Neglect Tests Research Articles

Double Dissociations between Neglect Tests: Possible Relation to Lesion Site

In 20 patients who had suffered a first right hemisphere stroke, we examined the prevalence of double dissociations between the results of a star cancellation and a line bisection test. Both are common methods to assess spatial hemineglect. Within the group of neglect patients, we found no significant correlation between the two tasks. Furthermore, 5 patients with impaired performance on one of the tests were within the normal range on the other one. In agreement with experimental studies, we argue that spatial hemineglect is not a unitary syndrome. Furthermore, the findings in one of our patients are compatible with the view that an isolated deficit on cancellation tasks might follow from a lesion in the right anterior cingulate gyrus.

MR perfusion imaging reveals regions of hypoperfusion associated with aphasia and neglect

To evaluate diffusion-weighted imaging (DWI) and MR perfusion imaging (MRPI) as tools for identifying regions of infarct and hypoperfusion associated with aphasia and neglect in hyperacute stroke. Secondary goal: to establish a functional correlate of a radiologically defined "ischemic penumbra." Forty subjects underwent DWI, MRPI, and standardized tests for lexical deficits or hemispatial neglect within 24 hours of stroke onset or progression. Ten patients had repeat DWI, MRPI, and cognitive testing after 3 days (in some cases after reperfusion therapy). Pearson correlations between error rate on cognitive testing and volume of abnormality on DWI versus MRPI were determined at each time period, and regions of hypoperfusion corresponding to specific cognitive deficits were identified. Error rate was more strongly correlated with volume of hypoperfused tissue on MRPI (r = 0.65 to 0.93; p < 0.01 to p < 0.0003) than with volume of lesion on DWI (r = 0.54 to 0.75; p = 0.14 to p < 0.01) for dominant and nondominant hemisphere stroke, at each time point. Forty-eight percent of aphasic patients and 67% of those with hemispatial neglect had either no infarct or only small subcortical infarct on DWI, but had focal cortical hypoperfusion. Patients who had successful reperfusion therapy showed resolution of the hypoperfused territory beyond the infarction on repeat MRPI and showed resolution of corresponding deficits. MRPI shows regions of hypoperfused cortex associated with lexical deficits or hemispatial neglect, even when DWI shows no infarct or only small subcortical infarct. MRPI-DWI mismatch indicates regions of functionally salvageable tissue.

Computer recording of standard tests of visual neglect in stroke patients.

To determine whether a computer-based method for recording standardized assessment of neglect identifies abnormalities in the 'process' as well as in the 'outcome' of such tasks. Prospective sequential assessment of patients admitted to a stroke rehabilitation unit. All consecutive patients with right-sided cerebrovascular accident confirmed on computerized tomography (CT) scan including 30 patients with neglect, 57 patients without neglect. An age-matched control group of 13 subjects. All patients were tested using the standard Rivermead Behavioural Inattention Test (BIT) and by computer recording of two standard tests for assessing neglect (line bisection and Albert's test). Age-matched controls were tested using computer recording of the two standard tests. Neglect was defined using the BIT with a cut-off score of 129. Computer recording measured the 'outcome' of tasks, i.e. the deviation from midline and omissions in cancellation, as well as the 'process' of tasks, i.e. time between cancellations, components of cancellation time including premovement, movement and drawing time, and the starting point for cancellation. The computer recording identified significant differences in 'outcome' and 'process' which distinguished neglect from non-neglect patients. There were significant differences between non-neglect patients and age-matched controls with regard to 'process' measures but not with regard to 'outcome' measures. Computer recording of standard tests for assessing neglect identifies novel impairments with regard to the process of carrying out tasks. These impairments may be used to investigate changes in neglect with time, the response of neglect to treatment and to explore further the neuropsychological changes associated with neglect in stroke patients.

