Visual size processing in spatial neglect

Evidence from the use of the landmark task and from two size-matching tasks shows that many patients with left-sided neglect systematically under-perceive visual extent in leftward parts of space. This perceptual distortion of size serves to explain the occurrence of rightward line-bisection errors in most neglect patients. One possibility is that attentional biases of a chronic nature might underlie these perceptual changes seen in neglect patients. But contrary to this idea, we have found that attentional cueing in the landmark task causes changes in neglect patients exactly opposite to those seen in healthy subjects. The distortions of size perception seen in neglect could instead be caused by a high-level alteration of visual processing rather than by an attentional bias. In order to explore which visual stream of cortical processing might be compromised in such a disorder, we have begun to examine neglect patients on visuomotor as well as perceptual tasks. We have found clear evidence in one patient for intact grip scaling for object size in the neglected half of space, despite gross perceptual underestimations of the same objects. This result suggests that neglect can occur without major disruption of the dorsal stream, and may result instead from damage to a cortical system whose predominant visual input comes from the ventral stream.     

Fluctuations in visual neglect after stroke?

Clinical experience suggests that the visual neglect in stroke patients fluctuates over short periods of time. This fluctuation has been variously attributed to fatigue, time of day, previous activities, patient learning and compensation. Such fluctuations have clinical implications for the assessment and rehabilitation of visual neglect but do date no formal study has evaluated the extent of such fluctuation over the course of a day. Twenty-two patients with an acute stroke and 19 patients with convalescent stroke were examined for visual neglect twice on the same day using the Visual Neglect Recovery Index (VNRI), a valid and sensitive measure of the severity of neglect, which could be used to select acute patients for trials of treatment of neglect. The inter-test reliability was extremely high. In contrast to past clinical accounts most patients failed to show significant fluctuation. Although preliminary, this finding suggests that a single assessment of visual neglect, using the VNRI, could help select patients for treatment trials.     

Search deficits in neglect patients are dependent on size of the visual scene.

Patients with hemispatial neglect are impaired at moving their attention to a target on the contralesional display side. In the present study, visual display area was varied independently of the number of items displayed within the area. Patients searched for the absence of a simple visual feature in displays that produce serial search performance in normals. The contralesional delay was enhanced for stimulus arrays that were distributed over a larger display area, which suggests that neglect is more severe when attention has to be moved over a larger distance. The directional disengage deficit in neglect therefore depends on the target's relative position within a display, the number of ipsilesional items competing for attention, and the distance of the contralesional attention movements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive components of deficit awareness in Alzheimer's disease.

Awareness of deficit was examined in 24 patients with Alzheimer's disease (AD) and their spouses (for a total of 48 participants) using performance prediction-postdiction and questionnaire discrepancy (QD) paradigms. Participants estimated their own memory performances as well the performances of spouses and of a fictional, memory-disordered patient observed on videotape. Patients overpredicted self-performances, but the extent of overestimation decreased for postdictions. Patients and caregivers accurately estimated caregiver performances but overestimated performances of the fictional patient. QD data revealed that patients underestimated their difficulties performing daily functioning tasks as compared with caregiver reports. Awareness of deficit is a complex ability, involving dissociable cognitive processes. AD patients may display intact immediate awareness of memory dysfunction but fail to incorporate incidents of memory failure into generalized self-belief systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissociable coordinate frames of unilateral spatial neglect: "viewer-centered" neglect

Detailed analyses of reading and nonlexical tasks by three patients with unilateral spatial neglect (USN) secondary to stroke indicate that the USN in each of these patients affects the left side (contralateral to brain damage) of the viewer, with respect to the viewer's head, mid-sagittal plane of the body, or line of sight. In one case, the neglect was further specified as concerning the left side of the viewer's line of sight (the left half of her residual visual field). Thus, the frame of reference of USN in these three cases appears to have viewer-centered (in at least one case, specifically retinotopic) coordinates. The performance of these patients is contrasted to that of other patients in the literature whose USN appears to have a frame of reference with stimulus-centered or object-centered coordinates. These results are interpreted within a model of visual processing (adapted from Marr, 1980 and others) with at least three coordinate frames. It is argued that USN can affect one or more of these coordinate frames independently.     

Unilateral spatial neglect in degenerative brain pathology.

Objective: In an attempt to interpret neglect as a disconnection syndrome, it is currently proposed that the disorder results from disorganization of large-scale networks involved in attentional spatial processes rather than of individual brain areas. We hypothesize that as degenerative brain diseases are “system pathologies,” degeneration could be restricted to some of the neural subsystems implicated in the functional organization of spatial attention and different neglect syndromes could emerge depending on the patterns of the subsystems involved. Method: We studied five neglect patients: one with corticobasal degeneration (CBD), three with Posterior Cortical Atrophy (PCA) and one with frontotemporal dementia (FTD). Results: The patient with CBD and left parietoccipital atrophy showed right allocentric neglect; the three patients with PCA mostly distributed in the right posterior regions showed left egocentric extrapersonal neglect; the patient with FTD, who displayed more severe frontotemporal atrophy on the right, had left motor-executive neglect for both personal and extrapersonal space. All patients also presented a deep breakdown of spatial working memory. Conclusion: Our data would confirm that left neglect is more frequent than right neglect also in degenerative pathology and that damage to different neural substrates can produce different types of neglect. Our findings are also consistent with the hypothesis that both lateralized and nonlateralized attention disorders contribute to generate the syndrome. We suggest that evidence from degenerative diseases may contribute to construction of models of spatial attention. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Preserved insight in an artist with extrapersonal spatial neglect

