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出境医 / 临床实验 / The Visual Scanning Test: a Neuropsychological Tool to Assess Extrapersonal Visual Unilateral Spatial Neglect (VST)

The Visual Scanning Test: a Neuropsychological Tool to Assess Extrapersonal Visual Unilateral Spatial Neglect (VST)

Study Description
Brief Summary:
Presentation and standardization on a normative sample of a new neuropsychological tool to provide a quantitative assessment of visual unilateral spatial neglect in the extrapersonal portion of space.

Condition or disease Intervention/treatment Phase
Spatial Neglect Diagnostic Test: Visual Scanning Test Not Applicable

Detailed Description:

Unilateral spatial neglect (USN) represents one of the most frequent and disabling neuropsychological consequences of acute brain damage. Patients with USN show an impaired ability to perceive sensory events and to perform actions in the contralesional side of the space, in absence of a lower-level sensory or motor deficit. Several studies found that controlesional USN is more frequent and more severe in right than left parietal damage and due to its prominent impairment, USN has broadly been studied in the visual modality (VUSN). VUSN can affect patient's own contralesional body (personal neglect), into the near space within reaching distance (peripersonal) or space beyond reaching distance (far extrapersonal space). Those portions of space may dissociate and patient may show extrapersonal VUSN without alterations on the other portions of space (i.e. personal and peripersonal). Traditional paper-and-pencil neuropsychological tests are useful and widely used to evaluate VUSN, even if several of them can provide an assessment of peripersonal VUSN. In fact, this portion of space can be assessed through line bisection, cancellation, or copy tasks which are normally completed within reaching distance. Instead, personal and extrapersonal neglect are less easily evaluated: this lack of assessment tools may lead to lower detection rates for USN in patients in clinical setting and lead to relevant clinical implications. Finally, paper-and-pencil tests can detect only a moderate or even severe deficit due to VUSN but not a mild impairment and they are not informative about patients' disability in natural setting. According to this limitations of traditional paper-and-pencil tests, several studies have shown that computerized reaction time tasks are more sensitive in the detection of lateralized spatial attention deficits in patients with mild or remitted VUSN. The primary aim of this study was to present and standardize a new neuropsychological tool to provide a quantitative assessment of VUSN in the extrapersonal portion of space.

The Visual Scanning Test (VST) involved a visual search for a target between similar visual distractors, projected in the far space, so as to simulate the search within a visual field. It is overall composed by four trials, each trial contained 20 cases and made up by 20 stimuli. On about the 80% of cases, the test provided the presence of target in the left, center or in right hemispace. In the remaining 20% of cases, the test provided the presence of a catch trial (absence of the target), to assess the presence of frontal disturbances or malingering. The test is constructed according to an increasing attentional load for the target on the left-hemispace. Participants, sitting in front a blank wall, were required to actively and free explore the projected visual field to search for the visual target, naming its identification (saying YES or NO). During the task, the examiner annotated the reaction times and the errors. From these data it was possible to get some informative indexes regarding the reaction times, the accuracy and the implicit learning of the progressive shift to the left of the target and the possible presence of asymmetry in the visual exploration.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 86 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: The Visual Scanning Test: a Neuropsychological Tool to Assess Extrapersonal Visual Unilateral Spatial Neglect
Actual Study Start Date : November 2, 2015
Actual Primary Completion Date : January 15, 2017
Actual Study Completion Date : January 9, 2018
Arms and Interventions
Arm Intervention/treatment
Experimental: Treatment
Healthy participants were administered the Visual Scanning Test
 Diagnostic Test: Visual Scanning Test
The Visual Scanning Test (VST) involved a visual search for a target between similar visual distractors, projected in the far space, so as to simulate the search within a visual field. It is overall composed by four trials, each trial contained 20 cases and made up by 20 stimuli. On about the 80% of cases, the test provided the presence of target in the left, center or in right hemispace. In the remaining 20% of cases, the test provided the presence of a catch trial (absence of the target), to assess the presence of frontal disturbances or malingering. The test is constructed according to an increasing attentional load for the target on the left-hemispace. Participants, sitting in front a blank wall, were required to actively and free explore the projected visual field to search for the visual target, naming its identification (saying YES or NO). During the task, the examiner annotated the reaction times and the errors.
Outcome Measures
Primary Outcome Measures :
  1. Scores of clinical indexes due to the accuracy and the reaction times [ Time Frame: Clinical indexes were obtained after completing th edata collecyion, which lasted two years ]
    From the obtained data it was possible to get some informative indexes regarding the reaction times, the accuracy and the implicit learning of the progressive shift to the left of the target and the possible presence of asymmetry in the visual exploration.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

- healthy subjects of full age.

