Temporal order judgements as a sensitive measure of the spatial bias in patients with visuospatial neglect

Visuospatial neglect is not a unitary phenomenon, but can be better considered a syndrome, consisting of a multitude of different spatial and non-spatial components. In this study, we used a temporal order judgement (TOJ) test in a large sample of stroke patients (n = 73) to scrutinize the contribution of a spatial bias to the performance on shape cancellation and line bisection tests. In the TOJ test, patients were presented with two elements, one in each visual field, after which the one needed to indicate which of the two elements was presented earlier. For each visual field, the presentation of the stimuli was determined by a staircase procedure where the interval between the two stimuli was determined by the performance of the patient. Results indicated that the strength of the spatial bias was strongly correlated with an object cancellation test, but not with a line bisection test. We argue that these findings are explained by differences in the extent to which a spatial bias determines performance on both tasks: In contrast to shape cancellation tests, successful performance on line bisection tests depends primarily on an object-based, allocentric representation of space, unrelated to any spatial bias in the detection of elements in the contralesional visual field.