title: Feasibility of a Semi-computerized Line Bisection Test for Unilateral Visual Neglect Assessment.
abstract: BACKGROUND
  Commonly used paper-and-pencil based test modalities for assessing the degree of unilateral visual neglect (ULN) in patients with hemispheric cerebral lesions consume human resources with a significant inter and intra-rater variability.
  
  
  OBJECTIVE
  To explore the feasibility of a semi-computerized electronic-pen based ULN assessment system (e-system) to improve assessment quality without altering the conventional user interface.
  
  
  METHODS
  Thirty cognitively healthy participants (HG) and 11 participants diagnosed with right-hemispheric lesion and unilateral visual neglect (NG) were recruited to evaluate the e-system. Line bisection tests (LBT) were repeatedly conducted twice for the inter-rater and intra-rater (reliability) comparisons. The LBT results were assessed by the e-system and the golden standard methods (manual rater assessment). The percent deviation (%), assessment duration (sec), and number of neglected line (each) were evaluated.
  
  
  RESULTS
  The inter-rater comparisons of the assessed deviation (%) variable showed excellent interrater reliabilities (CCCs) ranging from .84 (.59 to .95 (p < .001)) to .99 (.90 to .99 (p < .001)) for HG and NG. The Bland Altman mean difference (B-A) plots with bias (95% LOA (limits of agreement)) showed similar agreements between the e-system and the raters ranging from -.04 % (-2.10 to 1.97) to 1.30 % (-2.23 to 4.84) for HG and NG. The effect sizes (ES), which show similarities between the assessment methods, yielded smaller ranges from .01 to .30 for HG and NG. The reliability (test-retest) comparisons showed similar assessment results between the e-system, rater 1, and rater 2. The manual rater assessment time ranging from 5.85 to 6.00 minutes and inter- and intraassessment variations were virtually eliminated with the e-system.
  
  
  CONCLUSIONS
  The semi-computerized system with the conventional paper-and pencil user-interface showed valid and reliable assessment results. It may be a feasible replacement for the manual rater assessment modality even in a clinical setting.
authors.affiliation: Department of Sports and Health Care, Namseoul University , Cheonan-si, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Jee
authors.affiliation: School of Information and Communication, Inha University , Incheon-si, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Physical & Rehabilitation Medicine, Inha University Hospital , Incheon-si, Korea.
authors.forename: C
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Physical & Rehabilitation Medicine, Inha University Hospital , Incheon-si, Korea.
authors.forename: T
authors.initials: T
authors.lastname: Kim
authors.affiliation: School of Information and Communication, Inha University , Incheon-si, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Park
mesh_terms: D000328:Adult; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010468:Perceptual Disorders / Q000175:diagnosis*; D011786:Quality Control; D015203:Reproducibility of Results; D013997:Time Factors; D014584:User-Computer Interface; D055815:Young Adult
keywords: Unilateral visual neglect; computer-aided diagnosis; line bisection