Several reports of cases of experienced artists showing neglect after a brain lesion can be gleaned from the literature. The analysis of their drawings might provide better insight into the symptoms of neglect than that of non-artists's production. However, most of these reports are anedoctal. We describe in some detail the case of neglect of a distinguished artist, the internationally known Federico Fellini (FF), whom we followed-up for two months after his right parietal stroke. The neuropsychological profile of his neglect syndrome was characterized by left visuo-motor neglect which persisted for two months. At onset, FF also showed indications of neglect dyslexia as well as some evidence of implicit processing of the neglected parts of visual stimuli. However, there was no sign of personal and representational neglect, and FF was well aware of his motor and attentional deficits. FF's neglect was characterised by several dissociations, of which the lack of functional carryover despite intact conceptual and semantic insight is the most relevant.     

Attention, spatial representation, and visual neglect: Simulating emergent attention and spatial memory in the selective attention for identification model (SAIM).

The selective attention for identification model (SAIM) is presented. This uses a spatial window to select visual information for recognition, binding parts to objects and generating translation-invariant recognition. The model provides a qualitative account of both normal and disordered attention. Simulations of normal attention demonstrate 2-object costs and effects of object familiarity on selection, global precedence, spatial cueing, and inhibition of return. When lesioned, SAIM demonstrated either view- or object-centered neglect or spatial extinction, depending on the type and extent of lesion. The model provides a framework to unify (a) object- and space-based theories of normal selection, (b) dissociations within the syndrome of unilateral neglect, and (c) attentional and representational accounts of neglect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unilateral spatial neglect in the late stage of Alzheimer''s disease

This paper presents a method designed to register preoperative computed tomography (CT) images to vertebral surface points acquired intraoperatively from ultrasound (US) images or via a tracked probe. It also presents a comparison of the registration accuracy achievable with surface points acquired from the entire posterior surface of the vertebra to the accuracy achievable with points acquired only from the spinous process and central laminar regions. Using a marker-based method as a reference, this work shows that submillimetric registration accuracy can be obtained even when a small portion of the posterior vertebral surface is used for registration. It also shows that when selected surface patches are used, CT slice thickness is not a critical parameter in the registration process. Furthermore, the paper includes qualitative results of registering vertebral surface points in US images to multiple CT slices. The method has been tested with US points and physical points on a plastic spine phantom and with simulated data on a patient CT scan.     

Rehabilitating patients with left spatial neglect by prism exposure during a visuomotor activity.

Objective: Adaptation to prisms displacing the visual scene rightward is a therapeutic tool for left unilateral spatial neglect (USN). We aimed at comparing the effects of the classic adaptation procedure (repeated pointing toward visual targets, control treatment, C), with those of a novel adaptation method, involving ecological visuomotor activities (experimental treatment, E). Method: In 10 right-brain-damaged USN patients, each treatment was given for 1 week, with a crossover design, for a total of 20 sessions, twice per day. USN was assessed by cancellation, reading, and drawing tasks, and by a standardized scale. Neurological severity was assessed by the National Institutes of Health (NIH) stroke scale (Brott et al., 1989), disability by the Functional Independence Measure (FIM) scale. Results: The 2-week treatments (EC, CE) were equally effective, improving both USN, confirming previous reports (Frassinetti, Angeli, Meneghello, Avanzi, & Làdavas, 2002) and, importantly, disability. The improvement was independent of baseline performance, duration of disease, and neurological severity. Recovery took place after the first week, continued in the second week, and was stable at the follow-up of 3 months. The improvement of USN, measured by cancellation performance, and, in part, that of disability, measured through the FIM scale, were mediated by the size of the leftward aftereffects, suggesting a causal relationship between prism exposure and recovery. The E protocol was better tolerated. Conclusions: Daily life visuomotor activities, associated with prism exposure, are a useful tool for rehabilitating USN patients. This new treatment may widen the compliance with prism exposure treatments and their feasibility within home-based programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clock-drawing in a case of left visuo-spatial neglect: a deficit of disengagement?

A patient (C.B.) with severe left visuo-spatial neglect and hemianopia after right hemisphere stroke was tested on three conditions of a clock-drawing task. Either on spontaneous drawing or when the number sequence was provided by the experimenter, C.B. drew a clockface with left-sided numbers transposed to the right side of the dial. By contrast, when each number was drawn on a separate dial, its location was correct and there was no transposition. Directional hypokinesia or a representational deficit cannot explain these effects. It is proposed that a deficit in disengaging attention from right-sided visual stimuli plays a critical role in some forms of number transpositions.     

