Psychological assessment through digital tool has transformed the way psychologist use and explain data. Among neglect assessment tool, an example is given by the E-BTT, a technology enhanced version of an ecological task, the Baking Tray Task. Thanks to an artificial vision module, it is possible to detect the spatial coordinates of the sixteen disks placed and their temporal order, so that the whole sequence can be recreated. In this paper, a focus on the new suggestions of data analysis for this data is provided. Then, a new tool will be proposed: an analyst able to automatically compute spatial and quality indexes. E-TAN ANALYST would be a boost to spatio-temporal sequences analysis, allowing ipsative and normative comparisons.
In the last decades, the increasing application of digital tools to psychological assessment has stimulated a shift of perspective for psychologists. Technological enhancement can be very useful in every step of cognitive evaluation, from automated scoring to online administration platform. Thus, it unveils new possibilities of data coding and analysis.
As for the assessment of spatial neglect, some widely used tests witnessed the transition from
paperand-pencil to digital tools [
To give an example of digital administration of a well-known task, it can be cited the developing of
an open-source software for the administration of the cancellation task: CancellationTools [
Dalmaijer and colleagues [
As regards the data analysis, the author included several quantitative measures from cancellation literature and completed them with others they have developed. These measures can be divided in three categories: biases in spatial attention (omissions, revisits, centre of cancellation, first marking), measure of search organization (standardized inter-cancellation distance, intersection rate, best R, standardized angle) and of general performance (timing, search speed, quality of search). For the explanations and calculation algorithms of each index, please refer to Dalmaijer and colleagues. What was important to underline was how the transition from analogical to digital allowed the collection of complex data and thus stimulated new ideas on how to use them.
Another example we would focus on in this paper is the Baking Tray Task (BTT) [
BTT is easy to administer and proved to be sensitive in diagnosing neglect, especially when
combined with other batteries [
In recent years, BTT was enhanced thanks to a technological improvement by Cerrato and colleagues
[
Therefore, the hardware part is composed by:
• Modular 60x45 cm wooden frame. For practical reasons, a reduced area was preferred, considering
that also Tham and Tégner used a smaller tray [
ArUco marker tags [
Summing up, through E-TAN it is possible to administer a new version of BTT (from now on,
EBTT), using the same procedure of Tham and Tégner [
Another innovation was represented by the online database which the software is synchronized to. This could allow the storage of potentially a great amount of data from different research teams. Once created an account, the user can download the .csv file containing all E-BTT and other tasks information connected to that account.
The data collected are then: • Sixteen pairs of coordinates (in pixel); • The sequence, frame by frame, of each “step”, that is when the software correctly detected a disk; • The timestamp of each disk.
The digital enhancement of the BTT allows now to carry out a more in-depth performance evaluation, not only counting the number of disks in one half or in the other, but also recreating the user’s temporal sequence. In other words, it is now possible to study how the user has processed the available space and which strategy (if any) has been used to complete the task.
The number of studies analysing the new E-BTT data is still limited, as the final version is very
recent [
As in the original BTT, a first, simple analysis Cerrato and colleagues performed was to count how
many disks were placed on the left and how many disks on right part of the space [
Moreover, the area available can be divided in quadrants, in order to study how the exploration started and ended. The quadrant analysis through Pearson’s Chi Square was carried out on the first and the last disk’s quadrant [12]. As for the beginning of disks placement, a preference for the upper part of the space was highlighted, while the sixteenth disk was usually placed in the bottom right quadrant. Similarly, Somma [13] and colleagues found out the trend to place the first disk in the upper left quadrant. Moreover, this study proposed to study pseudoneglect with the E-BTT. Pseudoneglect is the tendency to start spatial exploration slightly from the left [14] in several spatial task, like line bisection. This bias was found also in E-BTT [13], analysing the first disk’s X coordinate and the mean of all disks’ X coordinates.
E-BTT gives the possibility to recreate the disks’ sequence, as said before. In one study was then performed a trajectory clustering analysis to find homogeneous clusters of strategies [15], in a sample of healthy undergraduate students. Three distinct groups emerged: a group in which subjects followed no clear plan; a second group which started from the right side and then went to the left; a third group of participants who tended to start from the left side.
Using the sequence described by the disks’ positions, it was also possible to analyse the portion of
the convex hull area delimitated by them [
More recently, the spatial sequences resulting from the E-BTT were analysed through Euclidean Distances, calculated in two different ways [16]: between two different configurations (BD) and within the same configuration (WD). While BD proved to be useful to detect different groups of patterns, WD discriminated between organized and disorganized configurations.
As previously mentioned, there has been a gradual transition from pen and paper to digital in the administration and personalization of cancellation tasks. Again, this provided scholars with new and richer information, like for example, reaction times. Starting from the coordinates of each sign and considering the path that goes from the first to the last of these marks, it was therefore possible to develop some indexes [17, 18]. These studies focused on visual search and its organization in patient with right hemisphere damage. Some author related a disorganized visual search to neglect deficits, but the issue is still controversial [17].
