Even subtle forms of hemispatial neglect after stroke negatively affect the performance of daily life tasks, increase the risk of injury, and are associated with poor rehabilitation outcomes. Conventional paper-and-pencil tests, however, often underestimate the symptoms. We aimed to identify relevant neglect-specific measures and clinical decision rules based on machine learning techniques on behavioral data generated in a new Virtual Reality (VR) application, the immersive virtual road-crossing task. In total, 59 participants were included in our study: two right-hemispheric stroke groups with left neglect (N = 20) or no neglect (N = 19), classified based on conventional tests and medical diagnosis, and healthy controls (N = 20). A neuropsychological test battery and the VR task were administered to all participants. We applied decision trees and random forest models to predict the respective groups based on the results of the VR task. Our feature selection procedure yielded six features as suitable predictors, most of which involved lateral time-related measures, particularly reaction times, and head movements. Our model achieved a high training accuracy of 96.6% and estimated test accuracy of 76.8%. These results confirm previous reports that temporal behavioral patterns are key to detecting subtle neglect in patients with chronic stroke. Our results indicate that VR combined with machine learning has the potential to achieve higher test accuracies while being highly applicable to clinical practice.

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