Testing the efficacy of a common visual perception test as a new method to diagnose unilateral spatial inattention with brain injury patients

Neglect or unilateral spatial inattention (USI) is defined as a condition where the patient fails to report, respond or orient to novel or meaningful stimuli presented to the side opposite of the brain lesion. 1 The Test of Visual Perceptual Skills non-motor Revised (TVPS-R) is a widely administered test of visual-analysis skills administered to brain injured patients to assess visual perception .. We hypothesized that USI could be diagnosed by administering the TVPS-R in the traditional horizontal format and in an experimental vertical format which would serve as a control. Our prediction being that more errors would be committed on the horizontal test items that were presented in the neglected hemi-field. We further hypothesized that by using a test we developed, the midline shift laser test, a measurable midline shift in an ipsilesional direction would be present in those subjects diagnosed with USI. We also planned to investigate the efficacy of the Star Cancellation test in paralleling the diagnoses of USI made by occupational therapists (OTs). Subjects for this investigation included those with recent brain injuries, both with neglect and without neglect. The diagnosis of neglect/US! was determined by licensed occupational therapists with experience in brain injury and neglect. The OTs then ran our series of tests, including the Star Cancellation test, two subtests of the TVPS-R in both a traditional horizontal format and an experimental vertical format, and finally the midline shift laser test. The results from all three tests were analyzed for recognizable patterns to confirm or disconfirm the study hypotheses. Results showed that subjects with neglect were not significantly more likely to miss the items in their neglected hemi-field on the TVPS-R subtests; however, they did show a greater rate of overall error compared to their non-neglect counterparts. All but one of the left neglect subjects had a significant midline shift to the right and of all three experimental methods the midline shift test appeared to be the most sensitive in diagnosing neglect. Further, the Star Cancellation test had an efficacy for diagnosing USI lower than previously reported. This study made clear that further research needs to be invested to determine the most accurate method for testing brain injured patients for USI diagnosis