Is the Posner Reaction Time Test More Accurate Than Clinical Tests in Detecting Left Neglect in Acute and Chronic Stroke?

Abstract

Objective To compare the accuracy of common clinical tests for left neglect with that of a computerized reaction time Posner test in a stroke population. Design Neglect measures were collected longitudinally in stroke patients at the acute (≈2wk) and chronic (≈9mo) stage. Identical measures were collected in a healthy control group. Setting Inpatient and outpatient rehabilitation. Participants Acute stroke patients (n=59) with left neglect, 30 of whom were tested longitudinally; healthy age-matched controls (n=30). Interventions Not applicable. Main Outcome Measures A receiver operating characteristic analysis, ranking the measures' sensitivity and specificity using a single summary statistic. Results Most clinical tests were adequately accurate at the acute stage, but many were near chance at the chronic stage. The Posner test was the most sensitive test at both stages, the most sensitive variable being the reaction time difference for detecting targets appearing on the left compared to the right side. Conclusions Computerized reaction time tests can be used to screen for subtle but potentially clinically relevant left neglect, which may not be detectable by conventional clinical tests, especially at the chronic stage. Such tests may be useful to assess the severity of the patients' deficits and provide more accurate measures of the degree of recovery in clinical trials than established clinical measures.

Computer-Based Attention-Demanding Testing Unveils Severe Neglect in Apparently Intact Patients

“…Thus, the assessment of contralesional spatial awareness deficits in the post-acute phase should not only rely on paper-and-pencil tests, in which patients can easily implement compensatory strategies. Computer-based testing seems to be an optimal solution for preventing these strategies and, thus, for increasing the sensitivity of assessment [7,8]. Nevertheless, computer-based testing is seldom, if ever, implemented for the diagnosis of neglect.…”

Oscar Marin and the Creation of a Cognitive Neuropsychology Laboratory

“…The sensitivity of reaction time as a measure of recovery is supported by studies showing that reaction time can detect changes not seen with other behavioral methods for detecting neglect (Rengachary, d'Avossa, Sapir, Shulman, Corbetta, 2009). As Oscar frequently remarked, you could trust patients to tell you that they had a vision problem, even if they attributed it mostly to their eyeglasses.…”

Adaptive Cognitive Rehabilitation

“…Old and favoured paper-and-pencil tests like line-bisection and cancellation tests in neglect have been converted to computer-based versions which have led to increased sensitive to the symptoms of neglect [51][52][53][54][55], as well as expansions of said tests to include observations and assessment of aberrant behaviour [54,[56][57][58][59][60][61], and the detection and separation of multiple disorders [62]. New assessment techniques have also been introduced e.g.…”