Validity of the immersive virtual reality lateralized attention test for the assessment of unilateral spatial neglect following right hemispheric stroke

BACKGROUND: Unilateral spatial neglect (USN) is a disabling syndrome that is prevalent following right hemisphere stroke. Clinicians must be able to identify the presence, characteristics, and severity of USN using psychometrically sound assessments. Virtual reality offers a standardized and rapid means of assessing for USN in a safe and controlled environment. Enabled by advances in technology, this study established the validity of a new, immersive version of a prior validated, reliable, and sensitive assessment tool, the Virtual Reality Lateralized Attention Test (VRLAT). This new version (VRLAT-2) is novel because it uses a head-mounted display to provide an immersive and more realistic experience where participants are free to turn their heads while participating. OBJECTIVE: To examine the concurrent and discriminant validity of the immersive VRLAT-2 and to establish a preliminary cutoff score for determining USN. DESIGN: Criterion standard. SETTING: Institutional laboratory. PARTICIPANTS: 37 adults with right hemisphere stroke and 16 age-matched neurotypical individuals. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome measure was the VRLAT-2. Additional outcome measures included the VRLAT-1, Catherine Bergego Scale, Behavioral Inattention Test, and Bells Test. RESULTS: The VRLAT-2 demonstrated moderate concurrent and discriminant validity. In comparison to the VRLAT-1, it classified a numerically greater number of individuals as having USN. CONCLUSIONS: These preliminary and exploratory findings provide initial support for the validity of the VRLAT-2, though further validation studies are warranted. Additional research is needed to examine the psychometric properties of the VRLAT-2 with broader samples (eg, left hemisphere lesions, acute/subacute stroke).