Exclusion Criteria:

  • past or present neurological diseases;
  • past or present psychiatric diseases;
  • presence of visual disturbances.
Contacts and Locations

No Contacts or Locations Provided

Tracking Information
First Submitted Date  ICMJE April 26, 2019
First Posted Date  ICMJE April 30, 2019
Last Update Posted Date May 7, 2019
Actual Study Start Date  ICMJE November 2, 2015
Actual Primary Completion Date January 15, 2017   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: April 26, 2019) 		Scores of clinical indexes due to the accuracy and the reaction times [ Time Frame: Clinical indexes were obtained after completing th edata collecyion, which lasted two years ]
From the obtained data it was possible to get some informative indexes regarding the reaction times, the accuracy and the implicit learning of the progressive shift to the left of the target and the possible presence of asymmetry in the visual exploration.
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE Not Provided
Original Secondary Outcome Measures  ICMJE Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE The Visual Scanning Test: a Neuropsychological Tool to Assess Extrapersonal Visual Unilateral Spatial Neglect
Official Title  ICMJE The Visual Scanning Test: a Neuropsychological Tool to Assess Extrapersonal Visual Unilateral Spatial Neglect
Brief Summary Presentation and standardization on a normative sample of a new neuropsychological tool to provide a quantitative assessment of visual unilateral spatial neglect in the extrapersonal portion of space.
Detailed Description

Unilateral spatial neglect (USN) represents one of the most frequent and disabling neuropsychological consequences of acute brain damage. Patients with USN show an impaired ability to perceive sensory events and to perform actions in the contralesional side of the space, in absence of a lower-level sensory or motor deficit. Several studies found that controlesional USN is more frequent and more severe in right than left parietal damage and due to its prominent impairment, USN has broadly been studied in the visual modality (VUSN). VUSN can affect patient's own contralesional body (personal neglect), into the near space within reaching distance (peripersonal) or space beyond reaching distance (far extrapersonal space). Those portions of space may dissociate and patient may show extrapersonal VUSN without alterations on the other portions of space (i.e. personal and peripersonal). Traditional paper-and-pencil neuropsychological tests are useful and widely used to evaluate VUSN, even if several of them can provide an assessment of peripersonal VUSN. In fact, this portion of space can be assessed through line bisection, cancellation, or copy tasks which are normally completed within reaching distance. Instead, personal and extrapersonal neglect are less easily evaluated: this lack of assessment tools may lead to lower detection rates for USN in patients in clinical setting and lead to relevant clinical implications. Finally, paper-and-pencil tests can detect only a moderate or even severe deficit due to VUSN but not a mild impairment and they are not informative about patients' disability in natural setting. According to this limitations of traditional paper-and-pencil tests, several studies have shown that computerized reaction time tasks are more sensitive in the detection of lateralized spatial attention deficits in patients with mild or remitted VUSN. The primary aim of this study was to present and standardize a new neuropsychological tool to provide a quantitative assessment of VUSN in the extrapersonal portion of space.

