Star Cancellation Test

Purpose of the measure

The Star Cancellation Test is a screening tool that was developed to detect the presence of unilateral spatial neglect (USN) in the near extra personal space in patients with stroke.

Available versions

The Star Cancellation Test was developed by Wilson, Cockburn, and Halligan in 1987.

Features of the measure

Items:
There are no actual items to the Star Cancellation Test. In the Star Cancellation Test, the stimuli are 52 large stars, 13 letters, and 10 short words interspersed with 56 smaller stars (see figure below). The patient must cross out with a pencil all the small stars on an 8.5″ x 11″ piece of paper. Two small stars in the centre are used for demonstration. The page is placed at the patient’s midline.

Scoring:
The maximum score that can be achieved on the test is 54 points (56 small stars in total minus the 2 used for demonstration). A cutoff of < 44 indicates the presence of USN. A Laterality Index or Star Ratio can be calculated from the ratio of stars cancelled on the left of the page to the total number of stars cancelled. Scores between 0 and 0.46 indicate USN in the left hemispace. Scores between 0.54 and 1 indicate USN in the right hemispace

Time:
Less than 5 minutes.

Training:
None typically reported.

Subscales:
None.

Equipment:

  • The test paper (8.5″x11″ page with 52 large stars, 13 letters, and 10 short words interspersed with 56 smaller stars).
  • Pencil
Alternative forms of the Star Cancellation Test

Laterally extended version of the Star Cancellation Test (Small, Cowey, & Ellis, 1994). In this version of the test, the section in the traditional version of the Star Cancellation Test extending from the midline to the right side of the page is duplicated at the right end (i.e. the display area is extended twice as far to the right of midline as to the left). The dimensions of the test paper in this version are 41 cm x 21 cm.

Client suitability

Can be used with: Patients with stroke.

  • Patients must be able to hold a pencil to complete the test (the presence of apraxia may impair this ability).
  • Patients must be able to visually discriminate between distractor items such as the words and big stars, and the small stars that are to be cancelled.

Should not be used with:

  • As with other cancellation tests, the Star Cancellation Test cannot be used to differentiate between sensory neglect and motor neglect because it requires both visual search and manual exploration (Ladavas, 1994).
  • The Star Cancellation Test cannot be completed by proxy.
In what languages is the measure available?

The words included in the Star Cancellation Test can be translated into the patients’ native language (Linden, Samuellson, Skoog, & Blomstrand, 2005).