Discrepancy in unilateral spatial neglect between daily living and neuropsychological test situations: a single case study.

We report results of our investigation of the case of a 34-year-old woman (YJ) who showed persistent left unilateral spatial neglect (USN) in daily living, frequently hitting obstacles or bumping into the wall, although her visuospatial ability was mostly preserved in paper and pencil neuropsychological tests. In order to clarify this apparent discrepancy, her eye fixation pattern was monitored in testing situations and in natural daily activities using an eye camera. The results showed that when taking the standard tests YJ tended to shift her fixation point to the left edge of the testing frame to overcome over-searching tendency to the right as left hemianopics without left USN would do. However in natural situations, this compensatory leftward fixation was not found. This may be due to the lack of adequate frames of reference in the natural environment. Our findings suggest limitation of laboratory neuropsychologicial testing to fully appreciate the scope of a patient's disability in natural settings.