Validating the Draw-A-Man Test as a Personal Neglect Test

The purpose of this study was to determine the reliability and validity of a Draw-A-Man Test in measuring personal neglect in patients with right brain stroke. Draw-A-Man Test was administered to 51 persons with right cerebrovascular accident (CVA) and 110 age-matched persons without brain insult. A categorical classification was developed based on the man drawn in the test. Participants who showed homogeneous bilateral representation of body parts were considered to not have personal neglect, whereas those who showed unilateral body parts were considered to have personal neglect. The completed tests were used to blindly categorize the persons with and without personal neglect according to the above definition by two raters for calculating interrater reliability. The Klein-Bell ADL (Activities of Daily Living) Scale was also administered to the participants with right CVA to validate the Draw-A-Man Test. This dichotomy--bilateral representation versus unilateral representation--showed a high percentage of agreement between two raters. Rater A classified all 110 "normal" participants as being without personal neglect and classified 13 of the 51 participants with stroke as having personal neglect. Participants demonstrating personal neglect showed significantly poorer ADL performance than did those without personal neglect. ADL performance was also found to be significantly related to somatosensation, motor status of the impaired limbs, and muscle strength of the sound limbs. However, even after controlling the effect of these variables by partial correlation, personal neglect was still highly related to ADL performance. The Draw-A-Man Test is a reliable and valid tool for discriminating clients with personal neglect from those without.

Evaluation of a test battery for hemineglect in elderly stroke patients for use by therapists in clinical practice

Hemineglect is not a single entity, and the syndrome has a number of sensory and motor manifestations. The purpose of this study was a) to measure performance of healthy elderly subjects on a battery of validated tests for hemineglect in order to establish appropriate cut-off scores and b) to assess performance of a large sample of elderly stroke patients in a rehabilitation unit, using the same battery. Tests were selected to identify rate of occurrence of hemineglect in visuo-spatial, representational, pre-motor and personal modalities. The battery was administered to 107 patients with right or left sided brain damage and 43 age-matched controls. Results showed that 39.2% right-sided brain damage), were 'neglecters', scoring below cut-off in one or more tests. Star Cancellation and Line Bisection showed the highest relative sensitivity for visuo-spatial neglect (76.4%) 'Baking Tray Task', the 'Exploratory Motor Task', and utilisation of common objects test for personal neglect are additionally suggested for use in the clinical situation. 'Copying a Daisy' and clock-drawing are not recommended due to low sensitivity and subjectivity in scoring respectively.

Multiple perceptual distortions and their modulation in leftsided visual neglect

There is an ongoing debate concerning the perception and neural representation of space in neglect. Four experiments are here reported designed to further investigate the nature of perceptual distortions and their modifiability in patients with neglect. In Experiment 1 it was found that neglect patients, in contrast to left- or right-hemisphere lesioned control patients and normal subjects, show similar distortions of perceived visual space when judging the extension of horizontal distances ( space distortion) as compared to the horizontal size of objects ( size distortion). Similar deficits were present in most neglect patients in a newly developed space bisection task. These results attest that neglect patients have perceptual distortions related to within-object (size) and between-object (distance) spatial processing in their horizontal plane. Objects were oversized by 33% and distances by 19% horizontally in neglect patients, whereas all control groups showed nearly veridical spatial coding (deviations<5%). In Experiment 2 the modifiability of these distortions was tested by the use of slow visual background motion. Leftward, coherent background motion transiently restored normal horizontal size and distance coding in neglect patients, whereas rightward motion aggravated the deficit significantly in the distance task, but not in the size task. None of the other subject groups showed any influence of background motion on spatial judgments. Experiment 3 evaluated possible effects of simultaneous vs successive stimulus presentation in perceptual distortions, thus modulating attentional factors. Neglect patients performed significantly better — although not normal — with a successive presentation of the spatial stimuli (2 s, 10 s delay) as compared to the simultaneous condition in the size judgment task, but not in the distance task. In contrast, this manipulation had no effects in any of the control groups. Experiment 4 reports more detailed results of subject J.S., a neglect patient with a right mediotemporal lesion, who showed a marked horizontal size distortion, but normal horizontal distance judgments. Despite some fluctuation in J.S.’s size judgments he showed a significant overestimation of horizontal object size by +22% to +40% across several test blocks and testing sessions. Thus, performance fluctuations due to attentional or other reasons cannot fully account for J.S.’s dissociation in size vs distance judgments. He thus shows that the visual coding of horizontal spatial extension within an object can be dissociated from that of the spatial extension between objects along the horizontal plane. Finally, performance in the three spatial tasks (used in Experiment 1) was found to correlate significantly with three typical tests of spatial neglect (line bisection, cancellation, copying, r=0.42–0.77), thereby indicating a significant relationship to the neglect syndrome. Together, the results of the four experiments are interpreted in support of multiple spatial–perceptual distortions in visual neglect, which are influenced by visual motion and attention. Perceptual distortions relating to objects and space between objects are present in most neglect patients, but may dissociate, as in case J.S. It is argued that these might reflect the existence of several, partially overlapping and diverging neural maps for the representation of different spatial attributes in the horizontal plane. Furthermore, it is hypothesized that these perceptual distortions constitute an important element of the spatial–perceptual deficits encountered in the syndrome, contribute to its severity, but are not the key deficit of the disorder.