The Visual Scanning Test (VST) involved a visual search for a target between similar visual distractors, projected in the far space, so as to simulate the search within a visual field. It is overall composed by four trials, each trial contained 20 cases and made up by 20 stimuli. On about the 80% of cases, the test provided the presence of target in the left, center or in right hemispace. In the remaining 20% of cases, the test provided the presence of a catch trial (absence of the target), to assess the presence of frontal disturbances or malingering. The test is constructed according to an increasing attentional load for the target on the left-hemispace. Participants, sitting in front a blank wall, were required to actively and free explore the projected visual field to search for the visual target, naming its identification (saying YES or NO). During the task, the examiner annotated the reaction times and the errors. From these data it was possible to get some informative indexes regarding the reaction times, the accuracy and the implicit learning of the progressive shift to the left of the target and the possible presence of asymmetry in the visual exploration.
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Condition  ICMJE Spatial Neglect
Intervention  ICMJE Diagnostic Test: Visual Scanning Test
The Visual Scanning Test (VST) involved a visual search for a target between similar visual distractors, projected in the far space, so as to simulate the search within a visual field. It is overall composed by four trials, each trial contained 20 cases and made up by 20 stimuli. On about the 80% of cases, the test provided the presence of target in the left, center or in right hemispace. In the remaining 20% of cases, the test provided the presence of a catch trial (absence of the target), to assess the presence of frontal disturbances or malingering. The test is constructed according to an increasing attentional load for the target on the left-hemispace. Participants, sitting in front a blank wall, were required to actively and free explore the projected visual field to search for the visual target, naming its identification (saying YES or NO). During the task, the examiner annotated the reaction times and the errors.
Study Arms  ICMJE Experimental: Treatment
Healthy participants were administered the Visual Scanning Test
Intervention: Diagnostic Test: Visual Scanning Test
Publications *
  • Priftis K, Passarini L, Pilosio C, Meneghello F, Pitteri M. Visual Scanning Training, Limb Activation Treatment, and Prism Adaptation for Rehabilitating Left Neglect: Who is the Winner? Front Hum Neurosci. 2013 Jul 8;7:360. doi: 10.3389/fnhum.2013.00360. eCollection 2013.
  • Vallar G, Calzolari E. Unilateral spatial neglect after posterior parietal damage. Handb Clin Neurol. 2018;151:287-312. doi: 10.1016/B978-0-444-63622-5.00014-0. Review.
  • Vallar, G., & Bolognini, N. (2014). Unilateral spatial neglect. In A. C. Nobre & S. Kastner (Eds.), Oxford library of psychology. The Oxford handbook of attention (pp. 972-1027). New York, NY, US: Oxford University Press..
  • Bisiach E, Vallar G, Perani D, Papagno C, Berti A. Unawareness of disease following lesions of the right hemisphere: anosognosia for hemiplegia and anosognosia for hemianopia. Neuropsychologia. 1986;24(4):471-82.
  • Ten Brink AF, Verwer JH, Biesbroek JM, Visser-Meily JMA, Nijboer TCW. Differences between left- and right-sided neglect revisited: A large cohort study across multiple domains. J Clin Exp Neuropsychol. 2017 Sep;39(7):707-723. doi: 10.1080/13803395.2016.1262333. Epub 2016 Dec 12.
  • Ten Brink AF, Biesbroek JM, Oort Q, Visser-Meily JMA, Nijboer TCW. Peripersonal and extrapersonal visuospatial neglect in different frames of reference: A brain lesion-symptom mapping study. Behav Brain Res. 2019 Jan 1;356:504-515. doi: 10.1016/j.bbr.2018.06.010. Epub 2018 Jun 22.
  • Bowen A, McKenna K, Tallis RC. Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke. Stroke. 1999 Jun;30(6):1196-202. Review.
  • Denes G, Semenza C, Stoppa E, Lis A. Unilateral spatial neglect and recovery from hemiplegia: a follow-up study. Brain. 1982 Sep;105 (Pt 3):543-52.
  • Machner B, Könemund I, von der Gablentz J, Bays PM, Sprenger A. The ipsilesional attention bias in right-hemisphere stroke patients as revealed by a realistic visual search task: Neuroanatomical correlates and functional relevance. Neuropsychology. 2018 Oct;32(7):850-865. doi: 10.1037/neu0000493. Erratum in: Neuropsychology. 2019 May;33(4):595.
