Is the posner reaction time test more accurate than clinical tests in detecting left neglect in acute and chronic stroke?
Rengachary J, d'Avossa G, Sapir A, Shulman GL, Corbetta M. Is the Posner Reaction Time Test more accurate than clinical tests in detecting left neglect in acute and chronic stroke?


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.


METHODS
Neglect measures were collected longitudinally in patients with stroke at the acute ( approximately 2wk) and chronic ( approximately 9mo) stages. Identical measures were collected in a healthy control group.


METHODS
Inpatient and outpatient rehabilitation.


METHODS
Patients with acute stroke (n=59) with left neglect, 30 of whom were tested longitudinally; healthy age-matched controls (n=30).


METHODS
Not applicable.


METHODS
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 was the reaction time difference for detecting targets appearing on the left compared with 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.
Rengachary
Jennifer
J
Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. jrengachary@wustl.edu
d'Avossa
Giovanni
G
Sapir
Ayelet
A
Shulman
Gordon L
GL
Corbetta
Maurizio
M
D000208:Acute Disease; D001288:Attention / Q000502:physiology; D016022:Case-Control Studies; D002908:Chronic Disease; D003201:Computers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000175:diagnosis / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology*; D012680:Sensitivity and Specificity; D020521:Stroke / Q000503:physiopathology*