Computer recording of standard test of visual neglect in stroke patients

Objective: To determine whether a computer-based method for recording standardized assessment of neglect identifies abnormalities in the ‘process’ as well as in the ‘outcome’ of such tasks.

Design: Prospective sequential assessment of patients admitted to a stroke rehabilitation unit.

Subjects: All consecutive patients with right-sided cerebrovascular accident confirmed on computerized tomography (CT) scan including 30 patients with neglect, 57 patients without neglect. An age-matched control group of 13 subjects.

Intervention: All patients were tested using the standard Rivermead Behavioural Inattention Test (BIT) and by computer recording of two standard tests for assessing neglect (line bisection and Albert's test). Age-matched controls were tested using computer recording of the two standard tests.

Main outcome measures: Neglect was defined using the BIT with a cut-off score of 129. Computer recording measured the ‘outcome’ of tasks, i.e. the deviation from midline and omissions in cancellation, as well as the ‘process’ of tasks, i.e. time between cancellations, components of cancellation time including premovement, movement and drawing time, and the starting point for cancellation.

Results: The computer recording identified significant differences in ‘outcome’ and ‘process’ which distinguished neglect from non-neglect patients. There were significant differences between non-neglect patients and age-matched controls with regard to ‘process’ measures but not with regard to ‘outcome’ measures.

Conclusions: Computer recording of standard tests for assessing neglect identifies novel impairments with regard to the process of carrying out tasks. These impairments may be used to investigate changes in neglect with time, the response of neglect to treatment and to explore further the neuropsychological changes associated with neglect in stroke patients.