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Updated: Apr 13, 2026
Virtual Reality Tools for Assessing Unilateral Spatial Neglect: A Novel Opportunity for Data Collection
Published on: March 10, 2021
Using augmented reality to assess spatial neglect: The Free Exploration Test (FET)
Britta Stammler1, Marian Lambert2, Thomas Schuster2,3
1Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
Background:
To capture the distortion of exploratory activity typical of patients with spatial neglect, traditional diagnostic methods and new virtual reality applications use confined workspaces that limit patients' exploration behavior to a predefined area. Our aim was to overcome these limitations and enable the recording of patients' biased activity in real, unconfined space.
Methods:
We developed the Free Exploration Test (FET) based on augmented reality technology. Using a live stream via the back camera on a tablet, patients search for a (non-existent) virtual target in their environment, while their exploration movements are recorded for 30 s. We tested 20 neglect patients and 20 healthy participants and compared the performance of the FET with traditional neglect tests.
Results:
In contrast to controls, neglect patients exhibited a significant rightward bias in exploratory movements. The FET had a high discriminative power (area under the curve = 0.89) and correlated positively with traditional tests of spatial neglect (Letter Cancellation, Bells Test, Copying Task, Line Bisection). An optimal cut-off point of the averaged bias of exploratory activity was at 9.0° on the right; it distinguished neglect patients from controls with 85% sensitivity.
Discussion:
FET offers time-efficient (execution time: ∼3 min), easy-to-apply, and gamified assessment of free exploratory activity. It supplements traditional neglect tests, providing unrestricted recording of exploration in the real, unconfined space surrounding the patient.
