
Motricity Index lower	.011	2	(2/16).10 =.013
Barthel Index	.018	3	(3/16).10 =.019
Functional Ambulation Categories	.025	4	(4/16).10 =.025
Days post stroke	.078	5	(5/16).10 =.031
Lesion side	.078	6	(6/16).10 =.038
Sex	.094	7	(7/16).10 =.044
Stichting Afasie Nederland test	.225	8	(8/16).10 =.05
Montreal Cognitive Assessment	.244	9	(9/16).10 =.056
RAVLT recognition	.322	10	(10/16).10 =.063
RAVLT immediate recall	.331	11	(11/16).10 =.069
D-KEFS Tower Test	.616	12	(12/16).10 =.075
RAVLT delayed recall	.666	13	(13/16).10 =.081
Stroke type	.684	14	(14/16).10 =.088
Age	.731	15	(15/16).10 =.094
Level of education	.974	16	(16/16).10 =.1

The largest p-value ≤ critical value is depicted in bold. All the p-values above are also significant. Abbreviations: Rey Auditory Verbal Learning Test (RAVLT); Delis–Kaplan Executive Function System (D-KEFS).

Benjamini-Hochberg correction that is applied to the post-hoc Mann Whitney U tests for comparing the significant clinical characteristics (Motricity index upper and lower, Barthel index, Functional ambulation categories) between the groups.

Comparisons (groups*)	p-values	Rank	Benjamini-Hochberg critical value
Motricity Index upper (1–3)	.002	1	(1/12).10 =.008
Motricity Index lower (1–3)	.003	2	(2/12).10 =.017
Barthel Index (1–2)	.007	3	(3/12).10 =.025
Motricity Index upper (1–2)	.007	4	(4/12).10 =.033
Barthel Index (1–3)	.007	5	(5/12).10 =.042
Motricity Index lower (1–2)	.014	6	(6/12).10 =.05
Functional Ambulation Categories (1–3)	.015	7	(7/12).10 =.058
Functional Ambulation Categories (1–2)	.034	8	(8/12).10 =.067
Functional Ambulation Categories (2–3)	.189	9	(9/12).10 =.075
Motricity Index lower (2–3)	.349	10	(10/12).10 =.083
Motricity Index upper (2–3)	.524	11	(11/12).10 =.092
Barthel Index (2–3)	.931	12	(12/12).10 =.1

The largest p-value ≤ critical value is depicted in bold. All the p-values above are also significant.

*Patient group that showed VSN on static cluster (group 1), Patient group that showed VSN on the dynamic cluster (group 2), Patients groups that showed VSN on both the static and dynamic cluster (group 3).