Neglect Tests Research Articles

Attentional distractibility by optokinetic stimulation in Alzheimer disease

Unilateral temporoparietal injury may result in an attentional deficit for stimuli presented in contralesional space. Thus, bilateral temporoparietal degeneration associated with Alzheimer disease (AD) might result in a bilateral attentional disturbance. Tests for hemispatial neglect, however, primarily assess spatial attentional asymmetries, and a bilateral attentional disorder might not be detected with these tests. The goal of this study was to learn whether optokinetic stimulation (OKS) would perturb the balanced attentional deficits of AD patients and alter their spatial allocation of attention. In Experiment I, 10 AD patients with bilateral temporoparietal glucose hypometabolism on PET and 10 controls bisected lines in two conditions: stationary solid lines superimposed on a moving background and "striped lines" where the whole line was stationary but the stripes within the line moved. The background OKS or the stripes within the line moved leftward or rightward or were stationary. In Experiment II, to investigate whether the influence of background movements would increase with AD severity, we conducted a similar experiment in 56 patients with various stages of AD. In Experiment I, the line bisection errors (LBEs) of AD subjects, but not of the controls, were markedly influenced by both background and within line stripe motions, deviations occurring in the same direction of movement. In Experiment II, LBEs also occurred in the same direction as background movement and increased with dementia severity. These results demonstrate that patients with Alzheimer disease are spatially distracted by moving stimuli.

Cognitive rehabilitation for spatial neglect following stroke

Unilateral spatial neglect causes difficulty attending to one side of space. Various rehabilitation strategies have been used but evidence of their benefit is lacking. To determine the persisting effects of cognitive rehabilitation specifically aimed at spatial neglect following stroke, as measured on impairment and disability level outcome assessments and on destination on discharge from hospital. We searched the Cochrane Stroke Group Trials Register (last searched 4 July 2005), MEDLINE (1966 to July 2005), EMBASE (1980 to July 2005), CINAHL (1983 to July 2005), PsycINFO (1974 to July 2005), UK National Research Register (July 2005). We handsearched relevant journals, screened reference lists, and tracked citations using SCISEARCH. We included randomised controlled trials of cognitive rehabilitation specifically aimed at spatial neglect. We excluded studies of general stroke rehabilitation and studies with mixed patient groups, unless more than 75% of their sample were stroke patients or separate stroke data were available. Two review authors independently selected trials, extracted data, and assessed trial quality. We included 12 RCTs with 306 participants. Only four had adequate allocation concealment, that is a low risk of selection bias. A large number of outcome measures were reported. Only six studies measured disability and two investigated whether the effects persisted. The overall effect (standardised mean difference) on disability had a wide confidence interval that included zero and was not statistically significant. For discharge destination there were clinically significant effects but in both directions and the confidence interval of the odds ratio included one. In contrast, cognitive rehabilitation did improve performance on some, but not all, standardised neglect tests. The number of cancellation errors made was reduced and the ability to find the midpoint of a line improved immediately and persisted at follow up. These effects appeared likely to generalise from the samples studied to the target population, but were based on a small number of studies. Several types of neglect specific approaches are now described but there is insufficient evidence to support or refute their effectiveness at reducing disability and improving independence. They can alter test performance and warrant further investigation in high quality randomised controlled trials. As we did not review whether patients with neglect benefit from rehabilitation input in general, such patients should continue to receive general stroke rehabilitation services.

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

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.

Security Attack Testing (SAT)—testing the security of information systems at design time

For the last few years a considerable number of efforts have been devoted into integrating security issues into information systems development practices. This has led to a number of languages, methods, methodologies and techniques for considering security issues during the developmental stages of an information system. However, these approaches mainly focus on security requirements elicitation, analysis and design issues and neglect testing. This paper presents the Security Attack Testing (SAT) approach, a novel scenario-based approach that tests the security of an information system at the design time. The approach is illustrated with the aid of a real-life case study involving the development of a health and social care information system.

