Date Presented 04/05/19
Primary Author and Speaker: Gabrielle Burns
Additional Authors and Speakers: Emily Grattan
PURPOSE: Neglect is common post stroke and leads to longer hospitalization/rehabilitation stays and greater disability (Chen, Hreha, Kong, & Barrett, 2015). Thus, it is critical to identify if stroke survivors have neglect in order to plan appropriate treatment. Research has shown behavioral and virtual reality tests are effective at detecting neglect, but there has been no conclusive data on which of these assessments (Behavioral Inattention Test [BIT], Catherine Bergego Scale [CBS], Naturalistic Action Test [NAT], Virtual Reality Lateralized Attention Test [VRLAT]) are the most effective and which should be used in practice (Grattan & Woodbury, 2017). Evidence suggests that the demands (dual task, distractors) of an assessment influence performance and whether or not neglect is detected (Bonato, 2012). The purpose of this study was to investigate if commonly used neglect assessments are detecting neglect equally across patients. We hypothesized that the VRLAT would detect neglect the most accurately, because it uses distractors that closely mirror situations individuals encounter in daily life.
DESIGN: We conducted a secondary analysis of data from a cross-sectional neglect assessment study. Participants were recruited from an academic research registry and were referred to the study by therapists who identified clients as having symptoms of neglect. Participants were eligible if they had a unilateral hemispheric stroke, were ≥18 years old, and exhibited signs/symptoms of neglect. Participants were excluded if they had severe aphasia, were unable to follow two-step directions, or had another neurological condition that could impair vision or perception.
METHOD: We enrolled participants from inpatient and outpatient settings. Participants completed a battery of descriptive and neglect assessments during an evaluation session conducted by trained assessors. The NAT, BIT, and CBS are all behavioral assessments that assess for neglect using functional activities. The VRLAT is a virtual reality neglect assessment. We conducted descriptive statistics and used the neglect assessments’ published cut-off scores to determine whether each assessment categorized participants as having neglect.
RESULTS: Thirty participants were enrolled in the study. On average, participants were 60.2 (16.6) years old and the majority of participants were white (63.3%) males who had a right hemispheric (83.3%) ischemic stroke (70.0%). Mean scores for the outcome measures were as follows: NAT, 0.37 (0.2); BIT, 64.8 (18.1); CBS, 10.0 (0.9); VRLAT, 11.9 (4.6). The BIT detected neglect in 58.6% (17/29) of participants. In contrast, the VRLAT, NAT, and CBS detected neglect in 100% (30/30), 96.5% (28/29), and 93.3% (28/30) of participants, respectively.
CONCLUSION: While the VRLAT, NAT, and CBS detected neglect across most participants, the BIT failed to detect neglect in ∼40% of participants. The VRLAT detected neglect in all participants. Neglect occurs in as many as 82% of individuals with right hemisphere stroke, but many therapists report a lack of knowledge on how to choose the best neglect assessment and there are a lack of clinical guidelines to support them (Bowen, McKenna, & Tallis, 1999; Grattan & Woodbury, 2017).
Therapists can take these results into consideration when selecting a neglect assessment. Future research is needed to determine whether these assessments measure different aspects of neglect and whether they measure neglect comprehensively when administered in isolation.
IMPACT STATEMENT: Therapists need assessments that will identify individuals with neglect, inform treatment, and monitor response to treatment. This study addresses a priority research area (functional cognition) by contributing to the evidence regarding assessment of neglect.
References
Chen, P., Hreha, K., Kong, Y., & Barrett, AM. (2015). Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility. Archives of Physical Medicine & Rehabilitation, 96(8), 1458-1466. doi: 10.1016/j.apmr.2015.03.019
Grattan, E. S., & Woodbury, M. L. (2017). Do Neglect Assessments Detect Neglect Differently? The American Journal of Occupational Therapy, 71(3), 7103190050p1–7103190050p9. doi.org/10.5014/ajot.2017.025015
Bonato, M. (2012). Neglect and extinction depend greatly on task demands: a review. Frontiers in Human Neuroscience, 6, 195. doi.org/10.3389%2Ffnhum.2012.00195
Bowen, A., McKenna, K., & Tallis, R. C. (1999). Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke. Stroke, 30, 1196–1202. doi.org/10.1161/01.STR.30.6.1196
