Tuesday, August 11, 2009

A new test for hemispatial neglect

There’s an interesting article about a new neurological exam which found its genesis in an Eastchester High School classroom.

An AP Psychology teacher there was explaining hemispatial neglect, a disorder caused by brain damage in which the person is not consciously aware of either the left or right side of space or objects--including the patient’s own body.

During the discussion, one of the students asked the question, “What happens if you ask patients with neglect to clap their hands?” The teacher, Mr. Weisman, didn’t know. So he tracked down Dr. Rafael LlinĂ¡s, a researcher at Johns Hopkins University, which in turn led to the development of what has been named the Eastchester Clapping Sign (ECS).

Here is a picture of one patient, who showed an improvement between the first and second day of administering ECS. You can see that he's clapping with one hand at the midline, near where his other hand should meet it.



The article in Annals of Neurology outlines how to perform and score the test:

ECS testing was performed as follows: (1) make sure patient's arms and hands are both down at their sides; and (2) ask patient to clap his or her hands. Grading was established as follows: ECS-2 = one-handed clap, respects midline; ECS-1 = searches in the contralateral hemispace for the other hand; ECS-0 = reaches over to clap against the plegic hand; and UTA = unable to assess, that is, does not follow the command; you can try pantomime.

The authors point out that this simple test can be done in 30 seconds, helping doctors to quickly administer the correct medicines to aid in stroke recovery.

This just goes to show that sometimes the best ideas come from people who aren’t involved in research. Mr. Weisman should be commended for following up on his students’ question.

References: dx.doi.org/10.1002/ana.21666

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