Computer recording of standard tests of visual neglect in stroke patients

Objective: To determine whether a computer-based method for recording stand ardized 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 acciden t confirmed on computerized tomography (CT) scan including 30 patients with neglect, 57 patients without neglect. An age-matched control group of 13 s ubjects. Intervention: All patients were tested using the standard Rivermead Behavio ural Inattention Test (BIT) and by computer recording of two standard tests for assessing neglect (line bisection and Albert's test). Age-matched cont rols were tested using computer recording of the two standard tests. Main outcome measures: Neglect was defined using the BIT with a cut-off sco re of 129. Computer recording measured the 'outcome' of tasks, i.e, the dev iation 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 f or cancellation. Results: The computer recording identified significant differences in 'outc ome' and 'process' which distinguished neglect from non-neglect patients. T here were significant differences between non-neglect patients and age-matc hed controls with regard to 'process' measures but not with regard to 'outc ome' measures. Conclusions: Computer recording of standard tests for assessing neglect ide ntifies 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 neuropsych ological changes associated with neglect in stroke patients.