Cognitive functions in patients with MR-defined chronic focal cerebellar lesions

The aim of the present study was to examine cognitive functions in a group of chronic patients with focal cerebellar lesions. Both effects of localization (anterior vs. posterior lobe) and side (left vs. right cerebellar hemisphere) were of interest. Fourteen patients with infarctions within the territory of the posterior inferior cerebellar artery (PICA) and seven patients with infarctions within the territory of the superior cerebellar artery (SCA) participated. The affected lobules and nuclei were assessed based on 3D MR imaging. The right cerebellar hemisphere was affected in eight PICA and two SCA patients, the left hemisphere in six PICA and four SCA patients. One SCA patient revealed a bilateral lesion. In order to study possible lateralization of functions, subjects performed a language task as well as standard neglect and extinction tests. Moreover, two tests of executive functions were applied. There were no significant group differences apart from a verbal fluency task, in which all cerebellar patients - but especially those with right-sided lesions - were impaired. Voxel-based lesion-symptom mapping (VLSM) revealed that a lesion of the right hemispheric lobule Crus II was associated with impaired performance in the verbal fluency task. In sum, the results showed preserved cognitive abilities in chronic cerebellar patients apart from impairments of verbal fluency in patients with right-cerebellar lesions. The latter findings are in line with the assumption that the right posterolateral cerebellar hemisphere supports functions associated with verbal fluency.

Reliability and Validity of the Chinese Behavioural Inattention Test–Hong Kong Version (CBIT-HK) for Patients with Stroke and Unilateral Neglect

Objective One of the explanations for the wide range in the reported incidence of unilateral neglect is probably the lack of agreement regarding evaluation methods. The aim of this study was to investigate the reliability and validity of the newly developed Chinese Behavioural Inattention Test–Hong Kong version (CBIT-HK) for research purposes, and for patients with stroke and unilateral neglect in Hong Kong. Methods Fourteen consecutive subacute patients with stroke were selected to determine the external reliabilities and new cutoff scores, and 54 subacute right hemisphere patients were given evaluations including the CBIT-HK, a clock drawing test, and a functional assessment battery to find out the internal reliability and concurrent validity of the test battery. Results The results indicated that the interrater, intrarater, and parallel-form reliability of the test were high [ICC (2,k) = 0.75 to 0.99]. The findings of low cutoffs and sensitivities for two language-related items in the Behavioural Subtest: “Article Reading” and “Address and Sentence Copying”, suggested that these items should be used with caution. The significant relationship between the Conventional Subtest with the clock drawing test (r = 0.34) and the functional assessment battery (r = 0.47) suggested that the Conventional Subtest, especially the “Star Cancellation” item, rather than the Behavioural Subtest, could be used as a single screening test or item for neglect in the initial assessment of patients with stroke by occupational therapists in daily practice. Conclusion The reliability and validity of the CBIT-HK were established. The results of this study should aid in making the CBIT-HK, designed to assess the unilateral neglect or visual inattention of patients with stroke and unilateral neglect, a tool for clinical application in occupational therapy as well as for future study in Hong Kong.

Anosognosia versus unilateral neglect. Coexistence and their relations to age, stroke severity, lesion site and cognition

The aim of this study was to examine the association between anosognosia and unilateral neglect (UN), with special focus on age, stroke severity, lesion location and pre-stroke dementia. The basis of this investigation was a population-based stroke incidence study. Anosognosia was assessed using a questionnaire, and UN using a three-item version of the Behaviour Inattention Test, the Baking Tray Task and a test of personal neglect. Stroke severity was assessed using the NIH stroke scale. Patients with anosognosia were older, and they more often had pre-stroke dementia than patients having UN only. No particular lesion localization was associated with anosognosia, while UN was strongly associated with previously defined lesion sites, often in the parietal lobe. There was a borderline significance regarding stroke severity in patients having anosognosia compared with those with UN only. Patients with anosognosia had higher mortality than patients without, but when controlled for age and stroke severity, this effect was not independent. While UN is closely associated with 'classical' lesion sites, anosognosia is a condition that more often occurs in a previously impaired brain. For anosognosia, lesion location appears to be less important. Anosognosia also tends to occur with larger strokes.