A temporal MRI assessment of neuropathology after transient middle cerebral artery occlusion in the rat: correlations with behavior.

The purpose of this study was to evaluate the temporal and spatial pathological alterations within ischemic tissue using serial magnetic resonance imaging (MRI) and to determine the extent and duration of functional impairment using objective behavioral tests after transient middle cerebral artery occlusion (tMCAO) in the rat. MRI signatures derived from specific anatomical regions of interest (ROI) were then appropriately correlated to the behavioral measures over the time course of the study (up to 28 days post-tMCAO). Sprague-Dawley rats (n = 12) were initially trained on the following behavioral tasks before surgery: bilateral sticky label test (for contralateral neglect); beam walking (for hindlimb coordination); staircase test (for skilled forelimb paw-reaching). Rats were then randomly assigned to receive either tMCAO (90 minutes, n = 6), by means of the intraluminal thread technique, or sham-control surgery (n = 6). Proton density, T2- and T2-diffusion-weighted MR images were acquired at 1, 7, 14, and 28 days post-tMCAO that were then smoothed into respective proton density, T2 relaxation, and apparent diffusion coefficient (ADC) maps. Apparent percent total lesion volume was assessed using T2W imaging. MR signatures were evaluated using the tissue maps by defining ROI for MCAO and sham-control groups, which corresponded to the caudate-putamen, forelimb, hindlimb, and lower parietal cortices both ipsilateral and contralateral to the occlusion site. Behavioral tests were undertaken daily from 1 to 28 days post-tMCAO. Results demonstrate that apparent percent lesion volume reduced from 1 to 7 days (P < 0.05) but then remained constant up to 28 days for the MCAO group. Pathological changes in the temporal profile of T2 and ADC tissue signatures were significantly altered in specific ROI across the time course of the study (P < 0.05 to <0.001), reflecting the progression of edema to necrosis and cavitation. Both T2 and ADC measures of ischemic pathology correlated with parameters defined by each of the functional tests (r > or =0.5, P < 0.05) across the time course. The staircase test revealed bilateral impairments for the MCAO group (P <0.001), which were best predicted by damage to the ipsilateral lower parietal cortex by means of hierarchical multiple regression analyses (R2 changes > or =0.21, P < or =0.03). Behavioral recovery was apparent on the beam walking test at 14 to 28 days post-MCAO, which was mirrored by MRI signatures within the hindlimb cortex returning to sham-control levels. This long-term study is the first of its kind in tracing the dynamic pathologic and functional consequences of tMCAO in the rat. Both serial MRI and objective behavioral assessment provide highly suitable outcome measures that can be effectively used to evaluate promising new antiischemic agents targeted for the clinic.

