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October 15, 2015: Eastchester Clapping Sign

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October 15, 2015

Eastchester Clapping Sign

What would happen if a patient with hemi-neglect clapped his or her hands? This question was asked by AP psychology students at Eastchester High School, which led to the development of the Eastchester Clapping Sign (ECS). This is a bedside tool that helps to detect hemispatial neglect, even in the presence of weakness in the same limb. The distinction between weakness and neglect can be challenging to assess rapidly, as the lack of spontaneity associated with neglecting one side of the body can be mistaken for motor weakness. Using the ECS, patients with neglect clap using one hand and abruptly stop at the midline of their body, whereas patients with isolated motor weakness will reach across the midline to clap against their paralyzed hand. In a small descriptive study of 14 patients with hemispatial neglect and positive ECS1, all the patients either had a stroke or diminished cerebral perfusion involving the non-dominant parietal cortex.

  1. Ostrow LW, Llinás RH. Eastchester Clapping Sign: A novel test of parietal neglect. Annals of Neurology 2009; 66: 114-117.

Submitted by Behzad Elahi, MD, PhD, Tufts Medical Center, Department of Neurology, Boston, MA, PGY2 Adult Neurology Program.

Disclosures: Dr. Elahi reports no disclosures.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.

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