Online and Offline Awareness Deficits: Anosognosia for Spatial Neglect

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Abstract

Purpose/Objective: Anosognosia for spatial neglect (ASN) can be offline or online. Offline ASN is general unawareness of having experienced spatial deficits. Online ASN is an awareness deficit of underestimating spatial difficulties that likely to occur in an upcoming task (anticipatory ASN) or have just occurred during the task (emergent ASN). We explored the relationships among spatial neglect, offline ASN, anticipatory ASN, and emergent ASN. Research Method/Design: Forty-four survivors of stroke answered questionnaires assessing offline and online self-awareness of spatial problems. The online questionnaire was asked immediately before and after each of 4 tests for spatial neglect, including shape cancellation, address and sentence copying, telephone dialing, and indented paragraph reading. Results: Participants were certain they had difficulties in daily spatial tasks (offline awareness), in the task they were about to perform (anticipatory awareness) and had just performed (emergent awareness). Nonetheless, they consistently overestimated their spatial abilities, indicating ASN. Offline and online ASN appeared independent. Online ASN improved after task execution. Neglect severity was not positively correlated with offline ASN. Greater neglect severity correlated with both greater anticipatory and emergent ASN. Regardless of neglect severity, we found task-specific differences in emergent ASN but not in anticipatory ASN. Conclusions/Implications: Individuals with spatial neglect acknowledge their spatial difficulty (certainty of error occurrence) but may not necessarily recognize the extent of their difficulty (accuracy of error estimation). Our findings suggest that offline and online ASN are independent. A potential implication from the study is that familiar and challenging tasks may facilitate emergence of self-awareness.

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