Clinical Assessment of Hemispatial Neglect: Evaluation of Different Measures and Dimensions

Abstract

The multidimensional nature of the neglect syndrome constitutes a challenge for clinical assessments. This study evaluates the sensitivity of different clinical measures to detect neglect and explores ways to evaluate the diversity of the syndrome in a clinical sample. An extensive battery of tests was used to examine aspects of visuospatial, representational, and personal neglect. A total of 31 normal control participants and 34 patients with right hemisphere stroke were examined 16.8 days post-stroke, on average. Of the patients, 24 showed neglect in at least one task. The Random shape cancellation test, Star cancellation, and two line bisection tasks appeared to be the most sensitive tests of visuospatial neglect. Personal neglect and neglect in far space occurred only together with extrapersonal neglect. Besides near space, other spatial aspects of neglect are important to consider in clinical assessments, but standardized methods are needed. In this patient group a minimum of 10 tests were needed to cover various aspects of detection, dissociations, and severity of neglect. A multifactorial approach in clinical testing of neglect is recommended.

ACKNOWLEDGMENT

This study was supported by the Academy of Finland (Grant # 37873 for Heikki Hämäläinen), University of Turku, and Turku University Central Hospital. We are grateful to Dr. Matti Haataja and the personnel at the Department of Rehabilitation and Department of Neurology at the University Central Hospital of Turku for the help and encouragement we have received during this study.

Notes

Mean ± SD (range).

*RCVA = Right hemisphere cerebrovascular accident.

*Asymmetry based on lateral omissions, only. More centrally located omissions were left out.

**Cut-off level was set at 2% omissions of the total amount of words to match the criteria used in the BIT.

Rank ordered by percentages detecting contralateral neglect.

¹Total contralateral inattention performance (asymmetry score 0.0), partial contralateral inattention performance (asymmetry score cut-off to 0.1).

²Total ipsilateral inattention performance (asymmetry score 1.0), partial ipsilateral inattention performance (asymmetry score cut-off to 0.9).

³Percentages calculated from patients without contralateral neglect.

ip = ipsilateral neglect.