Abstract
Both clinically observable and subclinical hemispatial neglect are related to functional disability. The aim of the present study was to examine whether increasing task complexity improves sensitivity in assessment and whether it enables the identification of subclinical neglect. We developed and compared two computerized dual-tasks, a simpler and a more complex one, and presented them on a large, 173 × 277 cm screen. Participants in the study included 40 patients with unilateral stroke in either the left hemisphere (LH patient group, n = 20) or the right hemisphere (RH patient group, n = 20) and 20 healthy controls. In addition to the large-screen tasks, all participants underwent a comprehensive neuropsychological assessment. The Bells Test was used as a traditional paper-and-pencil cancellation test to assess neglect. RH patients made significantly more left hemifield omission errors than controls in both large-screen tasks. LH patients' omissions did not differ significantly from those of the controls in either large-screen task. No significant group differences were observed in the Bells Test. All groups' reaction times were significantly slower in the more complex large-screen task compared to the simpler one. The more complex large-screen task also produced significantly slower reactions to stimuli in the left than in the right hemifield in all groups. The present results suggest that dual-tasks presented on a large screen sensitively reveal subclinical neglect in stroke. New, sensitive, and ecologically valid methods are needed to evaluate subclinical neglect.
Highlights
Hemispatial neglect is a common symptom of right hemisphere stroke (Ringman, Saver, Woolson, Clarke, & Adams, 2004)
In all groups, within-participants comparisons showed significant task and hemifield × task effects, with the reaction times for Crash being slower than those for Detection, and for Crash, they were slower over the left than the right hemifield
We examined whether varying the complexity of tasks would improve the sensitivity of the assessment and enable the identification of subclinical neglect
Summary
Hemispatial neglect is a common symptom of right hemisphere stroke (Ringman, Saver, Woolson, Clarke, & Adams, 2004). Traditional paper-and-pencil tests are not sensitive in revealing subclinical neglect (Bonato & Deouell, 2013). They have been criticized for their poor ecological validity since stimuli are static and presented in a narrow visual space 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)
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