Gauging Recovery after Hemorrhagic Stroke in Rats: Implications for Cytoprotection Studies

Successful clinical translation of prospective cytoprotectants will likely occur only with treatments that improve functional recovery in preclinical (rodent) studies. Despite this assumption, many rely solely on histopathologic end points or the use of one or two simple behavioral tests. Presently, we used a battery of tests to gauge recovery after a unilateral intracerebral hemorrhagic stroke (ICH) targeting the striatum. In total, 60 rats (N=15 per group) were stereotaxically infused with 0 (SHAM), 0.06 (MILD lesion), 0.12 (MODERATE lesion), or 0.18 U (SEVERE lesion) of bacterial collagenase. This created a range of injury akin to moderate (from SEVERE to MODERATE or MODERATE to MILD lesion size approximately 30% reduction) and substantial cytoprotection (SEVERE to MILD lesion size--51% reduction). Post-ICH functional testing occurred over 30 days. Tests included the horizontal ladder and elevated beam tests, swimming, limb-use asymmetry (cylinder) test, a Neurologic Deficit Scale, an adhesive tape removal test of sensory neglect, and the staircase and single pellet tests of skilled reaching. Most tests detected significant impairments (versus SHAM), but only a few (e.g., staircase) frequently distinguished among ICH groups and none consistently differentiated among all ICH groups. However, by using a battery of tests we could behaviorally distinguish groups. Thus, preclinical testing would benefit from using a battery of behavioral tests as anything less may miss treatment effects. Such testing must be based on factors including the type of lesion, the postoperative delay and the time required to complete testing.

A dissociation between visual and auditory hemi-inattention: Evidence from temporal order judgements

Patients with right hemisphere brain lesions often suffer from deficits in spatial attention that can be manifested in different sensory modalities. It has recently been claimed that a relationship (i.e., association) could exist between symptoms of hemi-inattention in different modalities, based on correlations between the results of visual and auditory clinical tests of neglect or extinction. However, it should be noted that the visual and auditory tasks varied greatly both in response type and level of sensitivity. Here, we have examined cross-modal associations in spatial attention deficits using a temporal order judgment task (TOJ) in which patients were required to identify which of two visual or auditory objects had appeared first. When compared to age and education matched control participants, the patients needed, on average, the contralesional stimulus to lead the ipsilesional stimulus to achieve the point of subjective simultaneity (PSS). No association between the degree of visual and auditory hemi-inattention was observed amongst the patients, suggesting that there is a certain degree of independence between the mechanisms subserving spatial attention across sensory modalities.

Virtual Reality Pencil and Paper Tests for Neglect: A Protocol

Hemispatial neglect is a common disorder that can occur after a lesion in the right hemisphere. Its main characterization is the difficulty in processing visual stimuli emanating from the space contralateral to the lesion. Pencil and paper tests (such as target cancellation, line bisection, or drawing copy) are used to diagnose neglect. We propose using virtual reality technology and haptic force feedback to enhance pencil and paper tests. Our system can track the patients' eye-gaze and their hand movements. Also, the efficiency of several techniques used to decrease the neglect in different sensory spaces are investigated.

Deafferentation–disconnection neglect induced by posterior cerebral artery infarction

To investigate patients with posterior cerebral artery (PCA) infarctions to learn whether hemispatial neglect is more frequent and severe after right than left PCA infarction; whether visual field defects (VFDs) influence the presence or severity of hemispatial neglect; and the anatomic loci of lesions that are associated with hemispatial neglect. The authors recruited 45 patients with PCA infarction that involved only the occipital lobe or the occipital lobe plus other areas served by the PCA. All subjects received seven neglect tests within 2 months after onset. Overall, the frequency of hemispatial neglect was 42.2%. The frequency did not significantly differ between the right (48.0%) and left (35.0%) PCA groups, but the severity of hemispatial neglect was significantly greater in the right group. VFD alone did not influence the frequency or severity of neglect after controlling other variables. Isolated occipital lesions were rarely associated with hemispatial neglect, and it was only the occipital plus splenial lesion that significantly influenced the frequency and severity of neglect. This study suggests that after excluding such confounding factors as aphasia or hemiplegia, neglect frequency does not differ between the right and left posterior cerebral artery (PCA) groups, but the severity of neglect is greater after right PCA infarctions; even in the acute stage of PCA infarction; visual field defect from an isolated occipital lesion does not cause hemispatial neglect; and the injury to both the occipital lobe and the splenium of the corpus callosum is important for producing hemispatial neglect with PCA infarction.

