Sylvie Chokron

Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke

Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. Results: 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. About 85% of patients presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

Right spatial neglect after left hemisphere stroke: qualitative and quantitative study

Objectives: Comparatively little research has been conducted on right neglect after left brain damage. The authors sought to assess contralateral neglect in subacute left hemisphere stroke patients using a comprehensive test battery validated in a large control group after right hemisphere stroke. Methods: Seventy-eight left hemisphere stroke patients were assessed. The test battery included a preliminary assessment of anosognosia and visual extinction, a clinical assessment of gaze orientation and personal neglect, and paper-and-pencil tests of spatial neglect in the peripersonal space. Only nonverbal tests were used. Results: Drawing and cancellation tasks revealed neglect in 10 to 13% of patients. The combined battery was more sensitive than any single test alone. A total of 43.5% of patients showed some degree of neglect on at least one measure. Anatomic analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The frequency of occurrence of right neglect was, as expected, much lower than that reported in a study using the same assessment battery in right brain damage stroke patients. Nevertheless, neglect was found in a substantial proportion of patients at a subacute stage, suggesting that it should be considered in the rehabilitation planning of left brain damage stroke patients.

Reading habits and line bisection: a developmental approach.

120 normal right-handed subjects, children and adults, with opposite reading habits (60 French, left-to-right readers, 60 Israeli, right-to-left readers) and 60 pre-school children (30 French and 30 Israeli), were submitted to a visuo-motor bisection task. Bisection is found to be dependent upon reading habits with a leftward deviation of the subjective middle for left-to-right readers, and a rightward bias for right-to-left readers. Even before formal reading learning, French and Israeli pre-school children differ significantly in bisecting a line. Results are discussed with respect to hemispheric activation theories and directional hypotheses.

Scanning direction and line bisection: a study of normal subjects and unilateral neglect patients with opposite reading habits.

Sixty normal dextrals (30 left-to-right and 30 right-to-left readers) and two left unilateral neglect patient with opposite reading habits performed a passive line bisection task. In order to study the effect of scanning direction on performance, subjects had to stop a mark moving on the to-be-bisected line either from the left to the right or in the opposite direction. Results showed that the position of the subjective middle was dependent upon the scanning direction of the line for all the subjects. A leftward deviation appeared for left to right scanning, whereas a rightward shift occurred when the mark moved from the right to the left. These results emphasize the role of scanning direction in space organization and are discussed with respect to the explanatory hypotheses of unilateral neglect.

Length Representation in Normal and Neglect Subjects with Opposite Reading Habits Studied Through a Line Extension Task

In the first part of this paper, 45 French (left-to-right readers) and 30 Israeli (right-to-left readers) normal dextrals were given half a line and requested to construct the missing other with the same length (either the left one or the right one). Using this line extension task, a significant effect of reading habits on the performance was found, with no significant bias for Israeli subjects, and a significant underconstruction when building the left half from the right one for French subjects. In the second part, two patients with opposite reading habits (one French, one Israeli) suffering from left unilateral neglect were submitted to the same protocol. Both patients were found to under-construct the right half of the line from the left given half, and to over-construct the left half from the right given one, hence reproducing the well-known line bisection bias. Results are discussed with regard to enhancement and activation hypotheses, and current theories of the neglect syndrome.

Patterns of dissociation between left hemineglect and deviation of the egocentric reference

Sixteen control subjects and six right brain-damaged patients with left hemiparesis (three showing signs of left unilateral neglect, three with no signs of neglect) performed a straight-ahead pointing task with their right hand while blindfolded. The aim was to test the hypothesis that the egocentric reference shows significant ipsilesional deviation in left neglect patients. We found no correlation between the position of the egocentric reference and the presence of neglect signs. Neglect patients, like non-neglect patients, showed leftward, rightward or no significant deviation when pointing straight ahead. Results are discussed with reference to egocentric hypotheses of neglect and experimental remission of neglect.