Albert’s Test

Evidence Reviewed as of before: 26-11-2010
Author(s): Lisa Zeltzer, MSc OT; Anita Menon, MSc
Editor(s): Nicol Korner-Bitensky, PhD OT; Elissa Sitcoff, BA BSc

Purpose

Albert’s Test is a screening tool used to detect the presence of unilateral spatial neglect (USN) in patients with stroke. In this test, patients must cross out lines that are placed in random orientations on a piece of paper. USN is indicated when lines are left uncrossed on the same side of the page as the patients motor deficit or brain lesion is located.

In-Depth Review

Purpose of the measure

Albert’s Test is a screening tool used to detect the presence of unilateral spatial neglect (USN) in patients with stroke. In this test, patients must cross out lines that are placed in random orientations on a piece of paper. USN is indicated when lines are left uncrossed on the same side of the page as the patients motor deficit or brain lesion is located.

Available versions

The original Albert’s Test was published by Albert in 1973.

Features of the measure

Items: The modified Albert’s Test is the preferred version of the test and varies only slightly from the original description in which 41 lines were placed on slightly smaller sheet of paper. In the modified version, a series of 40 black lines, each about 2 cm long, are randomly oriented on a sheet of white 11 x 8.6-inch size paper in 6 rows. The test sheet is presented to the patient at their midline. Some of the lines are pointed out to him/her, including those to the extreme right and extreme left. The examiner asks the patient to cross out all of the lines, and demonstrates what is required by crossing out the 5 central lines him/herself. The patient is encouraged to cross out all the lines until he/she is satisfied that they have all been crossed.

Scoring: The presence or absence of USN is based on the number of lines left uncrossed on each side of the test sheet. If any lines are left uncrossed, and more than 70% of uncrossed lines are on the same side as motor deficit, USN is indicated. This may be quantified in terms of the percentage of lines left uncrossed (Fullerton, McSherry, & Stout, 1986).

Time: Less than 5 minutes.

Training: None typically reported.

Subscales: None.

Equipment:

  • 11x 8.5-inch page of paper with 41 lines 2 cm in length each.
  • Pencil

Alternative forms of the Albert’s Test

Modified version of Albert’s Test. This version varies only slightly from the original version and consists of 40 black lines (25 mm long, 0.5 or 1.2 mm thick) of various orientations dispersed randomly on a 297 x 210 mm sheet of white paper. Each side of the stimulus sheet contains 18 lines divided into 3 columns of 6 lines. The columns are numbered as 1 to 6 from left to right.

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).

Should not be used with:

  • Albert’s Test should be used with caution in the clinical diagnosis of spatial neglect. Performance on Albert’s Test may be influenced by or may be indicative of other syndromes besides spatial neglect, such as hemianopia (damage of optic pathways that result in loss of vision in half of the visual field) (Ferber & Karnath, 2001). The use of a clinical expert system for assessment of perceptual disorders may be useful for interpreting results and forming a diagnosis (e.g. McSherry & Fullerton, 1985).

In what languages is the measure available?

Not applicable.

Summary

What does the tool measure? Unilateral Spatial Neglect (USN).
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 Modified version of Albert’s Test.
Other Languages Not applicable.
Measurement Properties
Reliability
  • No studies have examined the internal consistency of Albert’s Test.
  • One study examined the test-retest reliability of Albert’s Test and reported excellent test-retest.
Validity

Convergent:

Excellent correlations reported between Albert’s Test and the Line Bisection Test, the Wundt-Jastrow Area Illusion test, and the Catherine Bergego Scale. An adequate correlation has been reported between Albert’s Test and the Star Cancellation Test.
Known groups:

Albert’s Test can distinguish between patients with neglect from patients without neglect.
Predictive:

Albert’s Test significantly predicted functional outcome at 6 months post-stroke.

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Does the tool detect change in patients? Not applicable.
Acceptability Albert’s Test should be used as a screening tool rather than for clinical diagnosis of USN. Performance may be influenced by or may be indicative of other syndromes besides spatial neglect, such as hemianopia. This test cannot be completed by proxy.
Feasibility Albert’s Test requires no specialized training to administer and only simple equipment is required (an 11x 8.5-inch page of paper with 41 lines 2 cm in length each and a pencil). The clinician must present the test sheet to the patient at their midline. Some of the lines are pointed out to him/her, including those to the extreme right and extreme left. The clinician asks the patient to cross out all of the lines, and demonstrates what is required by crossing out the 5 central lines him/herself. The patient is encouraged to cross out all the lines until he/she is satisfied that they have all been crossed.
How to obtain the tool?