Relationships of Cognitive Performance and Daily Function of Clients following Right Hemisphere Stroke: Predictive and Ecological Validity of the LOTCA Battery

The purpose of this study was to determine the relationship of cognitive performance, as measured by the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery, to daily function in patients following right hemisphere stroke. Furthermore, to explore the predictive power of cognitive performance using the LOTCA at the first rehabilitative stage after stroke to long-term functional outcomes. The method was a longitudinal research design at 3 points in time: admission to rehabilitation; discharge from the rehabilitation hospital; and at follow-up, six months after discharge, which in some cases reached one year post onset. Subjects were 40 consecutive patient admissions to a rehabilitation hospital. All patients were right-handed adults with a CT-proven, first, single, right hemispheric stroke. Based on their total cutoff score in the Behavioral Inattention Test (BIT) for unilateral spatial neglect, patients were divided into 2 subgroups: 19 with neglect and 21 without neglect. Instruments included the LOTCA, the Functional Independence Measure (FIM), the Rabideau Kitchen Evaluation and Phone use. Results showed that right hemispheric stroke patients with unilateral spatial neglect performed at a lower level than patients without neglect on all measures of cognitive skills, as well as daily functional tasks as measured by the FIM and kitchen tasks. Differences were significant in all testing periods. Relationships between cognitive and functional measures showed that visuomotor organization and thinking operations correlated at moderate to high levels in both subgroups. The predictive results from admission to follow-up suggest that unilateral spatial neglect is the major predictor of activities of daily living (ADL) and instrumental activities of daily living (IADL) task performance, however cognitive skills, especially the more complex integrated visuomotor and thinking skills, were significantly related to functional outcomes in the non-neglect group. Thus, they are crucial in the assessment of stroke patients. The predictive and ecological validity of the LOTCA battery was supported.

Improving the Clinical Diagnosis of Personal Neglect: A Reformulated Comb and Razor Test

Beschin and Robertson (1997) devised a simple clinical test of left personal neglect, which characterises personal grooming behaviour according to the proportion of the total activity that is directed to the left side of the body. Although this test proved highly reliable, and more sensitive than prior diagnostic techniques, its formulation may yet be improved. The present paper reports a reanalysis of Beschin and Robertson's (1997) data, using additional control subjects, and a formula which characterises personal neglect as a lateral bias of behaviour rather than as a lateralised deficit. It is shown that this formula greatly enhances the test's sensitivity to the behavioural abnormalities of brain damaged patients, and it is recommended that this modification be adopted for the future diagnosis of personal neglect.

Developing algorithms to enhance the sensitivity of cancellation tests of visuospatial neglect.

We describe a set of algorithms that enhance the sensitivity of cancellation tests used in assessing visuospatial neglect. The algorithms can be readily implemented on a computer and can provide temporal and nontemporal data on strategies used during cancellation. We also present preliminary results from a group of 68 right-hemisphere brain-damaged patients and 12 age-matched control participants, which demonstrate the clinical significance of the measures we have defined.

Egocentric frame of reference: its role in spatial biasafter right hemisphere lesions

The reference shift hypothesis of unilateral neglect holds that spatial bias in left neglectstems from a rightward deviation of patients egocentric frame of reference (ER). Twenty fiveunselected right brain-damaged patients participated in a straight-ahead pointing task to assessthe position of their ER (Experiment 1). A rightward ER shift emerged only in the subgroup ofpatients with extensive parietal lesions. In Experiment 2, we found that the position of the ER didnot predict the outcome of various visuospatial neglect tests ( r = 0.07 to 0.27). In Experiment 3,no significant positive correlation emerged between the ER position and visual ( r = 0.26) ortactile ( r = −0.48) extinction. Two further experiments examined the relationships between theER position and patients performance on a reaction time test of directional motor bias(Experiment 4), and on a test of response times to lateralised visual stimuli (Experiment 5).Results showed that the ER position did not predict the distribution of accuracy scores orresponse times in either task (Experiment 3: accuracy: r = 0.06; response times: r = 0.16;Experiment 4: accuracy: r = 0.09; response times: r = 0.04). We concluded that the position ofthe ER plays no crucial role in the behavioural consequences of spatial bias induced by righthemisphere lesions.

Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect

Objective: To evaluate the impact of unilateral spatial neglect (USN) on the rehabilitation outcome and long-term functioning in activities of daily living (ADL) and instrumental ADL (IADL) of right hemisphere damaged (RHD) stroke patients. Design: Assessments of sensory-motor and cognitive impairment and of functional disability were conducted upon admission to rehabilitation, upon discharge from the rehabilitation hospital, and 6 months after discharge, up to a year postonset. Setting: The Loewenstein Rehabilitation Hospital, which receives patients from all general hospitals in Israel. Patients: Forty consecutive admissions of adult right-handed patients with a first, single, right hemispheric stroke proven by computed tomography. Based on their total score in the Behavioral Inattention Test for neglect, patients were divided into two groups: 19 with neglect (USN+) and 21 without neglect (USN-). Outcome Measures: Functional Independence Measure, for ADL; The Rabideau Kitchen Evaluation, for IADL. Results: Impairment and disability levels of RHD patients with and without USN were clearly differentiated. Neglect is associated with lower performance on measures of impairment (sensory-motor and cognitive), as well as on measures of disability in ADL and IADL. Differences were significant in all testing periods. The recovery pattern of USN+ patients is slower and more attenuated. In both groups, most improvement occurs in the first 5 months after onset. USN is the major predictor of rehabilitation outcome from admission to follow-up. Conclusions: The significance of neglect as a major source of stroke-related long-term disability justifies further research efforts to develop appropriate therapeutic modalities for this complex, multifactorial syndrome.

The corticostriatal system mediates the "paradoxical" contraversive rotation but not the striatal hyperexpression of Fos induced by amphetamine early after 6-hydroxydopamine lesion of the nigrostriatal pathway.

In rats with unilateral 6-hydroxydopamine (6-OHDA) lesion of the nigrostriatal pathway, amphetamine produces ipsiversive rotational behavior and activation of Fos in the intact striatum, but practically no activation of Fos in the denervated striatum. However, a seemingly paradoxical contraversive rotation, accompanied by intense striatal Fos activation in the lesioned striatum, has been observed during the first few days postlesion. In the present work, behavioral tests and immunohistochemistry for Fos protein and tyrosine hydroxylase (TH) were combined to study striatal changes 36 h after 6-OHDA lesion and particularly the possible involvement of glutamatergic corticostriatal afferents. Injection of amphetamine (0.5 mg/kg or 5 mg/kg) induced contraversive rotation and strong and evenly distributed Fos expression in the lesioned striatum; in the contralateral striatum, however, Fos density was lower than in nonlesioned rats. Pretreatment with the N-methyl-D-aspartate (NMDA) glutamate receptor antagonist MK-801 (either 0.5 mg/kg or 5 mg/kg) did not significantly affect the hyperexpression of Fos in the lesioned striatum, but suppressed the contraversive rotation. Similarly, rats that were subjected to corticostriatal deafferentation (confirmed by sensory neglect tests) and 6-OHDA lesion (1 week or 3 weeks later) showed no significant reduction in the striatal Fos hyperexpression induced by amphetamine (0.5 mg/kg or 5 mg/kg) and no significant rotational asymmetry. In conclusion, the present results indicate that glutamatergic corticostriatal afferents are essential for the contraversive rotational behavior but not the striatal hyperexpression of Fos observed in response to amphetamine early after 6-OHDA lesion, and suggest that intense dopaminergic stimulation of striatal neurons is sufficient for induction of Fos, but that concurrent glutamatergic stimulation is necessary for the motor response.

Dissociable long-term cognitive deficits after frontal versus sensorimotor cortical contusions.