  • Gainotti G. The role of automatic orienting of attention towards ipsilesional stimuli in non-visual (tactile and auditory) neglect: a critical review. Cortex. 2010 Feb;46(2):150-60. doi: 10.1016/j.cortex.2009.04.006. Epub 2009 May 14. Review.
  • Appelros P, Nydevik I, Karlsson GM, Thorwalls A, Seiger A. Assessing unilateral neglect: shortcomings of standard test methods. Disabil Rehabil. 2003 May 6;25(9):473-9.
  • Buxbaum LJ, Ferraro MK, Veramonti T, Farne A, Whyte J, Ladavas E, Frassinetti F, Coslett HB. Hemispatial neglect: Subtypes, neuroanatomy, and disability. Neurology. 2004 Mar 9;62(5):749-56.
  • Danckert J, Ferber S. Revisiting unilateral neglect. Neuropsychologia. 2006;44(6):987-1006. Epub 2005 Nov 21. Review.
  • Berti A, Smania N, Rabuffetti M, Ferrarin M, Spinazzola L, D'Amico A, Ongaro E, Allport A. Coding of far and near space during walking in neglect patients. Neuropsychology. 2002 Jul;16(3):390-9.
  • Lindell AB, Jalas MJ, Tenovuo O, Brunila T, Voeten MJ, Hämäläinen H. Clinical assessment of hemispatial neglect: evaluation of different measures and dimensions. Clin Neuropsychol. 2007 May;21(3):479-97.
  • Pedroli E, Serino S, Cipresso P, Pallavicini F, Riva G. Assessment and rehabilitation of neglect using virtual reality: a systematic review. Front Behav Neurosci. 2015 Aug 25;9:226. doi: 10.3389/fnbeh.2015.00226. eCollection 2015. Review.
  • Parton A, Malhotra P, Husain M. Hemispatial neglect. J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):13-21. Review.
  • Coslett HB. Apraxia, Neglect, and Agnosia. Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):768-782. doi: 10.1212/CON.0000000000000606. Review.
  • Butler BC, Eskes GA, Vandorpe RA. Gradients of detection in neglect: comparison of peripersonal and extrapersonal space. Neuropsychologia. 2004;42(3):346-58.
  • Cipresso P, Pedroli E, Serino S, Semonella M, Tuena C, Colombo D, Pallavicini F, Riva G. Assessment of Unilateral Spatial Neglect Using a Free Mobile Application for Italian Clinicians. Front Psychol. 2018 Nov 22;9:2241. doi: 10.3389/fpsyg.2018.02241. eCollection 2018.
  • Cocchini, G., Beschin, N., &Jehkonen, M. (2001). The Fluff Test: A simple task to assess body representation neglect. Neuropsychological Rehabilitation, 11(1), 17-31.
  • Azouvi P, Olivier S, de Montety G, Samuel C, Louis-Dreyfus A, Tesio L. Behavioral assessment of unilateral neglect: study of the psychometric properties of the Catherine Bergego Scale. Arch Phys Med Rehabil. 2003 Jan;84(1):51-7.
  • Rengachary J, d'Avossa G, Sapir A, Shulman GL, Corbetta M. Is the posner reaction time test more accurate than clinical tests in detecting left neglect in acute and chronic stroke? Arch Phys Med Rehabil. 2009 Dec;90(12):2081-8. doi: 10.1016/j.apmr.2009.07.014.
  • Cunningham LJ, O'Rourke K, Finlay C, Gallagher M. A preliminary investigation into the psychometric properties of the Dublin Extrapersonal Neglect Assessment (DENA): A novel screening tool for extrapersonal neglect. Neuropsychol Rehabil. 2017 Apr;27(3):349-368. doi: 10.1080/09602011.2015.1084334. Epub 2015 Sep 30.
  • Bonato M. Neglect and extinction depend greatly on task demands: a review. Front Hum Neurosci. 2012 Jul 17;6:195. doi: 10.3389/fnhum.2012.00195. eCollection 2012.
  • Barrett AM, Buxbaum LJ, Coslett HB, Edwards E, Heilman KM, Hillis AE, Milberg WP, Robertson IH. Cognitive rehabilitation interventions for neglect and related disorders: moving from bench to bedside in stroke patients. J Cogn Neurosci. 2006 Jul;18(7):1223-36. Review.
  • Hasegawa C, Hirono N, Yamadori A. Discrepancy in unilateral spatial neglect between daily living and neuropsychological test situations: a single case study. Neurocase. 2011 Dec;17(6):518-26. doi: 10.1080/13554794.2010.547506. Epub 2011 Jun 27.
  • Bonato M, Priftis K, Marenzi R, Umiltà C, Zorzi M. Deficits of contralesional awareness: a case study on what paper-and-pencil tests neglect. Neuropsychology. 2012 Jan;26(1):20-36. doi: 10.1037/a0025306. Epub 2011 Sep 5.
  • Bonato M, Deouell LY. Hemispatial neglect: computer-based testing allows more sensitive quantification of attentional disorders and recovery and might lead to better evaluation of rehabilitation. Front Hum Neurosci. 2013 May 1;7:162. doi: 10.3389/fnhum.2013.00162. eCollection 2013.
  • Priftis K, Bonato M, Zorzi M, Umiltà C. Spatial and non-spatial aspects of neglect. Front Hum Neurosci. 2013 Feb 5;7:25. doi: 10.3389/fnhum.2013.00025. eCollection 2013.
  • Kerkhoff G, Schenk T. Rehabilitation of neglect: an update. Neuropsychologia. 2012 May;50(6):1072-9. doi: 10.1016/j.neuropsychologia.2012.01.024. Epub 2012 Jan 28. Review.