Time perception in spatial neglect: A distorted representation?

Objective: It has been proposed that time, space, and numbers share the same metrics and cortical network, the right parietal cortex. Several recent investigations have demonstrated that the mental number line representation is distorted in neglect patients. The aim of this study is to investigate the relationship between time and spatial configuration in neglect patients. Method: Fourteen right-brain damaged patients (six with neglect and eight without neglect), as well as eight age-matched healthy controls, performed a time discrimination task. A standard tone (short: 700 ms and long: 1,700 ms) had to be confronted in duration to a test tone. Test tone differed of 100, 200, and 300 ms respect to the standard tone duration. Results: Neglect patients performed significantly worse than patients without neglect and healthy controls, irrespective of the duration of the standard tone. Conclusion: These results support the hypothesis that mental representations of space and time both share, to some extent, a common cortical network. Besides, spatial neglect seems to distort the time representation, inducing an overestimation of time durations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Time course of eye and head deviation in spatial neglect.

Spatial neglect is characterized by a deviation of the eyes and the head during active search, as well as at rest. Here the authors investigate the hitherto unknown relationship between these striking behaviors in the course of recovery. Gaze, eye-in-head, and head-on-trunk positions were recorded separately under two experimental conditions: (i) at rest (i.e., without any specific requirements, doing nothing) and (ii) during active exploratory search in a large visual array of 240° × 80° over a 10-month period. The authors observed a parallel decrease of eye and head (= gaze) deviation in both conditions, accompanied by a comparable decline in neglect severity. The results strengthen the view that the marked gaze deviation toward the ipsilesional side in patients with spatial neglect is due to a very elementary disturbance of human spatial information processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preattentive and attentive visual search in individuals with hemispatial neglect.

Preattentive and attentive visual processing was examined in patients with hemispatial neglect, hemispatial neglect with hemianopia, and control participants. In the preattentive search task, targets possessed a unique feature that was not shared by distractors. In the attentive search task, targets lacked a feature that was present in the distractors. Preattentive search was normal in 3 neglect patients with cortical lesions but not in 2 neglect patients with hemianopia. A 4th neglect patient without hemianopia with a subcortical infarct abnormally used serial search mechanisms in the preattentive task. Neglect patients were characteristically impaired in the contralesional field in the attentive search task. This study demonstrates preserved explicit detection of visual features in cases of hemispatial neglect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Auditory sustained attention is a marker of unilateral spatial neglect

The relationships between performance on a non-spatially-lateralized measure of sustained attention and spatial bias on tests sensitive to unilateral neglect were considered in a group of 44 patients with right hemisphere lesions following stroke. As predicted from earlier studies showing a strong association between unilateral spatial neglect and sustained attention, performance on a brief and monotonous tone-counting measure formed a significant predictor of spatial bias across a variety of measures of unilateral visual neglect. This study provides further evidence for a very close link between two attentional systems hitherto regarded as being quite separate, namely a spatial attention system implicated in unilateral neglect and a sustained attention system. A close connection between these two systems was predicted by Posner, who argued that the right hemisphere-dominant sustained attention system provides a strong modulatory influence on the functioning of the lateralized posterior attention system.     

The retinotopy of visual spatial attention

We used high-field (3T) functional magnetic resonance imaging (fMRI) to label cortical activity due to visual spatial attention, relative to flattened cortical maps of the retinotopy and visual areas from the same human subjects. In the main task, the visual stimulus remained constant, but covert visual spatial attention was varied in both location and load. In each of the extrastriate retinotopic areas, we found MR increases at the representations of the attended target. Similar but smaller increases were found in V1. Decreased MR levels were found in the same cortical locations when attention was directed at retinotopically different locations. In and surrounding area MT+, MR increases were lateralized but not otherwise retinotopic. At the representation of eccentricities central to that of the attended targets, prominent MR decreases occurred during spatial attention.     

Fear detection and visual awareness in perceiving bodily expressions.

Many research reports have concluded that emotional information can be processed without observers being aware of it. The case for perception without awareness has almost always been made with the use of facial expressions. In view of the similarities between facial and bodily expressions for rapid perception and communication of emotional signals, we conjectured that perception of bodily expressions may also not necessarily require visual awareness. Our study investigates the role of visual awareness in the perception of bodily expressions using a backward masking technique in combination with confidence ratings on a trial-by-trial basis. Participants had to detect in three separate experiments masked fearful, angry and happy bodily expressions among masked neutral bodily actions as distractors and subsequently the participants had to indicate their confidence. The onset between target and mask (Stimulus Onset Asynchrony, SOA) varied from ?50 to +133 ms. Sensitivity measurements (d-prime) as well as the confidence of the participants showed that the bodies could be detected reliably in all SOA conditions. In an important finding, a lack of covariance was observed between the objective and subjective measurements when the participants had to detect fearful bodily expressions, yet this was not the case when participants had to detect happy or angry bodily expressions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)