How Do Behavioral and Virtual-Reality Neglect-Assessment Scores Correlate With Each Other?

PURPOSE: Individuals who have neglect post stroke have impairments in attention and awareness of one side of the body or environment. Stroke survivors with neglect have greater disability compared to those without neglect (Chen, Hreha, & Barrett, 2015). It is critical that clinicians assess stroke survivors for neglect in order to inform treatment. Research suggests that popular paper-pencil neglect assessments lack sensitivity and ecological validity, yet the measurement properties of other types of neglect assessments (e.g. behavioral or virtual reality) are not as well studied (Grattan & Woodbury, 2017). Because neglect is prevalent and disabling, therapists need clear guidelines on choosing tests to administer in either a battery or in isolation. To date, the concurrent validity of behavioral neglect assessments (Catherine Bergego Scale [CBS], Behavioral Inattention Test [BIT], Naturalistic Action Test [NAT]) and newer virtual reality neglect assessments (Virtual Reality Lateralized Attention Test [VRLAT]) is unclear. The purpose of this study was to determine the concurrent validity of behavioral and virtual reality neglect assessments. We hypothesized that each of these assessments would have a strong positive or negative (r_s≥0.7, p<0.05) linear relationship since they all aim to measure real-world function.

DESIGN: We conducted a secondary analysis of data from a cross-sectional neglect assessment study. Participants were recruited from an academic research registry and via therapist referral. Participants were included if they had sustained a unilateral hemispheric stroke and were ≥ 18 years old but excluded if they had severe aphasia (unable to follow two-step directions) or had any other neurological disease that could affect vision or perception.

METHOD: Trained assessors administered a battery of descriptive and neglect assessments (Catherine Bergego Scale [CBS], Naturalistic Action Test [NAT], Behavioral Inattention Test- Behavioral subtests [BIT], and the Virtual Reality Lateralized Attention Test [VRLAT]) to inpatient or outpatient participants in an evaluation session. The CBS, NAT, and BIT are behavioral neglect assessments that examine the impact of neglect on performance of daily activities. The VRLAT is a computer-based virtual reality neglect assessment (Buxbaum, Dawson, & Linsley, 2012). We conducted descriptive statistics and Spearman’s rho correlational analyses to determine the relationship between the assessments (CBS, NAT, BIT, VRLAT). We used the following criteria to interpret the strength of the relationships: 1= perfect; 0.7=strong; 0.5=moderate; 0.3=weak; and 0=no.

RESULTS: Fifty-seven participants were included in the study. On average, participants were white (61.4%) males (52.6%) who had right hemispheric (63.2%) ischemic (71.9%) strokes. The CBS, VRLAT, BIT and NAT all had strong correlations that were statistically significant (p≤0.001). The CBS and the NAT had the strongest correlation (r_s=0.82, p≤0.001). The BIT and VRLAT had the weakest correlation (r_s=0.69, p≤0.001). The correlations were strong for the BIT and NAT (r_s=-0.76, p≤0.001), the CBS and BIT (r_s=-0.77, p≤0.001), CBS and VRLAT (r_s=-0.78, p≤0.001), and NAT and VRLAT (r_s=-0.71, p≤0.001).

CONCLUSION: Behavioral and virtual reality neglect assessments have a strong relationship. The results demonstrate the concurrent validity of the CBS, NAT, BIT, and VRLAT and further validate the VRLAT as a neglect assessment.

IMPACT STATEMENT: This study focuses on a priority research area (functional cognition) recognized by the American Occupational Therapy Foundation. These findings can help to inform a clinician’s decision in selecting a neglect assessment to use with clients post-stroke.

References

Chen, P., Hreha, K., Kong, Y., & Barrett, A. M. (2015). Impact of Spatial Neglect in Stroke Rehabilitation: Evidence from the Setting of an Inpatient Rehabilitation Facility. Archives of physical medicine and rehabilitation, 96(8), 1458. doi: 10.1016/j.apmr.2015.03.019

Grattan, E., & Woodbury, M. (2017). Do neglect assessments detect neglect differently? American Journal of Occupational Therapy, 71(3), 7103190050p1-7103190050p9. doi: 10.5014/ajot.2017.025015.

.Buxbaum, L. J., Dawson, A. M., & Linsley, D. (2012). Reliability and validity of the Virtual Reality Lateralized Attention Test in assessing hemispatial neglect in right-hemisphere stroke. Neuropsychology, 26(4), 430. doi: 10.1037/a0028674.