Cognitive deficits are the most enduring and disabling sequelae of human traumatic brain injury (TBI), but quantifying the magnitude, duration, and pattern of cognitive deficits produced by different types of TBI has received little emphasis in preclinical animal models. The objective of the present study was to use a battery of behavioral tests to determine if different impact sites produce different patterns of behavioral deficits and to determine how long behavioral deficits can be detected after TBI. Prior to surgery, rats were trained to criteria on delayed nonmatching to position, radial arm maze, and rotarod tasks. Rats received sham surgery (controls), midline frontal contusions (frontal TBI, 2.25 m/sec impact), or unilateral sensorimotor cortex contusions (lateral TBI, 3.22 m/sec impact) at 12 months of age and were tested throughout the next 12 months. Cognitive deficits were more robust and more enduring than sensorimotor deficits for both lateral TBI and frontal TBI groups. Lateral TBI rats exhibited transient deficits in the forelimb placing and in the rotarod test of motor/ambulatory function, but cognitive deficits were apparent throughout the 12-month postsurgery period on tests of spatial learning and memory including: (1)reacquisition of a working memory version of the radial arm maze 6-7 months post-TBI, (2) performance in water maze probe trials 8 months post-TBI, and (3) repeated acquisition of the Morris water maze 8 and 11 months post-TBI. Frontal TBI rats exhibited a different pattern of deficits, with the most robust deficits in tests of attention/orientation such as: (1) the delayed nonmatching to position task (even with no delays) 1-11 weeks post-TBI, (2) the repeated acquisition version of the water maze--especially on the first "information" trial 8 months post-TBI, (3) a test of sensorimotor neglect or inattention 8.5 months post-TBI, and (4) a DRL20 test of timing and/or sustained attention 11 months after surgery. These results suggest that long-term behavioral deficits can be detected in rodent models of TBI, that cognitive deficits seem to be more robust than sensorimotor deficits, and that different TBI impact sites produce dissociable patterns of cognitive deficits in rats.

Nonlateralized Attentional Deficits: An Important Component Behind Persisting Visuospatial Neglect?

Simple reaction time was examined in a consecutive series of 60 right hemisphere stroke patients at the postacute stage and at 6 to 7 months poststroke. Reaction times to auditory stimuli were measured within the ipsilesional side of space. Patients showing contralateral neglect in conventional tests of neglect showed significantly increased reaction times at the postacute stage and at the follow-up compared to those not showing neglect and to those in a group of normal controls. The results suggest that a lowered general attentional capacity may constitute a central component behind persistent neglect. An additional analysis of the CT scans of the patients showed that a large lesion including the paraventricular white matter in the temporal lobe was the most important anatomical correlate of persisting slow reactions.

Deficits in response initiation, but not attention, following excitotoxic lesions of posterior parietal cortex in the rat

Damage to posterior parietal cortex in humans is known to cause hemineglect, and specifically difficulty in disengaging attention in tests of covert orienting. Aspirative lesions of a region of cortex in rats which is thought to be homologous to primate posterior parietal cortex has also been reported to cause what appears to be multimodal neglect. In order to make an assessment of the nature of this disorder, a variety of tests were employed: (1) a test of somatosensory neglect after Schallert et al. (Pharmacol. Biochem. Behav., 16 (1982) 455–462); (2) a skilled paw-reaching test after Whishaw et al. (Brain 109 (1986) 805–843); (3) a visual reaction time task with peripheral cues analogous to Posner's test of covert orienting (Q. J. Exp. Psychol., 32 (1980) 3–25). Following the posterior parietal lesion there was a global increase in reaction time of responses made contralateral to the lesion in the reaction time task, but there was no evidence of a deficit in covert orienting. There was also no evidence of somatosensory neglect. There was a decrease in the number of attempted reaches with the contralateral paw and a tendency to spend a smaller proportion of time in the contralateral half of the reaching cage.

