The Semi-Structured Scale for the Functional Evaluation of Hemi-inattention is a screening tool used to detect the presence of unilateral spatial neglect (USN) in both the personal and extra personal space. In this scale, patients must perform functional activities, such as using a comb or serving tea.
The Semi-Structured Scale for the Functional Evaluation of Hemi-inattention was published by Zoccolotti, Antonucci, and Judica in 1992.
Patients are asked to perform different tasks with real objects.
To assess personal neglect, patients must demonstrate the use of three common objects: comb, razor/powder compact, and eyeglasses. The objects are placed at the patient’s midline one at a time and is asked:
- “Show me how you comb your hair?”
- “Show me how to use the razor?” (male) or “Show me how to powder yourself?” (female)
- “Show me how to put the eyeglasses on?”
To assess extra personal neglect, patients must serve tea, deal cards, describe a picture, and describe an environment. The patient is asked to perform these activities with objects that are provided on a table.
- Serving tea.
The patient is brought to a table with a tray containing 4 cups and saucers, a teapot, a sugar bowl, teaspoons, and paper napkins. Examiners are seated on the right, in front, and to the left of the patient who is asked to serve tea for him/herself and for those who are with him/her, to distribute napkins and teaspoons, and also to serve the sugar. The examiner, who is seated in front of the patient asks: “Would you like to serve the tea?”. If the patient serves the tea but not the napkins and/or teaspoons, the examiner asks: “Would you like to give us the teaspoons (napkins)?”.
- Card dealing.
The examiners and the patient are seated the same way as they were for the tea-serving situation. The patient is asked if he/she knows how to play “Scopa”. If necessary, he/she is reminded of the basic rules (3 cards for each player and 4 in the middle of the table). Note:As Scopa is an Italian card game, as an alternative, other card games featuring four players can be used. The examiner seated in front of the patient asks: “Would you like to deal the cards for a game of Scopa?”.
- Picture description.
A picture is placed in front of the patient and he/she is asked: “Will you describe everything you see in this picture?”. Three pictures are used. Two are cards 3 and 6 (45 x 32 cm) of Set 1 of the Progressive Picture Compositions by Byrne (1967); one is Tissot’s painting ‘The dance on the ship’ (60 x 100 cm). The examiner indicates the persons and objects pointed out by the patient with progressive numbers on a photocopy of the stimulus figure in the order in which they are reported, without soliciting in any way. When the description is finished, the patient is asked: “Well, what does this picture represent?”. The patients’ response is transcribed but it does not contribute to the score.
- Description of an environment.
The patient is placed in a room full of objects on both sides (arm chairs, pictures, lamps) and is asked to describe it. The patient is told: “Will you describe everything you see in this room?”. To facilitate scoring, it is useful to record the elements described by the patient on a schematic drawing of the environment.
Patients receive a score ranging from 0 to 3 for each item based on the symmetry of his or her performance. A total score is calculated for each subscale.
- Personal neglect subscale:A score of 0 indicates normal performance, 1 indicates slight asymmetry, 2 indicates clear omissions, and 3 indicates significant reduction in space explored. The maximum score that can be achieved is 9. A total score greater than the cutoff of 1 indicates the presence of personal neglect.
- Extra personal neglect subscale:A score of 0 indicates normal performance, 1 indicates slight asymmetries, uncertainty, or slowness in space explored, 2 indicates clear omissions, and 3 indicates significant reduction in space explored. The maximum score that can be achieved is 12. A total score greater than the cutoff of 3 indicates the presence of extra personal
It takes approximately 5 minutes to complete the personal neglect subscale and 15 minutes to complete the extra personal neglect subscale.
The therapist must be trained on how to use the rating scale.
Personal neglect and extra personal (spatial) neglect.
- Razor/Powder compact
- Tea set
- Playing cards
Can be used with:
- Patients with stroke.
Should not be used with:
- Patients who do not have unilateral voluntary movement and control of the shoulder, elbow, and fingers cannot be assessed for the presence of personal neglect.
- Patients who do not have unilateral voluntary movement and control of shoulder, elbow, and fingers, language, cognition, or visual perceptual skills cannot be assessed for the presence of extra personal It may be challenging for patients with stroke to perform these high-level activities soon after stroke, however this scale may become more useful as the patient approaches discharge from acute care (Menon & Korner-Bitensky, 2004).
- Need to rule out the presence of apraxia, given that this may impact the validity of testing results.
- A proxy respondent cannot be used because the measure is dependent on observed completion of each task.