The behavioural assessment of visual neglect

Abstract

Abstract Unilateral visual neglect is among the most striking consequences of right-sided brain damage and is characterised by the patient's failure to respond to stimuli on the side contralateral to the lesion. Visual neglect disrupts many aspects of daily living such as mobility, dressing, and reading, yet the underlying mechanisms remain poorly understood. This paper describes the development, standardisation and validation of a test battery designed to identify a wide variety of visual neglect behaviours observed in clinical practice. The Behavioural Inattention Test (B.I.T.), which was standardised on a large stroke population (n = 80), is described. Unlike existing studies of visual neglect, the B.I.T. relates test results to functional assessment and rehabilitation. Using the test battery and normative data from 50 age-matched controls, 30 patients (37.5%) were classified as demonstrating neglect. Neglect is more frequent and severe following right-rather than left-sided lesions. Inter-rater, test-retest, and parallel forms of the test show the neglect battery to be a reliable measure of patient performance. Correlations with ‘conventional’ and clinical judgements demonstrate the underlying validity of the battery. The B.I.T. thus provides a conceptual framework within which to investigate and characterise visual neglect in a manner that is useful to rehabilitation.