Dear Dr. Vasyura,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

The manuscript presents an interesting and potentially impactful contribution to the assessment of spatial neglect using a computer-based dual-task paradigm. The results were considered to be of both scientific and clinical interest by the reviewers.

However, following evaluation by three experts, several critical issues were identified—particularly with regard to the clarity and completeness of the sample characterization and the methodological description of the task. Specific concerns were raised regarding the detailed reporting of patient characteristics, the operationalization of diagnostic criteria, and the transparency of the task’s implementation and statistical analyses. In addition, questions emerged concerning the novelty of the method in relation to previous work, which should be adequately credited, as well as some theoretical and interpretative aspects of the findings.

Despite these concerns, both the manuscript and the results were regarded as valuable. I therefore invite you to carefully address the points raised by the reviewers and to resubmit a thoroughly revised version of your manuscript for further consideration.

==============================

Please submit your revised manuscript by Jul 07 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: The authors describe the validation of a test capable to assist in the diagnosis and rehabilitation of spatial neglect. The test has been administered to a large cohort of right-hemisphere stroke patients. The method leverages on the presentation of lateralized visual stimuli, which are presented at different eccentricities and possibly the lower/upper visual field. Additionally, the paradigm includes a visual dual-task: patients are asked to report a digit presented at fixation, which is known to increase the sensitivity to lateralized biases. The test has been confirmed to be sensitive to attentional biases and capable to highlight altitudinal neglect.

Overall, the topic is not entirely new. However, it bears tremendous clinical importance.

In my reading of the paper I found the task extremely similar to that described by Bonato et al. (2010, neuropsychologia). So where does the name “keen eye method” comes from? Are the authors building on previous methods called “keen eye” (not referenced) or suggesting their own? Bonato and colleagues are otherwise duly cited, including a recent preprint (now published in Communications Biology) which appears to have inspired many passages in the introduction.

My main issue with this manuscript lies in the fact that many aspects are not duly reported. In particular, the sample of patients is not described in several core clinical features. Are the patients tested in the acute, subacute, or chronic stage? This matters a lot. It would be also useful to add information about the different etiologies (i.e., the proportion of ischemic vs hemorrhagic strokes).

Importantly, the behavioral assessment leading to the diagnosis is not properly detailed as well. Later in the text it seems that both the Albert and Bells test were administered, though it remains unclear which one served the reach the diagnosis. Luria’s seminal work is referenced when mentioning that “a preliminary comprehensive neuropsychological examination to assess higher mental functions [72], as well as standardized quantitative assessments of visual neglect”. These standardized tests are what is used to assess convergence and criterion validity, which is why it is very important that all these tests are duly referenced and described early in the text for the benefit of the readers.

Other important points, in no particular order.

“Approbation” does not strike me to be a standard term. Consider revising the title and abstract to reflect the content of the paper.

Task parameters are given in terms of centimeters from the screen. Since it appears that there may be variability in the equipment used (different screen sizes and OS are mentioned), and the distance of the patients from the screen is not reported, I would advise to use degrees of visual angle as well.

Several measures in the statistical analyses are not defined or lack details: gini index, precision, recall, F1 score, all should be briefly defined for the readers. The crossvalidation setup is not explicit: how many folds were used? Which measure was used to evaluate cv performance?

Figure captions could be more descriptive. For example, figures 4,5,6 report the decision tree from three different models, but it is not spelled out the specificity of each. It would be useful to have reported the starting variables and the models’ goals (e.g., to maximize specificity) in the captions as well.

The authors write “The Keen Eye method identified LSB ≥ 12 as the threshold for diagnosing neglect, as determined by the classification tree method.” However, Figure 5 reports LSB <14. Please clarify.

As the authors acknowledge, one limitation is that the test can be long and tiring. Can the authors identify a subset of the original positions on screen such that enough sensitivity for the diagnosis is given, but with fewer trials? For example, would it be enough to administer the most eccentric positions in both the lower and upper visual fields?

Only dual-task conditions were administered. Do the authors consider useful to administer conditions without additional demands, that is a purely spatial task? For example, the authors suggest that the paradigm could be more sensitive, and identify as neglect more patients than the conventional testing. Would these patients show difficulties without multitasking? Would the definition of the clusters change when the original variables also include single task conditions?

Reviewer #2: The manuscript presents a relevant contribution to the assessment of visual neglect using a computer-based dual-task paradigm. The rationale is well grounded, and the proposed method has the potential to improve diagnostic sensitivity in both clinical and subclinical populations.

However, there are some theoretical and methodological aspects that would benefit from clarification or further elaboration. Below are specific comments and suggestions aimed at improving the clarity, rigor, and interpretability of the study.

