Comparison of the Milner and Bisiach Landmark Tasks: can neglect patients be classified consistently?

The aim of the presented studies was to investigate whether classifications of neglect patients into perceptual (i.e. identifying a patient as suffering from mainly attentional/space representation deficits) and premotor (judging the main impairment to be related towards actions into contralesional space) categories are consistent across similar Landmark techniques that have, in the past, been designed to tease these potentially overlapping aspects of hemispatial neglect apart. Thirteen patients with hemispatial neglect were tested both with the Landmark Test, adapted from Milner et al. (1992; 1993) in which they had to manually point to the half of a centrally pre-bisected line that, to them, appeared shorter and the motor version of the Bisiach Landmark Test (Bisiach et al., 1998) in which, rather than just judging a centrally prebisected line, they had to judge asymmetrically bisected lines as well. The specific question was whether these two tasks, which are very similar, would categorise the same set of patients in the same way. Most patients could be classified into either the premotor or perceptual category in each task, but no consistent categorisation emerged across the two tests. Just three out of the thirteen patients were consistently classified across both tests. Despite the apparent similarity of the two tests the Milner Landmark Test proved to be much more sensitive to identifying even a slight perceptual bias and seems therefore the test of choice if identification of perceptual bias is the major interest.