Functional consequences and awareness of unilateral neglect: Study of an evaluation scale

Unilateral neglect is a major predictor of poor outcome after right hemisphere stroke. However, conventional tests of neglect do not predict precisely everyday difficulties. We propose a functional scale consisting of 10 items related to neglect in everyday life (such as dressing, washing, eating, communicating, exploratory activities, and moving around): the Catherine Bergego scale (CBS). Inter-rater reliability has previously been found acceptable. The severity of neglect was assessed in 50 patients by an experienced therapist in real-life situations and scored for each item on a four-point scale. The CBS score correlated well with clinical tests of neglect, and with the Barthel index. Awareness of deficits was evaluated by questioning the patient about his difficulties on the 10 items of the CBS. A score of anosognosia can be calculated (difference between the score on the scale and the patient's self-evaluation). This anosognosia score was well correlated with the severity of neglect. We conclude that this scale is a simple and reliable test to evaluate the functional consequences of unilateral neglect in real-life situations and anosognosia.