Using Virtual Reality to Complement Paper-and-Pencil Tests to Assess Visual Unilateral Spatial Neglect: A Feasibility Study.

BACKGROUND

Visual neglect is one of the most frequent neuropsychological consequences of acute brain damage. Generally, paper-and-pencil tests, administered in the peripersonal space, are used to establish the presence of neglect. However, the multidimensional nature of neglect makes the diagnostic process challenging. Neglect varies, among other things, in spatial regions; that is, personal, peripersonal, and extrapersonal space.

OBJECTIVE

In this feasibility study, we aim to establish the reliability and validity of a newly developed Functional ExtraPersonal Space Neglect Test (FEPSNeT) executed on a virtual reality system.

METHODS

Stroke patients with a first stroke in the right hemisphere, treated in four rehabilitation centers in the Netherlands equipped with a GRAIL (Gait Real-Time Analysis Interactive Lab), were included in this study. The participants performed the FEPSNeT twice a week on separate days. The Line Bisection Test (LBT), the Star Cancelation Test (SCT), and the Catherine Bergego Scale (CBS) were also administered.

RESULTS

The test-retest reliability of the FEPSNeT was nearly acceptable. The construct validity of the FEPSNeT was considered sufficient because the subjects with the most asymmetrical reaction times all responded slower to stimuli on their left side. There was no significant correlation between the FEPSNeT and paper-and-pencil tests (LBT and SCT), and there was a low but significant correlation between the FEPSNeT and CBS.

CONCLUSIONS

The FEPSNeT appears to assess neglect in a different region (extrapersonal space) than paper-and-pencil tests (peripersonal space), and therefore, it can be of added value to paper-and-pencil tests in the assessment of visual neglect.