Abstract
OBJECTIVES: The conventional test to detect unilateral spatial neglect (USN) is the Bells Test performed in a paper-and-pencil format. While several studies showed immersive virtual reality (VR) tests may provide greater sensitivity in revealing the presence of USN using visual scanning tasks, none has investigated the Bells Test in VR. This study compares the Bells Test performed in paper-and-pencil format (PP) and in VR in conventional (CVR) and ecological (EVR) format, which differ by the size of the display, in stroke patients. DESIGN: Cross-sectional study. SETTING: Stroke patients. PARTICIPANTS: A convenience sample of 32 stroke patients. INTERVENTIONS: VR assessments were performed using an immersive system with a head-mounted display. In CVR, the Bells Test is reproduced in the same format as PP (A4 sheet), while in EVR, the targets are displayed in a wider space corresponding to a hemisphere of 1-m radius. RESULTS: The number of cancelled targets out of 35 was 32.5 (3.5) for PP, 33 (4) for CVR, and 34 (2) for EVR (mean [SD]), with a significant difference between PP and EVR (p < 0.05). The time to complete the Bells Test was 186 (69) s for PP, 184 (65) s for CVR, and 170 (58) s for EVR, without differences between modalities (p > 0.05). Bells Tests in the 3 modalities revealed the presence of USN, except for 1 patient in EVR. CONCLUSION: VR assessment of USN could be used in the same way as conventional cancellations tests. Moreover, VR could provide additional information on the type of USN through the different testing modalities available.