Application of the Brixton spatial anticipation test in stroke: ecological validity and performance characteristics

Executive dysfunction predicts functional recovery post-stroke. However, traditional neuropsychological tests have limitations with this population due to required verbal response, complex motor response, and lengthy administration time. This study examined the ecological validity and performance characteristics of a relatively new measure of executive function, the Brixton Spatial Anticipation Test, which does not place the aforementioned demands on these patients. A total of 57 ischemic stroke patients with frontal lobe and subcortical lesions were administered the Brixton, on average 2 weeks post-stroke, during inpatient rehabilitation and assessed using the Functional Independence Measure (FIM) upon discharge. Brixton performance was significantly correlated with the FIM Total and FIM Cognitive Subtotal at discharge but unrelated to FIM Motor Subtotal. After controlling for global ability measured by the RBANS, Brixton performance accounted for additional variance in predicting FIM Total score at discharge. Interestingly, patients with subcortical strokes in the thalamus and basal ganglia performed significantly worse than patients with strokes in the frontal cortex on the Brixton, supporting the role of subcortical structures in the frontal lobe circuitry and executive function. Based on the present findings, the Brixton is a sensitive measure conducive to the stroke population and has strong ecological validity for identifying cognitive functional outcomes post-stroke.