Dual-Task in Large Perceptual Space Reveals Subclinical Hemispatial Neglect

Abstract

Objective: Both clinically observable and subclinical hemispatial neglect are related to functional disability. The aim of the present study was to examine whether increasing task complexity improves sensitivity in assessment and whether it enables the identification of subclinical neglect. Method: We developed and compared two computerized dual-tasks, a simpler and a more complex one, and presented them on a large, 173 × 277 cm screen. Participants in the study included 40 patients with unilateral stroke in either the left hemisphere (LH patient group, n = 20) or the right hemisphere (RH patient group, n = 20) and 20 healthy controls. In addition to the large-screen tasks, all participants underwent a comprehensive neuropsychological assessment. The Bells Test was used as a traditional paper-and-pencil cancellation test to assess neglect. Results: RH patients made significantly more left hemifield omission errors than controls in both large-screen tasks. LH patients’ omissions did not differ significantly from those of the controls in either large-screen task. No significant group differences were observed in the Bells Test. All groups’ reaction times were significantly slower in the more complex large-screen task compared to the simpler one. The more complex large-screen task also produced significantly slower reactions to stimuli in the left than in the right hemifield in all groups. Conclusions: The present results suggest that dual-tasks presented on a large screen sensitively reveal subclinical neglect in stroke. New, sensitive, and ecologically valid methods are needed to evaluate subclinical neglect.

Spatial Neglect Subtypes, Definitions and Assessment Tools: A Scoping Review

“…New tools for identifying neglect are continually being developed, possibly due to the existing tools not being able to detect milder forms of neglect, or an inability to detect the different neglect subtypes. The increasing number of virtual reality and computer-based tools being developed have the potential to increase the task demands, such as dual-task paradigms or speeded reaction time tests, in order to identify mild or subclinical neglect (121)(122)(123). However, many of these tools are not feasible to use in clinical settings due to the complex setup or cost requirements.…”

Computer-Based Assessment: Dual-Task Outperforms Large-Screen Cancellation Task in Detecting Contralesional Omissions

“…The participants' characteristics have been described in detail in our previous study (Villarreal et al, 2020). In short, 40 patients with a first-ever stroke diagnosis (ischemic, hemorrhagic, or both) from the Neurology Outpatient Clinic of the Helsinki University Hospital (HUH) and 20 healthy volunteers participated in the study during 2016-2019.…”

“…Patients with milder forms of the deficit, however, tend not to show omissions in cancellation tasks without distractors. To overcome this problem, task sensitivity has been enhanced by specifically adjusting the stimuli, for example, by increasing the target density and the relative salience of distractors (Rapcsak et al, 1989;Aglioti et al, 1997;Chatterjee et al, 1999;Sarri et al, 2009;Bickerton et al, 2011;Basagni et al, 2017;Ten Brink et al, 2020;Villarreal et al, 2020). To prevent compensation and to identify milder deficits, time limits are sometimes introduced (Priftis et al, 2019).…”

“…It has been claimed that tasks presented on a standard computer screen or on a sheet of paper may have poor ecological validity (Nakatani et al, 2013;Ulm et al, 2013). Advantages of assessment methods with large perceptual space have been described in studies using dual-tasks (van Kessel et al, 2013;Villarreal et al, 2020) and cancellation tasks (Tanaka et al, 2005;Tsirlin et al, 2009;Ulm et al, 2013;Knobel et al, 2020). Both the large-screen dual-tasks and the large-screen cancellation tasks appear to be more sensitive in revealing spatial bias than paper-and-pencil cancellation tasks (Ulm et al, 2013;van Kessel et al, 2013;Villarreal et al, 2020).…”

“…Past studies have highlighted the important role of unspecific attentional demands (Dawson et al, 2008;Bonato et al, 2010Bonato et al, , 2012Buxbaum et al, 2012;Blini et al, 2016;Ricci et al, 2016;Andres et al, 2019), large test fields (Nakatani et al, 2013;Ulm et al, 2013), or both (Villarreal et al, 2020) in determining the sensitivity of tests for neglect and extinction. In the present study, we aimed to capitalize on the previous findings by contrasting these two characteristics.…”