3 New Assessments for Evaluating Right Hemisphere Dysfunction

In the past decade, new and revised assessments for right hemisphere dysfunction have come into practice. These newer tests focus on affective and communicative components as well as unilateral neglect.

Comprehensive Affect Testing System (CATS)

This test compares individual emotion processing relative to normal populations. Here are the twelve subtests and what they aim to accomplish:

  1. Ekman 3-Faces Task– Looking at patient’s ability to recognize faces
  2. Identity Matching– Matching faces by identity
  3. Affect Matching– Matching faces by different affective states
  4. Affect Discrimination– Determining what a state is based on presentation of stimuli
  5. Affect Naming– Naming different affective states like happy, sad, etc.
  6. Prosody Identification– Identifying different tones of voice
  7. Prosody Naming– Naming different tones
  8. Non-emotional Prosody Discrimination– Distinguishes words that are spelled the same but pronounced differently in different contexts
  9. Emotional Prosody Discrimination– Distinguishing between how different emotions sound
  10. Match Emotional Prosody to Face– Match tone of voice to facial expression
  11. Match Emotional Face to Prosody– Matching facial emotions to tone of voice
  12. Conflicting Facial Emotion/Prosody (Respond to Face/Respond to Prosody)– Exposure to conflicting emotions and facial expressions, e.g. sarcasm

Diller-Weinberg Visual Ca­­ncellation Test

This test was designed to evaluate patients with mild unilateral spatial neglect who experience visual scanning and tracking problems. The test includes two scanning tasks, Single Stimuli and Double Stimuli. Single Stimuli features a single letter at the top of a page and a patient is asked to find it in the lines below. The Double Stimuli is the same test but with two letters at the top of the page.


The Rehabilitation Institute Chicago Evaluation of Communication Problems in Right Hemisphere Dysfunction (RICE – 3) consists of several different components and uses a points system rather than comparison to normal. It’s assumed a normal adult would complete all tests without error. The subtests also do not need to be used together, and should be selected based on your initial assessment of the patient.

Begin the RICE-3 with a conversation about a subject of interest and observe the patient. Once the sample of communication and discourse is taken, you can rate the patient on the Pragmatic Communication Scale components, including:

  • Intonation
  • Facial expression
  • Eye contact
  • Gestures and proxemics
  • Conversational initiations
  • Conversational turn taking
  • Topic maintenance/adherence
  • Response length
  • Presupposition
  • Referencing

Another subtest includes a writing assessment. Using a spontaneous writing sample, you can analyze the sentence organization, creation, and visuospatial letter spacing.

The final subtest scores a patient on their grasp of a metaphorical language. Patients need to thoroughly understand the meaning, use, and idea of a metaphor in order to provide a correct response. Incorrect responses include literal explanations and personal interpretations.

With these new clinical tools clinicians can quickly identify key deficits that warrant treatment.

New Research and Approaches

Also in the last decade, new evidence-based research has shed light on effective right hemisphere dysfunction treatments. For example, the lighthouse strategy is now recognized as an effective approach for visual scanning and tracking.

There are also some excellent treatment approaches for social-emotional skills and cognitive linguistic skills. These new approaches facilitate clinicians in setting measurable treatment goals and developing practical treatment materials to meet those goals.