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Standardized Link's Probe (SLP)
Availability
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Classification
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
Description:  
The SLP asks patients to construct a single large cube by assembling 27 small cubes in such a manner that only the painted surfaces of the small cubes are visible. Metzler's variant of the SLP includes 10 behavior ratings to be made by the examiner for various aspects of the examinee's performance.
 
The SLP was standardized using a sample of 220 healthy control subjects aged between 14 and 60 years, considering the influences of age, gender, and education. The SLP was validated in n=69 patients with head trauma and cerebro-vascular diseases with 84% of those patients generating deficient results. Compared to patients with left frontal lesions, patients with right frontal lesions show significantly more difficulties in the SLP as when using the Wisconsin Card Sorting Test (WCST).
 
Purpose:  
The SLP assesses problem solving, identification of sub-goals, and planning abilities in adults as well as in adolescents and is relatively independent of educational levels. The task consists of several small cubes with partially colored sides that need to be arranged into one big 3-dimensional cube with a uniform external coloring. The task duration time is approximately 10 to 15 minutes. There are 10 areas assessed, each awarded 0 (failure) to maximally 3 points (achievement of sub-goal).
Comments
Naming and origin:  
The SLP is also known as Link’s cube test (LCT). Henry Charles Link (1889–1952) was a psychologist and the author of a book which was entitled Employment Psychology—The Application of Scientific Methods to the Selection, Training, and Rating of Employees. He described the cube test in Chapter XI (entitled Apprentice tool makers and machinists, pp. 123–129) of this book: “The cube test consists of a three-inch cube, painted in green on the outside. The cube is cut into 27 one-inch cubes. The large cube is placed before the subject and he is told that it will be demolished into 27 small cubes and that he must restore them so that the large cube looks exactly as it did before, viz., green on all sides with no wood color exposed.” (p. 124) Metzler's variant of the LCT was substantially based on his professional experience in Luria's laboratory, who himself developed the test based on the original version.   
 
Reliability:
Internal consistency (Cronbach’s alpha) was 0.93 for the overall sample (n=327) and 0.84 for the normative sample (n=220). Inter-rater reliability was 0.98.
 
Execution time:  About 10-15 min, depending on the degree of impairment
Scoring
Scoring is standardized, taking into consideration 10 aspects that are each rated on a Likert scale ranging from 0 – 3 points. The main outcome variable is a total score of maximally 30 points, convertible into a T-score.
Rationale/Justification
Given the high incidence of frontal lesions following SAH due to intracerebral hemorrhage from anterior circulation aneurysms, aneurysm occlusion therapy, ventriculostomy or lesions secondary to delayed cerebral ischemia, careful evaluation of frontal lobe function is essential. The SLP is simple to administer and has shown to be highly sensitive in patients with frontal lobe lesions. It can be used as alternative or addition to the Wisconsin Card Sorting Test. The Swiss national standard of neuropsychological assessment after SAH includes the SLP.
References
Metzler P (2000) Standardisierte Link'sche Probe zur Beurteilung exekutiver Funktionen (SLP). Manual. Swets Test Services Frankfurt am Main.  
 
Kopp B, Rösser N, Tabeling S, Stürenburg HJ, de Haan B, Karnath HO, Wessel K. Disorganized behavior on Link's cube test is sensitive to right hemispheric frontal lobe damage in stroke patients. Front Hum Neurosci. 2014;8:79.  
 
Stienen MN, Zweifel-Zehnder AE, Chicherio M, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert R, Schatlo B, Bijlenga P, Schaller K, Monsch AU, on behalf of the Swiss SOS study group. Neuropsychological testing after aneurysmal subarachnoid hemorrhage. Swiss Medical Forum. 2015;15(48):1122–1127.  
 
Zweifel-Zehnder AE, Stienen MN, Chicherio C, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Fournier JY, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch AU; Swiss SOS study group. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir (Wien). 2015;157(9):1449–1458.
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