Lines 128-129: Consider clarifying that Lavie’s Load Theory distinguishes between perceptual load and cognitive load in attentional processing. Specifically, under high perceptual load, attentional resources are fully occupied by task-relevant stimuli, thereby reducing the processing of irrelevant distractors. In contrast, under high cognitive load, top-down control may be weakened, potentially leading to increased distractor interference.

Lines 163-165: Consider adding that computer-based tasks represent a more promising method for quantifying patients’ performance for several reasons beyond the nature of the tasks themselves. First, they allow for the brief presentation of stimuli and the recording of response latencies with millisecond precision. This makes it possible to detect not only overt failures in processing contralesional space, but also subtle delays in spatial processing. Second, computerized tests can be tailored to the individual’s performance level using adaptive procedures and adjusting parameters such as stimulus duration, contrast, or spatial location until a performance threshold is reached. This reduces the risk of ceiling effects and learning effects. Furthermore, as the authors note, computerized settings facilitate the creation of tasks that engage different levels of attentional resources, up to full resource deployment under the most demanding conditions. While such attentional load can theoretically be induced even without computers, computerized implementation ensures better control, thereby enhancing diagnostic sensitivity and reproducibility.

Consider adding, at the end of the Introduction, a concise overview of the experimental method along with a clear statement of the main hypotheses. This would enhance the logical flow between the theoretical background and the empirical section of the paper. In particular, it would be helpful to briefly justify the choice of the primary task and explain why that specific secondary task was selected to manipulate attentional load.

Lines 182-189: Please clarify how the diagnosis of visual neglect was established in the VN group. It would be important to specify which specific neuropsychological tests were used. In addition, if available, please indicate how right hemisphere damage was confirmed—was neuroimaging (e.g., MRI, CT scan) performed, and were lesion locations documented or analyzed? Furthermore, consider reporting the etiology of the brain lesions (e.g., ischemic or hemorrhagic stroke, tumor), as this information is essential to fully characterize the sample.

Lines 201-206 and lines 229-230: Consider specifying in detail how many an what types of devices were used in administering the task. It is also important to indicate whether participants were seated at a fixed viewing distance from the screen, and if so, how this distance was controlled (e.g., using a chinrest, visual markers, or standardized instructions). Given that the task involves peripheral stimulus localization, variations in screen characteristics or viewing distance could significantly alter the visual angle and perceived eccentricity of stimuli, thereby impacting the task’s diagnostic validity. Providing this information would improve methodological transparency and support replicability across different research and clinical contexts.

Lines 236-240: It would be helpful to clarify how the number of trials was determined. Was this based on previous literature, pilot testing, or a formal power analysis? Given that the number of trials affects both the sensitivity of the task and the potential for participant fatigue, providing a rationale for this choice would strengthen the methodological rigor of the study.

Lines 207-216: In my view, it is important to note that a single-task condition was not included in the study design. Including such a baseline condition would have been usefull to isolate the specific effect of increased attentional load on spatial processing performance. A direct comparison between single-task and dual-task performance would have provided stronger evidence that the observed deficits emerge specifically under multitasking demands.

Lines 236-240: Currently, bilateral targets are only presented in spatially symmetrical positions. While this ensures experimental control, it may limit the ecological validity and diagnostic sensitivity of the task. Consider discussing the possibility of including asymmetrical bilateral target configurations in future versions of the method. Such arrangements could help assess the influence of spatial competition under less predictable and more naturalistic conditions, potentially revealing more subtle forms of extinction or residual neglect.

Lines 318-320: If the control group consists of the 64 patients who did not exhibit visual neglect, please specify this explicitly in the text.

Lines 479-481: Consider citing this recent study: https://doi.org/10.1038/s41598-025-95717-0

It shows that increased attentional load affects visual processing in healthy individuals, but without inducing the kind of spatial asymmetries typically observed in patients with neglect. This supports the idea that the asymmetrical effects under high attentional load are pathological rather than task-induced, and would strengthen the theoretical framework of your discussion.

Reviewer #3: In a relatively large group study with right hemisphere damaged neurological patients authors tested a computer-based method for detecting omissions of lateralized targets. Overall the method seems to have successfully detected contralesional omissions in the group of neglect patients. My main criticisms are related to the very close resemblance with previous studies and to the ambiguity in diagnostic criteria, in the analysis and in the purpose of the study.

