Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2023; 11(22): 5236-5243
Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5236
Standardization of apple cancellation test for neglect patients in Korea: An observational study
Woo-Hyuk Jang, Jong-Sik Jang
Woo-Hyuk Jang, Jong-Sik Jang, Department of Occupational Therapy, College of Health Science, Kangwon National University, Samcheok-si 25949, Gangwon-do, South Korea
Author contributions: Jang WH contributed to conceptualization, editing, and supervision; Jang JS contributed to analysis and writing; all authors have read and agreed to the published version of the manuscript.
Supported by National Research Foundation of Korea Grant funded by The Korea Government, No. 2021R1G1A1093494.
Institutional review board statement: This study was carried out after the approval of the Kangwon National Institutional Review Board (No. KWNUIRB-2021-06-002-002).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors declare having no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jong-Sik Jang, PhD, Assistant Professor, Department of Occupational Therapy, College of Health Science, Kangwon National University, No. 346 Hwangjo-gil, Dogye-eup, Samcheok-si 25949, Gangwon-do, South Korea. js_ot@kangwon.ac.kr
Received: March 6, 2023
Peer-review started: March 6, 2023
First decision: May 31, 2023
Revised: June 8, 2023
Accepted: July 11, 2023
Article in press: July 11, 2023
Published online: August 6, 2023
Abstract
BACKGROUND

Neglect can be divided into two types using apple cancellation test (apple test): Egocentric neglect (EN) and allocentric neglect (AN). However, in South Korea, apple test results and decision criteria are still largely dependent on tests by foreign countries.

AIM

To establish a new South Korea standard and improve the accuracy of neglect assessment, the apple experiment was standardized in this study.

METHODS

This study was conducted on 223 healthy subjects for a total of 7 mo from August 2021 to February 2022. Standardization was carried out using the original apple test developed by Bickerton in 2011. In scoring for the apple test, total omission error refers to the number of missed targets (full apple) in the entire test sheet (left, middle, and right area). The score for EN is the difference between the cor-rect number of right area and the correct number of left area (excluding the middle area). For AN, the score is difference between the number of left opening apples and number of right opening apples (including the middle area). Linear regression analysis was used for standardization using the general characteristics of subjects and the results of the apple test.

RESULTS

The cut-off score, which is the standard value indicating the pathological condition by combining the results of all subjects, is as follows: Total omission error (5), error for EN (2), and error for AN (2). Also, differences in cut-off score according to age were found.

CONCLUSION

This study will be helpful in facilitating a more accurate differential diagnosis of neglect.

Keywords: Apple cancellation test, Egocentric neglect, Allocentric neglect, Brain injury, Standardization

Core Tip: This study attempted to standardize the apple cancellation test for differential diagnosis of neglect in Korea. As a result, various cut-off scores are presented to establish criteria for diagnosing egocentric and allocentric neglect. In addition, the appropriate time to perform the test according to age and education level is also presented. We hope that this study will be useful for future studies.