Continuing Issues in the Assessment of Neglect

Clinical assessment of neglect is confounded by the multifactorial and multidimensional nature of the measures. This study addressed the relative utility of exemplars of approaches used in the assessment of neglect. A group of 40 right cerebral vascular accident (RCVA) subjects could respond reliably to task requirements, as assessed by test-retest correlations for task performance. A principal components analysis revealed two factors underlying task performance: (1) scanning of stimuli in external space; and (2) spatial representation or imagery. Impaired scanning of stimuli in external space, as assessed by cancellation tasks, is the most common symptom of the neglect syndrome. Representational deficit is less frequent but provides the strongest correlate with behavioural observation of neglect deficit in daily activities. Trimodal or bimodal extinction is comparatively uncommon in a non-acute RCVA population, but testing is limited by the presence of unilateral sensory deficit. Acceptable clinical measures of spatial representational deficit are still needed in the assessment of neglect.