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What is it?

USN is typically associated with rightÌýhemisphere lesions, particularly parietal lobe lesions andÌýsometimes frontalÌýlobe lesions,Ìýcausing neglect of theÌýleft side of space. It is possible toÌýhave right neglect after left brain damage but this is usually less severe and does not last as long.ÌýÌý

Stone et al (1993)Ìýlooking atÌýstroke survivors,ÌýfoundÌýthat atÌýthreeÌýdays post stroke neglectÌýisÌýequally likely after left (62%) and right hemisphere (72%) stroke,Ìýwhile byÌý3 months the figuresÌýdropped toÌý33% of left hemisphere strokesÌýversusÌý75% ofÌýright hemisphere strokes.

ItÌýisÌýalsoÌýpossible toÌýhave neglect for any part of space, not just the left (or right) side. Indeed,Ìýone can haveÌýbilateral neglectÌýas can be seen, for example,Ìýin patients with apperceptive agnosia (Wilson 1999). The prognosis for patients with neglect after several monthsÌýisÌýpoorÌý(TunnardÌýand Wilson 2014). InÌýeveryday life, such patients are likely to have accidents and bang into things on the left;Ìýin severe cases, men may onlyÌýshaveÌýon one sideÌýof the faceÌýand women only make up on one side.Ìý AllÌýmay fail to see food on one side of the plate, and have grooming problems.Ìý

How should one assess UN?Ìý

In clinical practice there are two main types of assessment: the first usingÌýstandardisedÌýtests, theÌýsecondÌýusingÌýmoreÌýfunctional orÌýbehaviouralÌýmeasures.

Both are useful when determining whether or not someone has USN. It is necessary to be cautiousÌýwhen assessing, however, with manyÌýstandardisedÌýtestsÌýbecauseÌýtheÌýUSN meansÌýthe patient is unable to attend toÌýallÌýparts of the stimulus materialÌýThereÌýare, of course, a number ofÌýstandardisedÌýtestsÌýto measureÌýneglect, includingÌýcancellation tests, bisection tasks and copying or drawing tasks.

There is also the Fluff TestÌý(Cocchini,ÌýBreschinÌýandÌýMehkonenÌý2001). This test requires participants to explore body parts with their eyes closed. Other functional measures includeÌýbehaviouralÌýobservations such as watching someoneÌýpreparing food, using a cooker,Ìýmoving thoughÌýdoorways, trapping theÌýleftÌýhand in the wheelchair spokes and so forth.Ìý

TheÌýBehaviouralÌýInattention Test, (BIT; Wilson, Cockburn and Halligan 1987). Perhaps the most comprehensiveÌýtest batteryÌýof USNÌýisÌýthe BIT.ÌýIt is an objective test of everyday skills relevant to visual neglect.Ìý
The BITÌýis in two parts, the first is comprised ofÌýsix conventional subtests,Ìýnamely: three cancellation subtests (line crossing; letter cancellation and starÌýcancellation), line bisection;Ìýcopying figures and copying shapes. TheÌýbehaviouralÌýsubtestsÌýreflect aspects of daily life such as dialling aÌýtelephone, telling and setting the time, menu reading,ÌýcoinÌýsorting and map navigation. The BITÌýhas been used to evaluate the effects of treatment for USN (TunnardÌýand WilsonÌý2014).Ìý

Personal Neglect, Near Neglect and Far Neglect

Although neuropsychologists tend to assess near neglect,Ìýthat is neglect as measured by subtests in the BIT, there are other types of neglect and we should consider these as part of any assessment.Ìý

Halligan and MarshallÌý(1991) describe a man who hadÌýUSN when tested on paper and pencil tests but, nevertheless,Ìýplayed darts for his pub team. This lead them to consider a distinction between peri-personal neglect (neglect for things within grasping or walking distance) and extra personalÌýneglectÌýÌý(neglect for things within throwing distance).ÌýWilliams et alÌý(2017)Ìýtested a man with severe neglect for near tasks (traditional USN tests). He was alsoÌýassessedÌýforÌýpersonal neglect (the Fluff Test) and far neglect.
ForÌýthis last measure the star cancellation test was projectedÌýon a distant wallÌýand a torch given to the man to cancel the small stars; the number of omissions were counted. He showed no personal neglect, severe nearÌýneglect and mild far neglect.

In conclusion, any neuropsychological assessment should include measures of neglect.Ìý

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ReferencesÌýÌý

BisiachÌýEÌý&ÌýLuzzatiÌýC (1978)ÌýÌýUnilateralÌýneglect of representational space.ÌýCorteÌý14Ìý129-33.ÌýÌý

Halligan, P., Marshall, J. Left neglect for near but not far space in man. NatureÌý350,Ìý498–500 (1991).ÌýÌý

Stone S. Halligan PÌýand Greenwood R.J (1993)ÌýThe incidence of neglect phenomena and related disorders in patients with an acute right or left hemisphere stroke.ÌýAge and AgeingÌý22ÌýÌý46-52Ìý

TunnardÌýC & Wilson B.AÌý (20014)ÌýComparison of neuropsychological rehabilitation techniques for unilateral neglect: An ABACADAEAF single-case experimental designÌýNeuropsychological RehabilitationÌý24Ìý382-399ÌýÌý

Williams A, Rose A, Wilson B andÌýFlorschutzÌýG (2017)ÌýAdapting assessment procedures for a man with unilateral neglect. Poster presented at the meetingÌýofÌý 15thÌýinternational meeting of the SIG NR-WFNR group in Prague.ÌýÌý

Wilson, B.A. (1999).ÌýCase Studies in Neuropsychological Rehabilitation. New York: Oxford University Press.Ìý

Wilson, B.A., Cockburn, J., & Halligan, P.W. (1987). TheÌýBehaviouralÌýInattention Test. Bury St Edmunds: Thames Valley Test Company.ÌýÌý

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About the author

Barbara WilsonÌýqualified as a clinical psychologist in 1977 and since 1979 she has worked in Brain Injury Rehabilitation, first at Rivermead Rehabilitation Centre in Oxford, then at Charing Cross Hospital, London and at The University of Southampton Medical School. Since 1990 she has been employed as a Senior Scientist at The Medical Research Council’s Cognition and Brain Sciences Unit, Cambridge.