Towards a dynamic assessment of unilateral spatial neglect

Background: The traditional paper and pencil tests are often inadequate to detect the mild forms of Unilateral Spatial Neglect (USN). Objective: To verify the effectiveness of a touchscreen-based cancellation test in assessing individuals with USN. Methods: Seven individuals, six with right and one with left brain damage, who showed moderate to severe USN at admission, were involved in the study. Besides classic paper and pencil tests, participants were presented with a new, “user-friendly”, device consisting of an interactive “table” that integrates the principles of ecologic interaction and sophisticated technology. Such a touch screen table made possible to analyse the spatial and temporal evolution of the participants’ performance, providing a set of indices related to “how” the different tasks have been fulfilled, rather than simple raw scores. Results: This new technological approach turned out to be much more sensitive than the classic paper and pencil tests to detect the slightest forms of USN. In particular, while four out of the seven participants, performed flawless on the papery version of the Albert’s test, all of them made errors on the technological versions of the same Albert’s test. Finally, under all the different experimental conditions, participants achieved always a better performance when asked to erase rather than mark stimuli. Conclusion: Such a device has a potential in the ecological assessment of USN as well as in monitoring its evolution. Although in need of further substantiation, our findings further support the need to go beyond the traditional paper and pencil tests in the assessment of USN. The information provided by a more dynamic approach seems to be relevant for both clinical and research purposes.