# From Patient to Musician: A Multi-Sensory Virtual Reality Rehabilitation Tool for Spatial Neglect
## 2 Background
### Assessment of USN  
To assess the degree and nature of the spatial neglect, several assessment methods are available today that try to measure a potential bias towards the non-neglected side of space. These assessment tests can be categorised into the so-called paper-and-pencil tests, which are often tools for quickly screening patients, and the behavioural tests, which aspire to assess spatial neglect based on everyday tasks [8; 24; 25]. Examples of paper-and-pencil tests are the line bisection test and the cancellation test. During the line bisection test, patients are asked to indicate the horizontal centre of a simple straight line ([[https://www.strokengine.ca/en/assessments/line-bisection-test/](https://www.strokengine.ca/en/assessments/line-bisection-test/)]([https://www.strokengine.ca/en/assessments/line-bisection-test/](https://www.strokengine.ca/en/assessments/line-bisection-test/)), accessed on 19 December 2021). A bias towards the right or left can then indicate USN, as shown in Figure 2[26; 27; 28]. For the cancellation test, the patient has to cross out certain symbols on a sheet of paper, often ignoring other distraction symbols. One example of such a cancellation test is the star cancellation test, shown in Figure 3, in which all small stars need to be indicated, ignoring the random distraction words ([[https://strokengine.ca/en/assessments/star-cancellation-test/](https://strokengine.ca/en/assessments/star-cancellation-test/)]([https://strokengine.ca/en/assessments/star-cancellation-test/](https://strokengine.ca/en/assessments/star-cancellation-test/)), accessed on 19 December 2021). The quantification of USN is then the difference between the missed stars on the left versus the right side [28; 29; 30; 31]. An example of a digital paper-and-pencil test is the neglect test of the Test for Attention Performance (TAP). The neglect test is a subtest of the TAP test suite ([[https://www.psytest.net/en/test-batteries/tap/subtests#visual_field_examination](https://www.psytest.net/en/test-batteries/tap/subtests#visual_field_examination)]([https://www.psytest.net/en/test-batteries/tap/subtests#visual_field_examination](https://www.psytest.net/en/test-batteries/tap/subtests#visual_field_examination)), accessed on 19 December 2021), during which the patient needs to respond to a flickering stimulus on the screen by pressing a button [32]. These paper-and-pencil tests are simple and quick to set up. Figure 1: When patients with representational neglect are asked to draw an analogue clock from memory, the numbers are placed in their non-neglected side of the clock (**a**–**g**). Reprinted with permission from [21]. Copyright 2022 Journal of Neuropsychology. However, they should only be used for initial screening and not for clinical diagnosis as they cannot discriminate between sensory and motor neglect. Examples of behavioural tests are the Behavioural Inattention Test (BIT), the Semi-Structured Scale for Functional Evaluation of Hemi-Inattention and the Catherine Bergego Scale (CBS). The BIT consists of conventional pen-and-paper tests as well as practical tests such as reading a menu or sorting coins [8; 28; 33]. Similarly, for the Semi-Structured Scale for Functional Evaluation of Hemi-Inattention ([[https://strokengine.ca/en/assessments/semi-structured-scale-for-the-functional-evaluation-of-hemi-inattention/](https://strokengine.ca/en/assessments/semi-structured-scale-for-the-functional-evaluation-of-hemi-inattention/)]([https://strokengine.ca/en/assessments/semi-structured-scale-for-the-functional-evaluation-of-hemi-inattention/](https://strokengine.ca/en/assessments/semi-structured-scale-for-the-functional-evaluation-of-hemi-inattention/)), accessed on 19 December 2021), the patient has to perform functional tasks such as combing their hair or serving tea [8; 28; 34].