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2 Quick Screens for Left Visual Neglect

Left visual neglect (also known as unilateral visual neglect or unilateral spatial neglect) is an attention disorder common in those with right hemisphere brain damage.

While it’s important to screen for left visual neglect, how do you fit it into your busy schedule?!

In this post, you’ll find 2 quick screens for left visual neglect. One takes less than 5 minutes. The other you can complete while observing activities of daily living.

As always, we provide direct links to the PDFs you need, saving you time and stress.

And to save even more time, check out the 5-star-rated Adult Speech Therapy Starter Pack!

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1. Albert’s Test

Albert’s Test is a visual neglect screen that requires patients to cross out lines on a single piece of paper. If the lines on the left side are left uncrossed, it indicates left visual neglect. Simple!

How Long Does It Take?

left visual neglect

Albert’s Test takes less than 5 minutes.

Who Should I Use It With?

left side neglect stroke
  1. Patients with right hemisphere damage after a stroke or brain injury and
  2. Patients who can use a pen or pencil

How do I Administer Albert’s Test?

Albert's Test for left visual neglect
  1. Print out Albert’s Test (on an 11×8.5 inch piece of paper)
  2. Present the test sheet at the patient’s midline
  3. Point out some of the lines. Include some on the far left and far right of the sheet
  4. Demonstrate the task by crossing out the 5 central lines yourself
  5. Finally, ask the patient to cross out all of the lines using a pen or pencil

How do I Score Albert’s Test?

how to score Albert's Test

Left visual neglect is indicated if:

  1. Any lines are left uncrossed and
  2. More than 70% of these uncrossed lines are on the left side

Score the percent of lines left uncrossed.

Is Albert’s Test Evidence-Based?

left visual neglect SLP

Research on Albert’s Test for unilateral spatial neglect has found:

  • Excellent test-retest reliability (Chen-Sea and Henderson, 1994)
  • Excellent correlation with the Line Bisection Test and Catherine Bergego Scale (Agrell et al 1997; Deloche et al 1996)
  • Adequate correlation with the Star Cancellation Test (Agrell et al 1997)
  • Significant prediction of functional outcomes 6 months post-stroke (Fullerton et al 1986)

Albert’s Test PDF

2. Catherine Bergego Scale (using KF-NAP™)

left visual neglect stroke

The Catherine Bergego Scale (CBS) is a well-regarded visual neglect screen in which the therapist observes a patient doing activities of daily living.

Although well-regarded, the CBS is hard to track down! It lives in a decades-old journal article and lacks detail on how to administer it.

Enter the Kessler Foundation!

With support from the NIH and Department of Education, they created the Kessler Foundation Neglect Assessment Process (KF-NAP™) which is essentially a protocol for how to administer the CBS.

Their manual and scoring sheet are both available on the Kessler Foundation website. We’ll link to both below.

The Catherine Bergego Scale also includes an anosognosia screen, although it’s not covered in this post.

See How to Improve Awareness for more on anosognosia.

How Long Does It Take?

left visual neglect speech therapy

The CBS takes approximately 30 minutes.

Who Should I Use It With?

  1. Patients with right hemisphere damage after a stroke or brain injury and
  2. Patients who can participate in the activities of daily living included in the CBS

How do I Administer the Catherine Bergego Scale?

how to administer the catherine bergego scale
  1. Gather materials

    Here’s a materials list from the KF-NAP™ Examiner’s Kit:

    • Empty garbage can
    • Lab coat/large button-down shirt
    • Plastic basin
    • Mirror with stand
    • Hairbrush
    • Soap
    • Paper towel
    • Food tray
    • Utensils
    • Water and food
    • Napkins

  2. Don’t cue the patient to attend to the left!

  3. Observe and score the patient on the following 10 items:
  1. Forgets to groom or shave the left part of their face
  2. Experiences difficulty in adjusting their left sleeve or slipper
  3. Forgets to eat food on the left side of their plate
  4. Forgets to clean the left side of their mouth after eating
  5. Experiences difficulty looking towards the left
  6. Forgets about a left part of their body (e.g., forgets to put their upper limbs on the armrest, or their left foot on the wheelchair rest, or forgets to use their left arm when they need to)
  7. Has difficulty paying attention to noise or people addressing them from the left
  8. Collides with people or objects on the left side, such as doors or furniture (either while walking or driving a wheelchair)
  9. Experiences difficulty in finding their way towards the left when traveling in familiar places or in the rehabilitation unit
  10. Experiences difficulty finding their personal belongings in the room or bathroom when they are on the left side

See the KF-NAP™ Manual for their specific assessment instructions.

