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.

Initial rightward orienting bias in clinical tasks: normal subjects and right hemispheric stroke patients with and without neglect.

In order to develop the diagnosis of hemi-inattention in patients with right hemispheric cerebrovascular accident (RCVA), the initial starting point of cancellation performance was studied in seven commonly used visual cancellation tasks, an Object Finding task, and a blindfold Tactuo-motor search task. The subject groups consisted of 34 patients with RCVA and 31 healthy subjects. Patients were divided into groups of contralateral neglect and no neglect. One additional case of ipsilesional neglect and one of nonlateralised attentional disorder in relation to early orienting bias, are reported. Patients with contralateral neglect showed a strong tendency to start their cancellation performance on the right. Also, half of the nonneglect patient group demonstrated right bias in initiating their cancellation performance, suggesting the presence of a subclinical hemi-inattention group. Contrary to expectations, also a small proportion of normal subjects were right-biased. Task dependent differences in the assessment of early rightward orienting bias were found.