MAIN

1) The logic behind the method as well as its implementation are very close if not almost identical to the methods that have been developed by the research group in Padova for the past 15 years (starting from Bonato et al., Neuropsychologia 2010 and Neuropsychology 2012). The resemblance is striking with respect to all aspects of the study as it includes the presence of a visual dual-task with a central digit to be reported along with lateralized targets (ipsi, contra or bilateral) whose detection accuracy is the dependent variable. The similarity extends to the clustering logic and to the interpretation in terms of compensatory strategies. While authors fully acknowledge previous studies the fact that their approach is virtually a replication of these previous studies should in my view be made explicit in the background section as well as for all the relevant sections with high resemblance (methods, analysis, discussion). Although to a lesser extent, also the idea of providing a name for the testing somehow clashes with the idea that the same method has been described in about ten previous papers and seems to result in indirect shadowing of previous studies. The aspects of novelty seem to be related to the spatial uncertainty and to the possibility to test together vertical and horizontal but paradoxically these new features are not tested explicitly nor emphasized much.

2) As for the availability of the data, many crucial aspects are missing including the etiology of the lesions (vascular only?) time from stroke and, most important, a clear operationalized set of criteria for neglect diagnosis. There is reference to two paper and pencil tests but these data are not reported nor it is clear whether all patients underwent testing with these two tests (only). More specifically, was the diagnosis for left neglect, for right neglect or for altitudinal neglect ?

3) As for the digital task, there is no indication about whether a response to the central digit was performed. If yes the handling of wrong responses should be described. If no, the ratio should be made explicit.

4) The ultimate aim of the study seems to be missing. The text refers multiple times to “high diagnostic accuracy” but this concept does not seem to have been fully operationalized. I think it would be clearer to explicitly diagnostic criteria for the different approaches (clinical vs computer based). Moreover, the task does not include a single task condition and therefore does not allow quantifying the effect of multitasking: From this point of view the statement about the presence of general impairments seems a bit far-fetched.

5) Strictly speaking LSB is an index of extinction not of neglect, and ideally should be corrected with respect to LSU. It is acceptable to keep it the way it is but this limitation should be spelled out.

6) Considering the presence of several tests (supplementary materials) I think it would be better to explicity focus on the idea that neglect from many points of view can be conceived within a continuum of omissions.

7) There are several acronyms (about 10). Due to their presence Table 3 is very difficult if not impossible to be understood. The full dataset seems full of relevant information yet the current format of table and the graphs do not seem to allow fully appreciate this info. Finally (Again in Table 3) variables 1 to 14, denoting the different positions, could be made more easy to visualize if ordered left to right.

8) Something I really couldn’t understand is the reason why positions 1,2, and 3 did not result in more omissions than positions 8, 9 and 10. For the maximal lateralization a clear disadvantage for left targets should be present. Overall, for positions 1 to 14 no clear lateralized pattern seems to be visible (a graph would help). This clashes with the conclusions and with the outcome of the clustering. Is this confusion due to the presence of trials with two targets ? From the image it seems as if there were 25 different combinations and I therefore wonder why not using all of them or, in alternative, cluster for left vs right low vs high eccentricity.

9) Clustering: at behavioural it seems unclear which are the variables better predicting neglect. The outcome of the clustering allows to refine the diagnostic threshold to converge more or less closely with the diagnosis of the clinician. Yet I see a circularity issue: if the diagnosis is based on the outcome in paper and pencil tests the outcome which is correctly predicted is exactly what we would like to avoid due to their low sensitivity. As already mentioned, the lack of criteria for describing neglect makes any reference in terms of sensitivity to the paper and pencil tests difficult to be understood.

10) The supplementary file contains a wealth of information yet several variables are not explained.

MINOR

One paper very similar to the present one is this:

https://www.nature.com/articles/s42003-025-08074-z

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: ReviewerComments.docx

Dear Dr. Vasyura,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Thank you very much for your thorough revision of the manuscript and for addressing most of the reviewers’ concerns. The revised version has been positively evaluated, and the overall strength of the study is considered significantly improved.

However, one of the reviewers has identified a remaining major issue, as well as several minor points, that should still be addressed before the manuscript can be considered further.

==============================

Please submit your revised manuscript by Oct 03 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Giulio Contemori, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

Reviewer #1: As far as my points are concerned, I think that the authors responded very well. I would endorse this paper for publication.

Only one minor note for the authors:

Please consider revising the title again: I don’t think it is necessary to specify “in dual-task paradigm” since this is what the Keen eye method is, but if you really want to keep it consider adding an article as in “in A dual-task paradigm” or perhaps “using a dual-task paradigm”.

Best wishes

Reviewer #2: I thank the authors for their thorough and thoughtful revisions. All my previous comments have been addressed in a satisfactory manner, and the manuscript has been significantly improved.