Neglect in elderly stroke patients: A comparison of five tests

Neglect is a disabling state in stroke patients. Five tests for visuo-spatial neglect, star cancellation, line crossing, line bisection, draw a clock and copy a cross, were compared in 57 elderly patients. Sensitivity and intercorrelations between the tests were determined. Patients with neglect were studied as regards their activities of daily living, motor activity and cognition. Left-hemisphere neglect in patients with right-hemisphere lesions was more severe than right-sided neglect in patients with left-sided lesions in the star cancellation test. Sensitivity of the tests was moderate for star cancellation, line bisection and draw a clock, and low for line crossing and copy a cross. Significant correlations existed between the tests and cognitive and functional ability. Intercorrelations between the tests were moderate. Neglect patients showed a slower recovery after 6 and 12 months. Draw a clock and a cross displayed no sensitivity for neglect in patients with hemianopia, which may be due to the fact that these tests also evaluate constructional apraxia. The cancellation tests were influenced by hemianopia and there is evidence that hemianopia exacerbates neglect. This study shows that a battery of neglect tests is required to diagnose the neglect syndrome.

Video feedback in the rehabilitation of patients with unilateral neglect

Objective: To compare the effects of a video procedure and a conventional verbal procedure in giving patients feedback on their neglect behavior in a practical task. Design: Subjects in group A were trained with a video feedback procedure and subjects in group B with a conventional, verbal procedure. Three hours after the procedures, the subjects were tested with four different neglect tests to evaluate the effects of training. Subjects: A consecutive series of 14 right-brain-damaged patients with moderate to severe unilateral neglect (UN): 7 patients in group A and 7 in group B. Interventions: Subjects in group A were given the opportunity to see their performances on video, directly after the performance of the “Baking Tray Task” (BTT). They could see their neglected left side on the right side of the TV monitor. Subjects in group B were given verbal and visual guidance to see their results in the BTT. Main Outcome Measures: Line Cancellation Task, Figure Copying Task, Line Bisection, and BTT before and after procedures. Results: The video feedback group improved significantly in the BTT, as tested 3 hours after training ( p < .02). Conventional training had no effect on the BTT or on the other neglect measures. In the video feedback group, no generalization effects from the videotaped BTT on other neglect tests were observed. Conclusion: Video feedback seems to be a useful technique in the rehabilitation of patients with unilateral neglect.

Measuring unilateral spatial neglect during stepping

Objective: To examine the diaschisis of faultless conventional neuropsychological tests of unilateral spatial neglect (USN) and defects of activities of daily living (ADL) functions. Design: The evaluations of USN by assessments now in wide use were compared with newly developed assessments using a dual-task methodology in which a stepping activity was used as a “distracter” during USN assessment. Setting: A rehabilitation unit in a medical school hospital. Patients: Subjects consisted of 31 patients who suffered from stroke (right hemisphere lesions, 19; left hemisphere lesions, 12). Main Outcome Measures: Observation of behavior of hemiinattention, ADL evaluation (transfer and gait), and conventional tests of USN (line bisection, line cancellation, copying of flowers) were conducted. USN test during stepping was performed by stepping on two force plates connected to a microprocessor and to videocassette player so that the subject was required to step continuously. Results: Most of the subjects who had exhibited USN in the written tests on admission showed no defects in the tests after about 60 days even if hemi-inattention was observed in behavior. In the test during stepping, subjects with hemi-inattention behavior neglected some visual stimulations applied from the direction contralateral to the hemisphere lesion. Conclusions: Combined tests of visual attention and distracter activity (stepping) can more effectively reflect the ADL functions of USN patients than conventional tests.

Personal Versus Extrapersonal Neglect: A Group Study of their Dissociation Using a Reliable Clinical Test

The validation of a simple quantitative clinical test of personal neglect is described in this study of 17 right brain damaged CVA patients with extrapersonal neglect, 14 without unilateral extrapersonal neglect, 13 left brain damaged CVA patients and 17 age-matched controls. The test had a high reliability and clearly differentiated neglect patients from all other groups. Furthermore the test identified a much higher incidence of personal neglect among extrapersonal neglect patients (59%) than has proviously been found. Moreover this study confirms earlier findings by showing a double dissociation between personal and extrapersonal neglect. Seven patients with extrapersonal neglect showed no personal neglect while five patients showing no extrapersonal neglect did show personal neglect on this test.