Rebalancing parietal activation underlies resolution of hemispatial neglect after right frontal stroke

This study sought to identify changes in neural activation, revealed by functional magnetic resonance imaging (fMRI), associated with the recovery of left hemispatial neglect after a right frontal stroke. The investigators studied 11 subjects who had left neglect after strokes that included damage to the right frontal cortex (in many cases also involving the right parietal and/or temporal cortex) using traditional behavioral tests for hemispatial neglect and spatial attention tasks during fMRI in the acute and chronic stages of recovery. They found that patients showed abnormally increased left dorsal parietal activation and abnormally decreased right dorsal parietal activation in the acute stage, and that activation normalized (decreased on the left and increased on the right) when left neglect improved. Activation in the visual cortex was also acutely higher in the left than right ventral and dorsal occipital cortex, but became more balanced with recovery. Activation in the right superior temporal gyrus depended on the accuracy in reorienting to unexpected targets in the right or left visual field, and was influenced by the stage of recovery. The results were interpreted as providing additional support for a new model of the neuroanatomical basis of hemispatial neglect. This model leads to specific predictions regarding interventions that may be useful for reducing persistent hemispatial neglect after stroke. For example, suppressing hyperactivity in the left dorsal parietal cortex using transcranial magnetic stimulation may to help restore the balance of activation during spatial attention and improve directed attention to the left.

Impact of alertness training on spatial neglect: A behavioural and fMRI study

The effects of a 3-week computerised alertness training on chronic (>3 months) visuospatial hemineglect were investigated prospectively in seven patients by means of neuropsychological tests and functional magnetic resonance imaging (fMRI). Following the alertness training, the group showed improved alertness and a significant improvement in the performance of a neglect test battery over and above any improvement during a 3-week baseline phase. Improvements in the neglect tasks were accompanied by an increase of right hemisphere neural activity in frontal cortex, anterior cingulate cortex, precuneus, cuneus and angular gyrus. These areas have previously been associated with alertness and spatial attention. A similar pattern of increased neural activity was found for the left hemisphere. Four weeks after the end of the training, the patients’ neglect test performance had mostly returned to baseline, while the increases in neural activity bilaterally in frontal areas, in the right anterior cingulate cortex, the right angular gyrus and the left temporoparietal cortex remained. The data show that a 3-week computerised alertness training can improve performance both in alertness and neglect tests and that these behavioural improvements are associated with reactivation in areas associated with alerting and visuospatial attention. The limited stability of these effects over time suggests that a 3-week alertness training alone does not result in long lasting improvements in every patient, but refining the treatment protocol may lead to a more stable amelioration of neglect symptoms.

Assessment of spatial attention after brain damage with a dynamic reaction time test

Lateralized spatial biases after brain damage are commonly assessed using batteries of paper-and-pencil tests. These tests hardly allow quantification of performance in different locations in space, and they tend to lose sensitivity along the course of recovery. We tested the dynamic Starry Night Test (SNT), a novel computerized test measuring reaction time and detection accuracy for visual target stimuli in a dynamic background, in 32 inpatients with right hemisphere stroke (RHS), 16 patients with left hemisphere stroke (LHS), and 9 healthy controls. As a group, only the RHS patients were significantly slower to respond to contralesional targets. Individually, 21 (66%) RHS patients and 5 (31%) LHS patients showed statistically significant contralateral deficits. In a number of RHS patients the SNT was more sensitive to the ipsilesional bias of spatial attention than the Behavioral Inattention Test (BIT), a standardized paper-and-pencil test battery of unilateral spatial neglect. Two illustrative case reports show that the dynamic SNT, but not the BIT, was sensitive to the spatial deficit in recovered patients, one of whom was involved in repeated car accidents. The SNT overcomes serious shortcomings of paper-and-pencil tests of unilateral neglect. It provides a simple quantitative tool for monitoring the natural and treatment-induced recovery of patients.

Considerations in the selection of behavioural tests to gauge recovery after intracerebral hemorrhagic stroke in rats

