A battery of tests for the quantitative assessment of unilateral neglect

Issue title: Plasticity in Spatial Neglect – Recovery and Rehabilitation

Article type: Research Article

Authors: Azouvi, Philippe | Bartolomeo, Paolo | Beis, Jean-Marie | Perennou, Dominic | Pradat-Diehl, Pascale | Rousseaux, Marc

Affiliations: Service de Médecine Physique et de Réadaptation, Université de Versailles-Saint-Quentin, et INSERM UPMC 731, AP-HP, Hôpital Raymond Poincaré, Garches, France | INSERM U 610, Hôpital de la Salpétrière, Paris, France | Institut Régional de Réadaptation, Nancy, France | Service de Rééducation Neurologique, CHU and INSERM ERM 207, Dijon, France | Service de Médecine Physique et de Réadaptation, INSERM UPMC 731, AP-HP Hôpital de la Salpétrière, Paris, France | Service de Rééducation Neurologique, CHRU, Lille, France

Note: [] Corresponding author: Prof. Philippe Azouvi, MD, PhD, Department of Physical Medicine and Rehabilitation, Raymond Poincare Hospital, 92380 Garches, France. Tel.: +33 14 710 70 74; Fax: +33 1 47 10 77 25; E-mail: philippe.azouvi@rpc.aphp.fr

Abstract: Purpose: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of unilateral neglect (UN) after stroke. In addition, dissociations have been reported between performance on traditional paper-and-pencil tests and UN in everyday life situations. Methods: In this paper, we present the validation studies of a quantitative test battery for UN, including paper-and-pencil tests, an assessment of personal neglect, extinction, and anosognosia, and a behavioural assessment, the Catherine Bergego Scale (CBS). The battery was given to healthy subjects (n=456–476) and to patients with subacute stroke, either of the right or the left hemisphere. Results: In healthy subjects, a significant effect of age, education duration and acting hand was found in several tasks. In patients with right hemisphere stroke, the most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. An important finding was that behavioural assessment was more sensitive than any other single test. Neglect was two to four times less frequent, but also less severe and less consistent after left hemisphere stroke. Conclusion: Assessment of UN should rely on a battery of quantitative and standardised tests. Some patients may show clinically significant UN in everyday life while obtaining a normal performance on paper-and-pencil measures. This underlines the necessity to use a behavioural assessment of UN.

Keywords: Unilateral neglect, assessment, stroke

Journal: Restorative Neurology and Neuroscience, vol. 24, no. 4-6, pp. 273-285, 2006