One additional recommendation concerns the use of the term "diagnostic". While the Keen Eye method shows promising classification accuracy based on data-driven thresholds, I would advise caution in referring to it as a "diagnostic tool" in a strict clinical sense, at least until standardization procedures (e.g., normative scoring based on healthy or diverse clinical populations) are completed. A brief clarification of this point in the Discussion would be appropriate and would strengthen the positioning of the method as a potentially diagnostic instrument, pending further validation.

In summary, I have no further mandatory requests. I support the publication of this manuscript, with the optional recommendation above.

Reviewer #3: I thank the authors for having revised the manuscript according to my comments. While I think the strength of this interesting study is significantly improved I also noticed the interpretation of the findings seems to be still ambiguous. I better detail below this only major point remaining (point 4. of previous review) which in my view needs to be addressed by both the framing of the study as well as by describing and interpreting the data better.

Framing: Authors explicitly mention the clinical use of the task and should be commended in case their choice is to provide it openly to the neuropsychological community. Yet, expanding on point 4. of the first revision it still seems rather unclear whether the final aim is to achieve the same sensitivity of standard tests (paper and pencil + CBS) or whether this computer-based approach can result in different/better sensitivity. This is crucial as someone might claim that trying to replicate the (low) diagnostic sensitivity characterizing paper and pencil tests is not an optimal objective. I suggest that the reference to this aspect should be more explicit and I also suggest explaining more in depth what the task is actually measuring. This seems mandatory also when considering the very peculiar spatial distribution of omissions (Fig. 4), which seem to be more ipsilesional than contralesional.

Data description and interpretation: From the above mentioned point of view It would be clearer if the % of ipsi vs contra lesional omissions for graphs 5 would be spelled out. I would rather tend to think that the peculiar asymmetry described which favour the contralesional hemispace is due to compensation. I might be wrong but it seems prominent in patients classified as being without VN. For reference about the spatial distribution of ipsilesional omissions at different ipsilesional eccentricities authors might want to consult the study with ipsilesional targets presented with low and high eccentricity by Bonato, Romeo et al., 2019 (Frontiers). Also the asymmetries represented in figure 6 should be in my view described as indexing a bias towards ipsi or contralesional space (now this crucial aspect is not clear, in particular when considering figure 4).

MINOR

The description of the analysis is sometimes a bit more difficult than the standard. I suggest explaining the rationale/meaning more explicitly. The comprehension seems sometimes difficult also because the amount of acronyms is still overwhelming.

I suggest avoiding colloquial terms like “skeleton” for describing the spatial distribution of attention.

For neuropsychological standards the sample is rather wide, I would emphasize this strength better.

In the abstract as well as in the text target positions are referred to as “fixed”. I suggest avoiding this term as it can be easily misunderstood. Rather, I would better emphasize that the position of appearance was variable… and eventually (but in the methods only) that the targets appeared in a fixed order. The random (fixed) position of appearance is a major strength of this study along with the vertical measure. I would highlight it better as spatial uncertainty might trigger interesting mechanisms including the one I see here resulting in better contralesional performance (was this statistically tested?) which I interpret as compensatory.

I suggest checking for typos and grammatical errors.

**********

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

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Dear Dr. Vasyura,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

Only some minor adjustments required.

==============================

Please submit your revised manuscript by Oct 29 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Giulio Contemori, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

Reviewer #1: I have assessed the differences introduced in the last review round to the best of my possibilities and think that the results are sound. I commend the authors for self-correcting their work.

Reviewer #2: All my previous comments have been addressed in a satisfactory manner and I would endorse this paper for publication.

Reviewer #3: I am happy to read that my comments on the atypical spatial distribution of omissions eventually led to discover and correct an error in the data coding. Now results in general and more specifically graph 4 makes much more sense and also the rationale seems more convincing.

Some minor and final comments starting from graphs:

I could not find figure captions and therefore the values represented by the histogram seem a bit obscure. (Figure 4) Is the black line a median/average value ? Is so, does the histogram represent (Yaxis) “percentage of maximum omissions” i.e. the worst individual performance for that location ? If so please be explicit as it seems a non-standard statistic to report.

Ipsilesional omissions: I no longer see the need to discuss in depth this aspect unless there is a significant difference (maybe I missed it). My request to tackle this issue was related to the previous pattern. Now that data have been recoded and ipsilesional omissions are not particularly evident I would avoid insisting on this topic. More specifically, the lack of a control group of healthy participants does not allow to conclude much. If anything, I would instead discuss more in depth the contralesional omissions found in the N- group, as that is a result of great clinical importance.

I would also consider calling the current “control group” something more informative like “patients without neglect diagnosis”. Regardless on the specific collective name I would avoid referring to them as “control participants” as the readers might think they were healthy controls.

Signed

M Bonato

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Validation of the Keen Eye computer-based method for diagnosing visual neglect using a dual-task paradigm

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