Cerebral ischemia and hemorrhage (stroke) are leading causes of death and disability. The goal of experimental cytoprotectants (neuroprotection) for stroke is to reduce cell death and thereby improve functional outcome. Rodents (rat, gerbil, mouse) are most commonly used to model ischemic and hemorrhagic insults. Despite the fact that behavioral recovery is the clinical endpoint of greater concern, many cytoprotection studies rely solely upon histopathological endpoints (e.g., infarct volume) to gauge treatment efficacy (DeBow et al., 2003; Can. J. Neurol. Sci). Furthermore, those studies that assess recovery often use only a neurological deficit score (NDS; e.g., paw placement, spontaneous rotation) and do not use more demanding / informative tests (e.g., skilled reaching). Successful translation of putative cytoprotectants from rodent models to human will depend upon how well treatments are initially assessed. Many functional tests are available in the rat and have been used in focal ischemia studies. Presently, we used a battery of functional tests, which are sensitive to sensory and motor system dysfunction, to gauge outcome after an intracerebral hemorrhagic stroke (ICH) largely targeting the striatum. Sixty adult male Sprague Dawley rats (N = 15 per group) were stereotaxically infused with 1 L of sterile saline containing 0 (SHAM), 0.06 (MILD lesion), 0.12 (MODERATE lesion), or 0.18 U (SEVERE lesion) of bacterial collagenase. Testing began one day following ICH and was repeated over 30 days. Tests included the horizontal ladder and beam walking tests, swimming, limb-use asymmetry (cylinder) test, a NDS, an adhesive tape removal test of sensory neglect, and the staircase and single pellet tests of skilled reaching. At present, the NDS, staircase, neglect and single-pellet tests have been analyzed. Overall, these tests revealed significant impairments (vs. SHAM) that improved over time (e.g., deficits on the NDS were greatest on days 1 and 2). However, despite significant differences in lesion size, we were often unable to statistically distinguish between MILD and MODERATE or MODERATE and SEVERE groups (e.g., neglect test). As for skilled reaching, the staircase test revealed significant contralateral forelimb impairments in the three ICH groups and was often able to distinguish among ICH groups. The SEVERE group also had significant ipsilateral impairments. Skilled reaching impairments were also found with the single-pellet test in the ICH groups. However, it was not possible to compare success among ICH groups because many rats in the MODERATE and SEVERE groups completely switched limb preference. Indeed, a detailed analysis of the entire reaching sequence with the contralateral limb was only possible in the SHAM and MILD groups. In conclusion, multiple behavioral tests are needed to comprehensively evaluate functional recovery after ICH. However, some tests (e.g., neglect test) are either not recommended for this model owing to the time required to test animals, variability, and the insensitivity to lesion size, or are of limited use (e.g., for small lesions). Finally, our results show that modest neuroprotection (e.g., reducing lesion size from SEVERE to MODERATE) may not consistently improve functional recovery, thereby necessitating the use of several tests.

Children and Adolescents With Chronic Cerebellar Lesions Show No Clinically Relevant Signs of Aphasia or Neglect

We studied language and visuospatial functions of 12 children and adolescents who had undergone surgery for cerebellar astrocytoma without subsequent radiation or chemotherapy and compared them with 27 age-, gender-, and education-matched healthy control subjects. To study possible lateralization of the functions of the left and right cerebellar hemispheres, subjects performed several language tasks including a verb-generation task as well as standard neglect and extinction tests. Three-dimensional-MR images confirmed that lesions affected cerebellar hemispheres in all children but one who had a pure vermal lesion. The right cerebellar hemisphere was affected in six, the left hemisphere in four children, and both hemispheres in one child. There were no signs of aphasia in the children or adolescents with cerebellar lesions. Language abilities did not differ between cerebellar patients and control subjects except for small increases in reaction times in verb generation in patients with left-sided lesions. Visuospatial functions were also intact in cerebellar subjects except for minor group differences in neglect tasks. In sum, chronic focal cerebellar lesions acquired in childhood or youth do not result in persistent language disorders or clinically significant signs of spatial neglect or extinction.

The neglected role of the right hemisphere in spatial representation of words for reading

Background: Previous studies have indicated that focal brain damage can result in different types of “neglect dyslexia” (reading errors specific to the side of printed material contralateral to the side of brain damage).Aims: To identify the sites of lesions (or dysfunctional brain tissue) responsible for distinct types of neglect dyslexia, to inform a functional neuroanatomical model of brain regions involved in early stages of reading.Methods & Procedures: A battery of tests of hemispatial neglect and reading designed to distinguish neglect dyslexia in different reference frames (viewer-centred, stimulus-centred, and object-centred) was administered to 95 patients within 48 hours of onset of nondominant hemisphere stroke. Magnetic resonance diffusion and perfusion imaging was obtained on the same day as testing. Associations between each type of neglect dyslexia and areas of hypoperfusion and/or infarct were evaluated using chi-squared tests.Outcomes & Results: Viewer-centred neglect dyslexia was associated with hypoperfusion and/or infarct in right angular and supramarginal gyri and visual association cortex (“dorsal stream”). Stimulus-centred neglect dyslexia was associated with hypoperfusion and/or infarct of right superior temporal cortex (“ventral stream”). Object-centred neglect dyslexia was observed only with hypoperfusion and/or infarct of non-dominant superior temporal cortex in left-handed individuals.Conclusions: The identified associations provide evidence that different regions of cortex are critical for spatial attention to, or processing of, representations of words with distinct coordinate frames in the reading task.