Please click here.

Psychometric Properties

Overview

For the purposes of this review, we conducted a literature search to identify all relevant publications on the psychometric properties of Albert’s Test.

Reliability

Internal consistency:

No evidence.

Test-retest:

Chen-Sea and Henderson (1994) reported that Albert’s Test has an excellent test-retest reliability of r = 0.79.

Validity

Construct

Convergent:

Agrell, Dehlin, and Dahlgren (1997) compared the performance of 57 elderly patients with stroke on 5 different tests for visuo-spatial neglect (Star Cancellation, Line Crossing, Line Bisection, Clock Drawing Task and Copy A Cross). Albert’s Test had an excellent correlation with the Line Bisection Test (r = 0.85) and correlated adequately with the Star Cancellation Test (r = 0.63).

Massironi, Antonucci, Pizzamiglio, Vitale, Zoccolotti (1988) found an excellent correlation between the Wundt-Jastrow Area Illusion test and Albert’s Test (r = 0.64).

Deloche et al. (1996) reported an excellent correlation between the Catherine Bergego Scale and Albert’s Test (Spearman’s r = 0.73).

Known groups:

Potter, Deighton, Patel, Fairhurst, Guest, and Donnelly (2000) examined a computer-based method of administering the Albert’s Test in 30 patients with stroke and neglect, 57 patients with stroke and without neglect, and 13 age-matched control subjects. Significant differences were found between subjects with neglect and those without neglect, as well as subjects with neglect and age-matched controls. No difference between patients without neglect and age-matched controls was observed.

Criterion

Predictive:

Fullerton, McSherry, and Stout (1986) found that test scores on Albert’s Test administered to 205 patients with stroke within 48 hours of hospital admission significantly predicted functional outcome at 6 months post-stroke (as measured by a 4-point crude scale). This study specifically found that 56.8% of individuals identified with visual neglect using the Albert’s Test were true cases of neglect (true positives). Approximately 4.3% of individuals without neglect were also screened negative on the Albert’s Test (true negatives). However, more than 35% of the individuals were unable to comply with the test because of an altered state of consciousness or dysphasia during this early phase of recovery.

Responsiveness

Not applicable.

References

  • Agrell, B. M., Dehlin, O. I., Dahlgren, C. J. (1997). Neglect in elderly stroke patients: a comparison of five tests.Psychiatry Clin Neurosci, 51(5), 295-300.
  • Albert, M. L. (1973). A simple test of visual neglect.Neurology, 23, 658 664.
  • Chen-Sea, M. J., Henderson, A. (1994). The reliability and validity of visuospatial inattention tests with stroke patients.Occup Ther Int, 1, 36-48.
  • Deloche, G., Azouvi, P., Bergego, C., Marchal, F., Samuel, C., Morin, L., Renard, C., Louis-Dreyfus, A., Jokic, C., Wiart, L., Pradat-Diehl, P. (1996). Functional consequences and awareness of unilateral neglect: Study of an evaluation scale. Neuropsychol Rehabil, 6, 133 150.
  • Fullerton, K. J., McSherry, D., Stout, R. W. (1986). Albert’s Test: A neglected test of perceptual neglect. The Lancet,1(8478), 430-432.
  • Massironi, M., Antonucci, G., Pizzamiglio, L., Vitale, M. V., Zoccolotti, P. (1988). The Wundt-Jastrow illusion in the study of spatial hemi-inattention. Neuropsychologia, 26(1), 161-166.
  • McSherry, D., Fullerton, K. (1985). Preceptor: A shell for medical expert systems and its applications in a study of prognostic indices in stroke. Expert Systems, 2, 140-145.
  • Menon, A., Korner-Bitensky, N. (2004). Evaluating unilateral spatial neglect post stroke: Working your way through the maze of assessment choices. Topics in Stroke Rehabilitation, 11(3), 41-66.
  • Plummer, P., Morris, M. E., Dunai, J. (2003). Assessment of unilateral neglect. Phys Ther, 83(8), 732-740.
  • Potter, J., Deighton, T., Patel, M., Fairhurst, M., Guest, R., Donnelly, N. (2000). Computer recording of standard tests of visual neglect in stroke patients. Clinical Rehabilitation, 14(4), 441-446.
  • Na, D. L., Adair, J. C., Kang, Y., Chung, C. S., Lee, K. H., Heilman, K. M. (1999). Motor perseverative behavior on a line cancellation task. Neurology, 52, 1569-1576

See The Measure

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