Assessment of Unilateral Neglect

Abstract

Unilateral neglect (ULN) (or “neglect”) is a common behavioral syndrome in patients following stroke. The reported incidence of ULN varies widely from 10%1 to 82%2 following right-hemisphere stroke and from 15%3 to 65%2 following left-hemisphere stroke. Reasons for the variability in the published rates of occurrence of ULN after stroke include subject selection criteria, lesion site, and the nature and timing of the assessment.4 The clinical impression that ULN occurs more frequently following right brain damage than left brain damage has been supported in a systematic review of published data.4 Unilateral neglect is characterized by the failure to report or respond to people or objects presented to the side opposite a brain lesion. If the failure to respond can be accounted for by either sensory or motor deficits, it is not considered to be neglect.5 Patients may have one type of neglect or a combination of neglect behaviors.6 Because ULN has a wide variety of clinical presentations, no single test can be used to identify the disorder in all patients, nor will a single test provide a comprehensive diagnosis of neglect behavior.7 Some authors7,8 have recommended that assessment of neglect include a test battery. To ensure sufficient sensitivity, the battery should include measures for all types of neglect.9 The purposes of this update are: (1) to clarify the different types of neglect, as a basis for understanding the tests and measures of ULN, (2) to review the validity and reliability of determinations of ULN, and (3) to make recommendations regarding the use of these tests by physical therapists. Given the scope of this article—which is an update of the assessment of neglect—only the major tests for ULN are discussed. For an extensive discussion of the pathophysiology and …