What is the most valid method of assessing neglect / inattention in an adult post stroke? (Right Cerebrovascular accident (CVA) – left hemiparesis). A critically appraised topic (CAT).

Abstract

Background/purpose:

A critically appraised topic (CAT) answers a specific clinical question by summarising the best available evidence to date, including a clinical 'bottom-line' [1].

Method:

The North Staffordshire Neurology Research Group (NRG) agreed on the following inclusion criteria: right hemispheric stroke, 18+ years, individuals with neglect, measures for functional/extended ADLs, peer-reviewed papers in English, between 1985-2010. A health librarian performed the literature search in databases: AMED, CINAHL, Embase, Medline, PEDro, Cochrane, Zetoc, NARICS (Instant disability information centre), BNI, web of Science and rehab data.

Results:

Two hundred and fifty seven abstracts were identified of which 12 full papers were selected. Four were deemed most relevant to this CAT, by consensus from the NRG. Two were subsequently excluded due to poor internal validity [3,4], one due to presentation of a non-functional test [5] and one was accepted and critically appraised in depth [2].

Conclusion:

There is level III evidence that Unilateral Spatial Neglect is a complex syndrome which cannot be adequately assessed by a single test alone. The best available evidence to date [2], suggests that a whole battery of tests is more sensitive in detecting neglect. Most importantly, behavioural assessment of neglect in ADLs using the Catherine Bergego Scale (CBS) [2] has proved more sensitive than any other single measure and sensitive to change during rehabilitation. Further research is required to establish the sensitivity of neglect tests at different stages of post-stroke recovery. This would assist clinicians in applying appropriate and timely measures when assessing and treating neglect.

Support:

This is a critically appraised topic (CAT) in Neurology prepared and completed by the authors with the support of the North Staffordshire Neurology Research Group (NRG), based at Keele University. This CAT was completed in December 2010 and will be reviewed in December 2012.

References

1. Foster, N, Barlas, P, Chesterton, L and Wong, J (2001) 'Critically appraised topics (CATs): One method offacilitating evidence-based practice in physiotherapy' Physiotherapy, 87, 4: 179-190.

2. Azouvi P, Samuel C, Louis-Dreyfus A, Bernati T, Bartolomeo P, Beis J-M, Chokron S, Leclercq M, Marchal F, Martin Y, de Montety G, Olivier S, Perennou D, Pradat-Diehl P, Prairial, C, Rode G, Sieroff E, Wiart L, Rousseaux M (2002). Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke. J Neurol Neurosurg Psychiatry; 73:160-166

3. Lindell A, Jalas M, Tenovuo O, Brunila T, Voeten M, Hamalainen H (2007) Clinical assessment of hemispatial neglect: Evaluation of different measures and dimensions. The Clinical Neuropsychologist 21: 479-497.

4. Menon A, Korner-Bitensky N (2004) Evaluating unilateral spatial neglect post stroke: Working your way through the maze of assessment choices. Topics in Stroke Rehabilitation 11:3:41-66.

5. Rengachary J, d'Avossa G, Sapir A, Schulman GL, Corbetta M (2009) Is the Posner Reaction Time test more accurate than clinical tests in detecting left neglect in acute and chronic stroke? Arch Phys Med Rehabil 90: 2081-2088