Table 2.
Diagnostic instruments used for visuospatial neglect symptoms
| Tests | Brief description | Comments and recommendations |
|---|---|---|
| Cancellation | Crossing out visual targets on a paper sheet. Omissions of contralesional targets indicates visuospatial neglect. | Good sensitivity (Marsh & Kersel, 1993). Qualitative interpretation enhances the detection rate. Starting point is most sensitive to visuospatial neglect. |
| Line bisection | Marking the middle point of horizontal lines. Ipsilesional deviation indicates visuospatial neglect. | Easy and fast administration, used for screening rather than for clinical diagnosis. Good retest reliability (Facchin, Beschin, Pisano, & Reverberi, 2016). Note, that false positive results can result from HH. |
| Copying figures and drawing | Copying (e.g., flower, house etc.) or drawing objects (e.g., clock). Omissions or cramming of contralesional details indicates visuospatial neglect. | Assesses mainly representational aspects of visuospatial neglect. Interpretation is limited by subjectivity. |
| Reading | Reading a paragraph of text. Omissions of words or letters at the contralesional side of a line or a word indicate visuospatial neglect. | Assesses ‘Neglect dyslexia’. |
| BIT (Behavioural inattention test) | Compilation of 17 subtests (such as the ones described above, and tasks related to ADL-functions). An overall index can be calculated. | Assesses functional performance. |
| Catherine Bergego scale | 10-item checklist that assesses visuospatial neglect-specific behavior in ADL. | Widely used in clinical studies. |
| Comb and Razor test | The patient is asked to comb their hair and shave. Omissions on contralesional side of the face indicate personal visuospatial neglect. | Used for bedside-screening rather than for clinical diagnosis. |
| Eyetracking oculography | Requires the patient to focus at the midpoint of a given object, image, or task. An orientation bias towards the ipsilesional side indicates visual visuospatial neglect. | Pure assessment of visual visuospatial neglect as no manual exploration is necessary. Does not assess other aspects of visuospatial neglect. |
| Test for attentional performance (TAP): subtest ‘Neglect’ | Pressing a button when a peripheral flicker stimulus appears on a screen together with distractor stimuli. Omissions on the contralesional side indicate visuospatial neglect. | If a patient suffers from HH, visuospatial neglect cannot be diagnosed with this test. |
| Test for attentional performance (TAP): subtest ‘Covert Attention’ | Reacting to stimuli presented on either side of the screen preceded by a valid or invalid cue stimulus. Visuospatial neglect is indicated by reaction times in invalid trials towards the contralesional hemi-field that are even more prolonged than in healthy subjects. | Used to differentiate visuospatial neglect from visual field deficits. |
| Virtual reality | Exploration of a virtual environment conveyed through a head-mounted display. The system tracks eye and head movements. | This allows the safe assessment of ADL in a virtual environment. More information on validity, reliability, or sensitivity is required. |
| Clinical observation and information from relatives | Behavioural observation (e.g., during self-care, dressing, eating, or in therapeutic settings). This should also include information obtained from care-givers. | Adds important diagnostic value. |