The Catherine Bergego Scale is a standardized checklist to detect presence and degree of neglect during observation of everyday life situations. The scale also provides a measure of neglect self-awareness (anosognosia).
There is only one version of the CBS. The CBS is comprised of a 10-item checklist for use by clinicians, and a corresponding patient-administered questionnaire that can be used to measure self-awareness of neglect (anosognosia).
The CBS is comprised of 10 everyday tasks that the therapist observes during performance of self-care activities. The therapist scores the patient on the following items:
Forgets to groom or shave the left part of his/her face
Experiences difficulty in adjusting his/her left sleeve or slipper
Forgets to eat food on the left side of his/her plate
Forgets to clean the left side of his/her mouth after eating
Experiences difficulty in looking towards the left
Forgets about a left part of his/her body (e.g. forgets to put his/her upper limb on the armrest, or his/her left foot on the wheelchair rest, or forgets to use his/her left harm when he/she needs to)
Has difficulty in paying attention to noise or people addressing him/her from the left
Collides with people or objects on the left side, such as doors or furniture (either while walking or driving a wheelchair)
Experiences difficulty in finding his/her way towards the left when traveling in familiar places or in the rehabilitation unit
Experiences difficulty finding his/her personal belongings in the room or bathroom when they are on the left side
There is a corresponding patient/carer questionnaire that can be used to assess anosognosia (i.e. self-awareness of neglect). The questionnaire is comprised of 10 questions that correspond with CBS items. For instance, in accordance with the first item the clinician would ask the patient: “do you sometimes forget to groom or shave the left side of your face?” If the patient identifies that the difficulty is present, the clinician asks: “do you find this difficulty mild, moderate or severe?”
The CBS uses a 4-point rating scale to indicate the severity of neglect for each item:
0 = no neglect
1 = mild neglect (patient always explores the right hemispace first and slowly or hesitantly explores the left side)
2 = moderate neglect (patient demonstrates constant and clear left-sided omissions or collisions)
3 = severe neglect (patient is only able to explore the right hemispace)
This results in a total score out of 30.
Azouvi et al. (2002, 2003) have reported arbitrary ratings of neglect severity according to total scores:
0 = No behavioral neglect
1-10 = Mild behavioral neglect
11-20 = Moderate behavioral neglect
21-30 = Severe behavioral neglect
In cases of severe impairment the patient may not able to perform an item of the CBS. In these instances the item is considered invalid, is not scored, and is not included in the final score. As such, the total score would be a calculation of the average score of the valid questions (i.e. sum of individual scores divided by number of valid questions x 10).
The patient questionnaire also uses a 4-point rating scale according to the following levels of difficulty experienced by the patient:
0 = no difficulty
1 = mild difficulty
2 = moderate difficulty
3 = severe difficulty
The anosognosia score is then calculated as the difference between the clinician’s total score and the patient’s self-assessment score (Azouvi et al., 2003):
Anosognosia score = clinician’s CBS score – patient’s self-assessment score
Description of tasks:
The clinician observes the patient performing self-care activities and provides a score for each of the 10 items according to observations of neglect behaviors (Plummer et al., 2003).
What to consider before beginning:
The items of the CBS vary in their degree of difficulty (tasks listed from least difficult to most difficult, with item numbers indicated in parentheses): cleaning mouth after a meal (item 4); grooming (1) / auditory attention (7); eating (3); spatial orientation (9); gaze orientation (5); finding personal belongings (10); collides when moving (8); left limb knowledge (6); dressing (2). Note that two items (grooming, auditory attention) share the same level of difficulty (Azouvi et al., 2003).
The CBS takes approximately 30 minutes to administer.
There are no formal training requirements for administration of the CBS.
The clinician requires the form, a pen and household equipment used to perform the tasks (e.g. razor, brush, toothbrush, clothing, mealtime utensils, serviette). The test can be administered in the patient’s own environment or in the rehabilitation setting.
There are no alternative forms of the CBS.
Can be used with:
Patients with stroke and hemispatial neglect. While the authors specify use of the CBS with patients with right hemispatial neglect, it may be modified for use with individuals with left hemispatial neglect (Plummer et al., 2003).
Should not be used with:
The CBS requires patients to perform upper limb and lower limb movements in various testing positions for approximately 30 minutes (Menon & Korner-Bitensky, 2004). While scoring can be adjusted for patients who are not able to perform all tasks, the clinician must consider whether these difficulties are due to neglect or other neurological deficits such as apraxia (Azouvi et al., 1996; Menon & Korner-Bitensky, 2004).