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Updated: Sep 26, 2025
Virtual Reality Tools for Assessing Unilateral Spatial Neglect: A Novel Opportunity for Data Collection
Published on: March 10, 2021
The mobility assessment course: A ready-to-use dynamic measure of visuospatial neglect
Katinka N Nelemans1, Tanja C W Nijboer1,2, Antonia F Ten Brink1
1Department of Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands.
Abstract:
The Mobility Assessment Course (MAC) is a tool to measure visuospatial neglect in a dynamic fashion. Although the MAC has been shown to dissociate between patients with and without neglect, it remains unclear whether it is applicable in clinical settings. We evaluated the MAC regarding its (1) feasibility as a diagnostic tool as part of standard care, (2) construct validity, and (3) underlying constructs and potential confounders. A consecutive sample of stroke patients admitted to inpatient rehabilitation completed the MAC, shape cancellation, line bisection, and/or Catherine Bergego Scale (CBS) as part of the standard assessment. To assess feasibility, we computed the percentage of patients who completed the MAC. Construct validity was tested by evaluating MAC performance between patients with and without neglect and controls. Finally, a regression analysis was conducted to assess underlying constructs and potential confounders of MAC performance (i.e., level of mobility and lesion side). The MAC was completed by 82% of patients (N = 182/223; of whom 145 completed all tasks). Patients with neglect performed worse on the MAC (indicating more severe neglect) compared to patients without neglect and controls. The MAC had a lower sensitivity and higher specificity than paper-and-pencil tasks and the CBS. Performance on shape cancellation, line bisection, and CBS were predictors of MAC performance. Level of mobility and lesion side did not predict MAC scores, indicating that these factors do not confound its reliability. To conclude, the MAC is an easy-to-implement tool to evaluate neglect in a dynamic manner, which can be administered in addition to conventional paper-and-pencil tasks.
Insights
The Mobility Assessment Course (MAC) effectively measures visuospatial neglect in stroke patients. This dynamic tool is feasible for clinical use and shows high specificity compared to traditional tests.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Clinical Psychology
Background:
- Visuospatial neglect is a common deficit after stroke.
- Existing assessment tools for neglect have limitations in dynamic evaluation.
- The Mobility Assessment Course (MAC) offers a dynamic approach to measuring visuospatial neglect.
Purpose of the Study:
- To evaluate the feasibility, construct validity, and confounding factors of the MAC in a clinical rehabilitation setting.
- To compare the MAC's diagnostic performance against established neglect assessment methods.
- To determine if mobility level and lesion side impact MAC reliability.
Main Methods:
- A consecutive sample of 223 stroke patients in inpatient rehabilitation completed the MAC and other standard assessments (shape cancellation, line bisection, Catherine Bergego Scale).
- Feasibility was assessed by completion rates.
- Construct validity was examined by comparing MAC performance across patient groups (neglect, no neglect, controls).
- Regression analysis identified predictors and confounders of MAC performance.
Main Results:
- The MAC was completed by 82% of patients, demonstrating good feasibility.
- Patients with neglect performed significantly worse on the MAC than those without neglect and controls.
- The MAC exhibited lower sensitivity but higher specificity than paper-and-pencil tests and the CBS.
- Mobility level and lesion side did not confound MAC scores.
Conclusions:
- The MAC is a feasible and reliable tool for dynamic visuospatial neglect assessment in clinical settings.
- It complements traditional neglect assessments with good specificity.
- The MAC's performance is not confounded by patient mobility or lesion side, enhancing its clinical utility.
