The Fluff test: Improved scoring system to account for different degrees of contralesional and ipsilesional personal neglect in brain-damaged patients

The Fluff test is a simple test to assess evidence of personal neglect (PN) in brain damaged patients. While blindfolded, patients are asked to remove targets previously attached on their body and the number of targets detached provides information about possible spatial bias. This test has been widely used for clinical and research purposes. However, the current scoring system presents some limitations, which make difficult to interpret patients’ performance in terms of both contralalesional and ipsilesional PN when they omit targets on the ipsilesional side. Moreover, it does not consider possible confounding variables, such as non-spatial cognitive deficits or lack of compliance that may affect patients’ performance and lead to incorrect diagnosis. The present paper proposes a new scoring method overcoming the limitations mentioned above and it analyses data from a large sample of 243 brain damaged patients. Findings showed that contralesional PN was significantly more severe, but not more frequent, following right (31%) than left (21%) brain damage. We also found evidence of left ipsilesional PN and cases of potential mis-diagnosis that would have passed unnoticed with the original scoring system. The new scoring method allows to identify different degrees of contralesional and ipsilesional PN and potential confounding variable

Personal Neglect Following Unilateral Right And Left Brain Damage

Patients showing unilateral neglect fail to respond, report or orient to stimuli located in the contralesional (usually the left) side of the environment, of own body or of mental representations. Several studies have investigated different forms of neglect for stimuli located in the extra personal or reaching space confirming that this syndrome is more frequent and persistent following right than left brain damage. However, relatively little attention has been paid to the personal domain of this syndrome and the cognitive mechanisms underlying personal neglect (PN) are not well known. PN was assessed on a sample of 101 right- and 96 left-brain damaged (RBD and LBD, respectively) patients by means of two classical tests: the Comb & Razor Test and the Fluff Test. Patients were asked to perform the Fluff Test also with their eyes opened. PN was more frequent amongst RBD (42.57%) than LBD patients (35.41%); however, the difference was not significant. Considering RBD patients, each test identified a different percentage of PN (Comb and Razor=26.73%; Fluff test with eyes closed=35.64%; Fluff Test with eyes opened=22.77%). The difference between the two versions of the Fluff test was significant. On the other hand, in the LBD group, all the three tests assessed similar percentages of PN (i.e. Comb and Razor test=21.88%; Fluff Test with eyes closed=20.83%; Fluff Test with eye opened=20.83%) with no significant differences. Our findings suggest that PN following lesions of the left hemisphere may be more frequent than previously reported, and that PN following right hemisphere damage may be linked to impairment of different underlining mechanisms