Assessment and Functional Impact of Allocentric Neglect: A Reminder from a Case Study

Abstract

SR suffered a right hemispheric stroke more than 3 years ago, and now lives with left-sided hemiparesis and chronic spatial neglect due to damaged white matter pathways connecting the frontal, temporal and parietal regions. We report here that SR suffers from both viewer-centered (i.e., egocentric) and object-centered (i.e., allocentric) spatial neglect. Notably, unlike most neuropsychological and functional assessments that focus on egocentric deficits, a specialized neuropsychological figurative discrimination test (the Apples test) revealed SR’s allocentric neglect. Further, using assessments sensitive to detect functional deficits related to allocentric neglect, we observed SR’s difficulty in reading and using clocks, reflecting his object-centered errors in these everyday activities. SR’s case suggests that allocentric-specific assessments, both neuropsychological and functional, are valuable in standard neglect examinations, particularly to predict daily function after stroke. We recommend that neglect-related functional disability be distinguished further with respect to allocentric spatial deficits, and functional assessments for allocentric neglect should be validated in future large sample studies. Identifying allocentric neglect early, and learning about its influence on daily function, may enhance care quality and facilitate effective rehabilitation planning for stroke recovery.

Keywords:

• Stroke
• Spatial neglect
• Egocentric neglect
• Allocentric neglect
• Figurative discrimination tasks

Notes

We thank Mooyeon Oh-Park and Anne Foundas for advice on neuroradiological data. This work was supported by the Kessler Foundation and the National Institute of Neurological Disorders and Stroke, National Institutes of Health (R01 NS055808; K24HD062647; PI: Barrett) and the Department of Education (NIDRR grant number H133 G120203; PI: Barrett). Study contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the federal government.