Bells Test


Bells Test Evaluation Summary

  What does the tool measure? Unilateral Spatial Neglect (USN) in the near extra personal space
  What types of clients can the tool be used for? Patients with stroke
  Is this a screening or assessment tool? Screening
Time to administer Less than 5 minutes.
  Versions None.
Other Languages Not applicable
Measurement Properties
  Reliability – No studies have examined the internal consistency of the Bells Test.
– No studies have examined the test-retest reliability of the Bells Test.

Known groups:
The Bells Test was able to discriminate between patients with right cerebral lesions and patients with left cerebral lesions. 

One study reported that the Bells Test is more likely to identify the presence of neglect than the Albert’s Test in patients with stroke. One study found that the Bells Test and the Letter Cancellation Test were more likely to detect the presence of neglect than the Line Bisection Test in 35 patients with spatial neglect.

  Does the tool detect change in patients? Not applicable.
  Acceptability The Bells Test should be used as a screening tool rather than for clinical diagnosis of USN. Apraxia must be ruled out as this may affect the validity of test results. This test cannot be completed by proxy. Patients must be able to hold a pencil and visually discriminate between distractor items to complete. The measure cannot be used to differentiate between sensory neglect and motor neglect.
Feasibility The Bells Test requires no specialized training to administer and only minimal equipment is required (a pencil, a stopwatch, the test paper and scoring sheet). The test is simple to score and interpret. The test is placed at the patient’s midline and a demonstration sheet is used to familiarize the patient with the images used in the test. The examiner is required to follow along with the patient as they circle each bell, and record on the scoring sheet the order in which the bells are cancelled. Upon completion of the test, the examiner must count the number of bells cancelled out of a total of 35, and record the time taken by the patient.
An omission of 6 or more bells on the right or left half of the page indicates USN.
How to obtain the tool? You can download a copy: Bell’s Test