How do I Score the Catherine Bergego Scale?

The CBS uses a 4-point scale ranging from 0-4.

0 = no neglect
1 = mild neglect (patient always explores the right hemispace first and slowly or hesitantly explores the left side)
2 = moderate neglect (patient demonstrates constant and clear left-sided omissions or collisions)
3 = severe neglect (patient is only able to explore the right hemispace)

  1. Rate the patient on each of the 10 items on the scale
  2. Record the patient’s total score out of 30. The higher the score, the more severe the visual neglect.

For very specific scoring instructions for each item on the scale, see the KF-NAP™ Manual.

Is the Catherine Bergego Scale Evidence-Based?

how to assess left neglect

Previous research on the CBS has found:

  • Adequate to excellent internal consistency (Bergego et al. 1995, Azouvi et al 1996, Azouvi et al 2003, Luukkainen-Markkula et al. 2011)
  • Adequate to excellent interrater reliability (Bergego et al 1995)
  • Adequate to excellent correlation with Albert’s Test and all conventional neglect tasks (Azouvi et al. 1996, Azouvi et al. 2002)
  • CBS can detect changes in neglect (Samuel et al. 2000)

Catherine Bergego Scale & KF-NAP™ PDFs

catherine bergego scale pdf

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References

  1. Agrell, B. M., Dehlin, O. I., Dahlgren, C. J. (1997). Neglect in elderly stroke patients: a comparison of five tests.Psychiatry Clin Neurosci, 51(5), 295-300.
  2. Azouvi, P., Marchal, F., Samuel, C., Morin, L., Renard, C., Louis-Dreyfus, A., Jokie, C., Wiart, L., Pradat-Diehl, P., Deloche, G., & Bergego, C. (1996). Functional consequences and awareness of unilateral neglect: Study of an evaluation scale. Neuropsychological Rehabilitation, 6(2), 133-150.
  3. Azouvi, P., Olivier, S., de Montety, G., Samuel, C., Louis-Dreyfus, A., & Tesio, L. (2003). Behavioral assessment of unilateral neglect: Study of the psychometric properties of the Catherine Bergego Scale. Archives of Physical Medicine and Rehabilitation, 84, 51-7.
  4. Bergego, C., Azouvi, P., Samuel, C., Marchal, F., Louis-Dreyfus, A., Jokie, C., Morin, L., Renard, C., Pradat-Diehl, P., & Deloche, G. (1995). Validation d’une Ă©chelle d’évaluation fonctionnelle de l’hĂ©minegligence dans la vie quotidienne: l’échelle CB. Annales de Readaptation et de Medecine Physique, 38, 183-9.
  5. Chen-Sea, M. J., Henderson, A. (1994). The reliability and validity of visuospatial inattention tests with stroke patients.Occup Ther Int, 1, 36-48.
  6. Deloche, G., Azouvi, P., Bergego, C., Marchal, F., Samuel, C., Morin, L., Renard, C., Louis-Dreyfus, A., Jokic, C., Wiart, L., Pradat-Diehl, P. (1996). Functional consequences and awareness of unilateral neglect: Study of an evaluation scale. Neuropsychol Rehabil, 6, 133-150.
  7. Fullerton, K. J., McSherry, D., Stout, R. W. (1986). Albert’s Test: A neglected test of perceptual neglect. The Lancet,1(8478), 430-432.
  8. Luukkainen-Markkula, R., Tarkka, I.M., Pitkänen, K., Sivenius, J., & Hämäläinen, H. (2011). Comparison of the Behavioral Inattention Test and the Catherine Bergego Scale in assessment of hemispatial neglect. Neuropsychological Rehabilitation, 21(1), 103-116.
  9. Samuel, C., Louis-Dreyfus, A., Kaschel, R., Makiela, E., Troubat, M., Anselmi, N., Cannizzo, V., & Azouvi, P. (2000). Rehabilitation of very severe unilateral neglect by visuo-spatio-motor cueing: Two single case studies. Neuropsychological Rehabilitation, 10(4), 385-99.
  10. Stroke Engine: Albert’s Test
  11. Stroke Engine: Catherine Bergego Scale (CBS)
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