  • Capitani, E. (1997). Normative data and neuropsychological assessment. Common problems in clinical practice and research. Neuropsychological Rehabilitation, 7(4), 295-310.
  • Capitani E, Laiacona M. Composite neuropsychological batteries and demographic correction: standardization based on equivalent scores, with a review of published data. The Italian Group for the Neuropsychological Study of Ageing. J Clin Exp Neuropsychol. 1997 Dec;19(6):795-809.
  • Wilks, S. S. (1941). Determination of sample sizes for setting tolerance limits. The Annals of Mathematical Statistics, 12(1), 91-96.
  • Capitani E, Laiacona M. Outer and inner tolerance limits: their usefulness for the construction of norms and the standardization of neuropsychological tests. Clin Neuropsychol. 2017 Aug - Oct;31(6-7):1219-1230. doi: 10.1080/13854046.2017.1334830. Epub 2017 Jun 9.
  • Bartolomeo P, Chokron S. Left unilateral neglect or right hyperattention? Neurology. 1999 Dec 10;53(9):2023-7.
  • Bartolomeo, P. (2014). The attention systems of the human brain. In Attention Disorders After Right Brain Damage (pp. 1-19). Springer, London.
  • Bourgeois A, Chica AB, Migliaccio R, Thiebaut de Schotten M, Bartolomeo P. Cortical control of inhibition of return: evidence from patients with inferior parietal damage and visual neglect. Neuropsychologia. 2012 Apr;50(5):800-9. doi: 10.1016/j.neuropsychologia.2012.01.014. Epub 2012 Jan 20.
  • Posner MI, Walker JA, Friedrich FJ, Rafal RD. Effects of parietal injury on covert orienting of attention. J Neurosci. 1984 Jul;4(7):1863-74.
  • Lupianez J, Klein RM, Bartolomeo P. Inhibition of return: Twenty years after. Cogn Neuropsychol. 2006 Oct 1;23(7):1003-14. doi: 10.1080/02643290600588095.
  • Hartmann M, Sommer NR, Diana L, Müri RM, Eberhard-Moscicka AK. Further to the right: Viewing distance modulates attentional asymmetries ('pseudoneglect') during visual exploration. Brain Cogn. 2019 Feb;129:40-48. doi: 10.1016/j.bandc.2018.11.008. Epub 2018 Nov 22.
  • Gamberini L, Seraglia B, Priftis K. Processing of peripersonal and extrapersonal space using tools: evidence from visual line bisection in real and virtual environments. Neuropsychologia. 2008 Apr;46(5):1298-304. doi: 10.1016/j.neuropsychologia.2007.12.016. Epub 2007 Dec 27.
  • Bjoertomt O, Cowey A, Walsh V. Spatial neglect in near and far space investigated by repetitive transcranial magnetic stimulation. Brain. 2002 Sep;125(Pt 9):2012-22.
  • Heilman KM, Van Den Abell T. Right hemisphere dominance for attention: the mechanism underlying hemispheric asymmetries of inattention (neglect). Neurology. 1980 Mar;30(3):327-30.
  • Mesulam MM. Spatial attention and neglect: parietal, frontal and cingulate contributions to the mental representation and attentional targeting of salient extrapersonal events. Philos Trans R Soc Lond B Biol Sci. 1999 Jul 29;354(1387):1325-46. Review. Erratum in: Philos Trans R Soc Lond B Biol Sci 1999 Dec 29;354(1352):2083.
  • Borsotti M, Mosca IE, Di Lauro F, Pancani S, Bracali C, Dore T, Macchi C, Cecchi F; IRCCS Don Gnocchi Stroke Group. The Visual Scanning Test: a newly developed neuropsychological tool to assess and target rehabilitation of extrapersonal visual unilateral spatial neglect. Neurol Sci. 2020 May;41(5):1145-1152. doi: 10.1007/s10072-019-04218-2. Epub 2020 Jan 2.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: April 26, 2019) 		86
Original Actual Enrollment  ICMJE Same as current
Actual Study Completion Date  ICMJE January 9, 2018
Actual Primary Completion Date January 15, 2017   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

- healthy subjects of full age.

Exclusion Criteria:

  • past or present neurological diseases;
  • past or present psychiatric diseases;
  • presence of visual disturbances.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE Yes
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Not Provided
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03931798
Other Study ID Numbers  ICMJE IRCCSdongnocchi
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Plan Description: We didn't plan to share these data
Responsible Party Francesca Cecchi, Fondazione Don Carlo Gnocchi Onlus
Study Sponsor  ICMJE Fondazione Don Carlo Gnocchi Onlus
Collaborators  ICMJE
  • Rehabilitation Istitute Santa Maria Bambina
  • Clinical Center Agoretis
Investigators  ICMJE Not Provided
PRS Account Fondazione Don Carlo Gnocchi Onlus
Verification Date May 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

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