Visual neglect in the first weeks after a stroke in the right hemisphere

The aim of the study was to characterize symptoms of visual neglect among patients who recently survived a stroke in the right hemisphere (RH), and to contribute to the understanding of change in symptoms during the first months after a RH stroke. Thirteen patients with a RH stroke and twenty controls were assessed by using standard neglect tests. Five patients were followed up by repetitive test sessions during the next four months. To assess more subtle symptoms, reaction-time (RT) measures derived from an experimental cue-target paradigm were included in the final test session. A high frequency of neglect symptoms was documented at the first test session. The changes in performance during the first weeks were characterized by a high inter-individual as well as a high intra-individual variability. Although the remission rate on standard tests was high in the follow-up study, the RT measures indicated sustained symptoms of visual extinction in all patients. The long-term implication of the changes of neglect symptoms during the first weeks after a stroke and signs of sustained symptoms of visual extinction calls for further longitudinal studies including a larger group of patients.

Reliability and Validity of a Wheelchair Collision Test for Screening Behavioral Assessment of Unilateral Neglect After Stroke

To examine the reliability and validity of a new wheelchair collision test (WCT) for screening behavioral unilateral neglect in people with stroke. A total of 19 patients with left hemiplegia resulting from first-ever stroke (mean +/- SD, 61.9 +/- 25.8 days after onset) were examined with the WCT, whereby the patient was asked to propel a wheelchair to pass four round chairs arranged in two rows. Separate tests were done using two different distances between the chairs: 120 and 140 cm. The number of collisions with the chairs was recorded. The Catherine Bergego Scale was used to evaluate behavioral unilateral neglect. Because unilateral neglect has an unfavorable impact on rehabilitation, the FIMtrade mark instrument was used to determine the function of daily activities. Test-retest reliability ranged from 0.68 to 0.97 in different situations in the WCT. The rate of agreement tested by Kappa statistics between the WCT and Catherine Bergego Scale was higher when the distance between chairs was 120 cm than when the distance was 140 cm (0.68 vs. 0.58). Spearman's rank-correlation coefficient between the WCT and Catherine Bergego Scale was 0.72 (P < 0.001) if the distance between the chairs was 120 cm and 0.75 (P < 0.001) if the distance was 140 cm. The WCT and Catherine Bergego Scale correlated well with the FIM instrument. Spearman's rank-correlation coefficient between the Catherine Bergego Scale and FIM total score was -0.70 (P < 0.001). The WCT is a simple screening test with high test-retest reliability and validity to evaluate behavioral unilateral neglect.

Right spatial neglect after left hemisphere stroke

Comparatively little research has been conducted on right neglect after left brain damage. The authors sought to assess contralateral neglect in subacute left hemisphere stroke patients using a comprehensive test battery validated in a large control group after right hemisphere stroke. Seventy-eight left hemisphere stroke patients were assessed. The test battery included a preliminary assessment of anosognosia and visual extinction, a clinical assessment of gaze orientation and personal neglect, and paper-and-pencil tests of spatial neglect in the peripersonal space. Only nonverbal tests were used. Drawing and cancellation tasks revealed neglect in 10 to 13% of patients. The combined battery was more sensitive than any single test alone. A total of 43.5% of patients showed some degree of neglect on at least one measure. Anatomic analyses showed that neglect was more common and severe when the posterior association cortex was damaged. The frequency of occurrence of right neglect was, as expected, much lower than that reported in a study using the same assessment battery in right brain damage stroke patients. Nevertheless, neglect was found in a substantial proportion of patients at a subacute stage, suggesting that it should be considered in the rehabilitation planning of left brain damage stroke patients.