The use of these visual search organization indexes could be an interesting inspiration for the EBTT data. Despite the differences with the cancellation task, the result of the E-BTT task consists of a series of coordinates too. This would allow us to hypothesize that these indexes used in literature can also be applied to the case of E-BTT. So far, spatiality (in particular laterality) was the only dimension to be investigated, through the analysis of the right-left asymmetry or the pseudoneglect. This was of course due to the original goal of the BTT task, the assessment of unilateral neglect. However, extending this horizon also to healthy subjects with the aim of studying neurotypical spatial cognition, it would be interesting to pay attention to this new construct as well.
Our goal was initially to look for visual search indexes in cancellation studies. These measures were brought together with the ones already used and some new calculations, inspired by the new information available. This work led to a long list of old and new indexes to be applied in future E-BTT research.
On this list, a first classification could be made between spatial indexes and quality indexes. The spatial indexes summarized where the disks have been arranged and are in turn divided into laterality (if calculated on the X coordinates) or verticality (calculated on the Y coordinates). The quality indexes, on the other hand, inform on how the disks were placed and therefore the organization of the spatial sequence. A short sample of these indexes is summarized in Table 1.
These measures would be very helpful in spreading a new light on spatial cognition studies. Not to mention that ensuring cut-offs that distinguishes between patients and healthy subjects would support clinician’s work.
Table 1
analysis2
2 The quadrant analysis cannot be strictly considered an index. Nonetheless, it was included as an important measure of disks placement tendency.
First disk’s X coordinate First disk’s Y coordinate
occupied by the convex hull delimited by the disks
3.1.
Starting from these indexes, it is possible to imagine a digital tool that uses the cloud database and calculate them. This paragraph, therefore, will present the proposal for the design and then implementation of an application for the analysis of spatial and temporal data of the E-BTT: E-TAN ANALYST.
This need arises from the evidence that the calculation of the spatial and quality indexes mentioned above requires a considerable workload. It would certainly be a plus to have a tool capable of automatically calculating each index. Furthermore, in order to develop the potential of the database, that is to collect a large number of different sessions - potentially from different research groups - it will also be possible to develop a data dashboard able to show the distributions of the indexes as a function of the variables of interest.
In figure 2 we show a general overview of the software system.
Furthermore, E-TAN ANALYST means to be a data analysis app designed in order to have the elaborations of the individual sessions available, providing normative and ipsative assessment. Thanks to an authentication system, it will be possible to access one’s analysis profile, or to create an account. The analysis can be carried out both on local data, uploading them from time to time; or by synchronizing the account with the cloud database. All sessions recorded in E-TAN will then be available, obviously divided by Id and type of task. At the time of the analysis, the user will be asked what type of processing they prefer (plot, spatial indexes and quality indexes) and if they prefer to download or view it in the main dashboard.
Here it will be possible to have an exhaustive summary of the measures for the specific session, as well as to make ipsative comparisons, with the past sessions of the same patient, or normative, comparing them with the aggregate data of the online database.
The application will preferably be developed with STELT, a software platform created by SMARTED s.r.l. [19]. STELT (Smart Technologies to Enhance Learning and Teaching) responds to the need for providing support to psychologists, educators, trainers and teachers. It is a very versatile platform, able to integrate with other programming languages thanks to its set of libraries. STELT has already been used with various learning applications, thanks above all to the possibility of creating an environment for gamification of tasks and the possibility of integrating the implementation of augmented reality systems with tangible interfaces.
Summing up, the prototype of E-TAN ANALYST could represent the possibility to establish a standardized procedure of data treatment and analysis for the E-BTT task. 3 Verticality indexes are specular to laterality ones. Note that there is no reference about them. This is because verticality has not been explored in these tasks, yet.
In this paper, new possibilities of data analysis for the spatio-temporal data from E-BTT task were explored. Some indexes were already used in classical BTT, mostly laterality ones. We proposed to complement them with verticality measure, calculated in the same way. Moreover, inspired by the visual search studies, other kinds of indexes were considered: quality indexes. Further validation and reflections about the use of these indexes will be needed, though. In particular, the structure we proposed in this paper should be verified through a Principal Component Analysis (PCA). Future studies will aim to that goal.
Once the use of these indexes would be well defined, they will be implemented in a software, ETAN ANALYST, able to compute those measure automatically. This application would have the goal of analysing the E-TAN database data (or uploading them manually), giving scholars and clinician a standardized procedure of data analysis for this particular task.
Having a standardized data analysis protocol available would make it possible to fully exploit the potential of E-BTT. As it was designed, the E-BTT uses tangible interfaces to study the arrangement of objects in space. Moreover, thanks to the application of some indexes such as those of quality, it would also be possible to study the representation of the peri-personal space and the construction of cognitive maps.
These processes are obviously active and embodied in action, so that it was suggested that place cells activation depends not just on movement itself, but on the active role the animal (or the robot) has in the space [20]. Indeed, place cells were implied in building cognitive maps and their activation was selective to target area only when the subject was free to explore. Therefore, the selection of salient stimuli made by the agent is fundamental in these processes.
Summing up, the use of digital tools in psychological assessment and data analysis may have implication in our current understanding of spatial cognition.
The first author’s PhD scholarship has been supported by Programma Operativo Complementare Ricerca e Innovazione 2014-2020, funded by Italian Ministry for University and Research. This research was also funded by Programma per il Finanziamento della Ricerca di Ateneo (FRA), ASIA project.
For the remarkable work done at NAC laboratory, authors would like to thank Antonio Cerrato.
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