to assess disability self-awareness with computerized Implicit Identification Testing (IIT) based on the Implicit Association Test (IAT; Greenwald et al., 1998).

Disability is defined by an individual experience of limitation (World Health Organization, 2002), and currently cannot be objectively detected.  However, many people with neurological conditions cannot self-report disability (Barrett, 2010) because of anosognosia (pathological lack of knowledge of disease; Adair and Barrett, 2012).  Patients who cannot verbally report disability may have implicit knowledge of their deficits (Fotopoulou et al., 2010).   Thus, implicit attitude testing might be used to measure the experience of disability. 

Caregivers of 6 right brain stroke survivors reported survivor disability using the Barthel Index (BI; mean 52/100).  Patients also self-rated disability.  

Patients categorized pictures of “me” versus “someone else,” on a computerized test, pressing a left- or right-hand key.  Based on the IAT, they then sorted “Ability” versus “Disability” symbols by key press. Lastly, participants performed two blocks of a combined sorting task, including both faces and Ability/Disability symbols. Response speed was assessed to determine whether participants implicitly associated “me” with “Ability” and “someone else” with “Disability”, versus implicitly pairing “me” with “Disability” and “Someone else” with “Ability.” In other words, participants implicitly themselves as more, or less able than other people.

Consistent with prior  IAT studies, we measured implicit bias with a response ratio (RR). RR < 1.0 indicated that subjects viewed themselves as disabled.  5/6 stroke survivors tested met criteria for spatial neglect, and activities of daily living were self-rated higher (BI mean 72.5) than caregiver-rated ADLs (BI mean 51.7), suggesting anosognosia.  However, RR indicated implicitly self-perceived disability (mean 0.8).

Computerized implicit attitude assessment may be able to detect self-perceived disability in stroke survivors with anosognosia.  Our future studies will assess the IIT in larger groups of stroke survivors with and without spatial neglect.