Behavioral Inattention Test

Purpose

The BIT is a comprehensive battery designed to screen for unilateral visual neglect and provide information relevant to its treatment.

Link to Instrument

Instrument Details

Acronym BIT

Area of Assessment

Vision & Perception

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$280.00

Diagnosis/Conditions

Stroke Recovery

Stroke

Divided into 2 subtests:
1) Conventional
2) Behavioral
BIT Conventional subtest (BITC) consists of 6 items:
1) Line crossing
2) Letter cancellation
3) Star cancellation
4) Figure and shape copying
5) Line bisection
6) Representational drawing
BIT Behavioral subtest (BITB) consists of 9 items:
1) Pre-scanning
2) Phone dialing
3) Menu reading
4) Article reading
5) Telling and setting the time
6) Coin sorting
7) Address and sentence copying
8) Map navigation
9) Card sorting
Total and subscores are obtained by adding the subtests scores together.
Maximum scores:
1) BIT = 227
2) BITC = 146
3) BITB = 81
Lower scores are indicative of more severe visual impairment.

Number of Items

BITC: 6
BITB: 9

BITC and BTIB Forms
Photographs of: A meal, A wash-basin and toiletries, A large room with pieces of furniture and hospital aids, Different settings of a digital clock
Open-out menu
Analogue clock
Six different types of coins
Playing cards
Paper and pencil

40 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

ICF Domain

Body Function

Measurement Domain

Sensory

Considerations

Cost of the test is approximately $280 dollars.

Behavioral Inattention Test translation:
Spanish: http://www.funveca.org/revista/PDFespanol/1998/art04.3.06.pdf

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Cut-Off Scores

Cut-Off Scores: (Halligan et al, 1991; Menon & Korner-Bitensky, 2004)

Indicating the presence of spatial neglect:

- BITC < than 129
- BITB < than 67
- BIT < than 196

Test/Retest Reliability

Stroke & Healthy Normals: (Wilson et al, 1987, n = 28 stroke and 14 non stroke patients; mean age (patients) = 54.29 (8.82) years; time since stroke = 12.25 (20.06) days)

Excellent test-retest reliability (r = 0.83)

Acute Stroke: (Halligan et al, 1991, n = 80; mean age = 56.2 (10.5) years; average time since stroke = 2 months)

Excellent test-retest reliability (r = 0.89 BITC; r = 0.97 BITB)

Interrater/Intrarater Reliability

Acute Stroke: (Halligan et al, 1991):

Excellent inter-rater reliability (r = 0.99 BITC; r = 0.99 BITB)

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Jehkonen et al, 2000, n = 57, mean age = 63.23 (10.21) years, examined within 10 days of stroke)

Excellent predictor of poor functional outcomes
- Results accounted for 73%, 64% and 61% of the total variance of the Frenchay Activity Index at 3, 6 and 12 months respectively

Construct Validity

Acute Stroke: (Halligan et al, 1991; Cassidy et al, 1999)

Excellent to adequate convergent validity with:
- Occupational Therapist Checklist (r = -0.65)
- Rivermead Activities of Daily Living Assessment (r = 0.55)
- Barthel Index (r = 0.64)

Content Validity

Test development: (Wilson et al, 1987)

Interviewed clients with stroke about everyday difficulties
Retrieved information from published cases, behavioral observation of patients with neglect, as well as from discussions with occupational therapists, physiotherapists, clinical psychologists, and neurologists, all of whom had worked with patients with visual neglect.
Final selection of items was determined based on results of a pilot study

Bibliography

Cassidy, T., Bruce, D., et al. (1999). "The association of visual field deficits and visuo-spatial neglect in acute right-hemisphere stroke patients." Age and Ageing 28(3): 257. Find it on PubMed

Halligan, P., Cockburn, J., et al. (1991). "The behavioural assessment of visual neglect." Neuropsychological Rehabilitation 1(1): 5-32.

Jehkonen, M., Ahonen, J. P., et al. (2000). "Visual neglect as a predictor of functional outcome one year after stroke." Acta Neurol Scand 101: 195-201. Find it on PubMed

Menon, A. and Korner-Bitensky, N. (2004). "Evaluating unilateral spatial neglect post stroke: working your way through the maze of assessment choices." Top Stroke Rehabil 11: 41-66. Find it on PubMed

Wilson, B., Cockburn, J., et al. (1987). "Development of a behavioral test of visuospatial neglect." Arch Phys Med Rehabil 68: 98-9102. Find it on PubMed