Understanding the effects of moving visual stimuli on unilateral neglect following stroke

A Meta-Analysis of Line Bisection and Landmark Task Performance in Older Adults

Young adults exhibit a small asymmetry of visuospatial attention that favours the left side of space relative to the right (pseudoneglect). However, it remains unclear whether this leftward bias is maintained, eliminated or shifted rightward in older age. Here we present two meta-analyses that aimed to identify whether adults aged ≥50 years old display a group-level spatial attention bias, as indexed by the line bisection and the landmark tasks. A total of 69 datasets from 65 studies, involving 1654 participants, were analysed. In the meta-analysis of the line bisection task (n = 63), no bias was identified for studies where the mean age was ≥50, but there was a clear leftward bias in a subset where all individual participants were aged ≥50. There was no moderating effect of the participant’s age or sex, line length, line position, nor the presence of left or right cues. There was a small publication bias in favour of reporting rightward biases. Of note, biases were slightly more leftward in studies where participants had been recruited as part of a stand-alone older group, compared to studies where participants were recruited as controls for a clinical study. Similarly, no spatial bias was observed in the meta-analysis of the landmark task, although the number of studies included was small (n = 6). Overall, these results indicate that over 50s maintain a group-level leftward bias on the line bisection task, but more studies are needed to determine whether this bias can be modulated by stimulus- or state-dependent factors.

Keeping an eye on visual search patterns in visuospatial neglect: A systematic review

Patients with visuospatial neglect exhibit a failure to detect, respond, or orient towards information located in the side of space opposite to their brain lesion. To extend our understanding of the underlying cognitive processes involved in neglect, some studies have used eye movement measurements to complement behavioural data. We provide a qualitative synthesis of studies that have used eye-tracking in patients with neglect, with a focus on highlighting the utility of examining eye movements and reporting what eye-tracking has revealed about visual search patterns in these patients. This systematic review includes twenty studies that met the eligibility criteria. We extracted information pertaining to patient characteristics (e.g., age, type of stroke, time since stroke), neglect test(s) used, type of stimuli (e.g., static, dynamic), eye-tracker specifications (e.g., temporal and spatial resolution), and eye movement measurements (e.g., saccade amplitude, fixation duration). Five key themes were identified. First, eye-tracking is a useful tool to complement pen-and-paper neglect tests. Second, the lateral asymmetrical bias in eye movement patterns observed during active exploration also occurred while at rest. Third, the lateral asymmetrical bias was evident not only in the horizontal plane but also in the vertical plane. Fourth, eye movement patterns were modulated by stimulus- and task-related factors (e.g., visual salience, local perceptual features, image content, stimulus duration, presence of distractors). Fifth, measuring eye movements in patients with neglect is useful for determining and understanding other cognitive impairments, such as spatial working memory. To develop a fuller, and a more accurate, picture of neglect, future research would benefit from eye movement measurements.

Visual search in unilateral spatial neglect: The effects of distractors on a dynamic visual search task

The objective of this study was to examine visual scanning performance in patients with Unilateral Spatial Neglect (USN) in a visual search task. Thirty-one right hemisphere stroke patients with USN were recruited. They performed a dynamic visual search task with two conditions, with and without distractors, while eye movements were monitored with an eye-tracker. The main goal of the task was to select target stimuli that appeared from the top of the screen and moved vertically downward. Target detection and visual scanning percentage were assessed over two hemispaces (right, left) on two conditions (distractor, no distractor). Most Scanned Regions (MSR) were calculated to analyze the areas of the screen where most points of fixation were directed to. Higher target detection rate and visual scanning percentages were found on the right hemispace on both conditions. From the MSRs we found that participants with a center of attention further to the right of the screen also presented smaller overall MSRs. Right hemisphere stroke patients with USN presented not only a significant rightward bias but reduced overall search areas, implying hyperattention does not only restrict search on the horizontal (right-left) axis but the vertical axis (top-bottom) too.

Neglect and Motion Stimuli--Insights from a Touchscreen-Based Cancellation Task

Background and Purpose

In stroke patients, neglect diagnostic is often performed by means of paper-pencil cancellation tasks. These tasks entail static stimuli, and provide no information concerning possible changes in the severity of neglect symptoms when patients are confronted with motion. We therefore aimed to directly contrast the cancellation behaviour of neglect patients under static and dynamic conditions. Since visual field deficits often occur in neglect patients, we analysed whether the integrity of the optic radiation would influence cancellation behaviour.

Methods

Twenty-five patients with left spatial neglect after right-hemispheric stroke were tested with a touchscreen cancellation task, once when the evenly distributed targets were stationary, and once when the identic targets moved with constant speed on a random path. The integrity of the right optic radiation was analysed by means of a hodologic probabilistic approach.

Results

Motion influenced the cancellation behaviour of neglect patients, and the direction of this influence (i.e., an increase or decrease of neglect severity) was modulated by the integrity of the right optic radiation. In patients with an intact optic radiation, the severity of neglect significantly decreased in the dynamic condition. Conversely, in patients with damage to the optic radiation, the severity of neglect significantly increased in the dynamic condition.

Conclusion

Motion may influence neglect in stroke patients. The integrity of the optic radiation may be a predictor of whether motion increases or decreases the severity of neglect symptoms.

Impact of dynamic bottom-up features and top-down control on the visual exploration of moving real-world scenes in hemispatial neglect

Patients with hemispatial neglect are severely impaired in orienting their attention to contralesional hemispace. Although motion is one of the strongest attentional cues in humans, it is still unknown how neglect patients visually explore their moving real-world environment. We therefore recorded eye movements at bedside in 19 patients with hemispatial neglect following acute right hemisphere stroke, 14 right-brain damaged patients without neglect and 21 healthy control subjects. Videos of naturalistic real-world scenes were presented first in a free viewing condition together with static images, and subsequently in a visual search condition. We analyzed number and amplitude of saccades, fixation durations and horizontal fixation distributions. Novel computational tools allowed us to assess the impact of different scene features (static and dynamic contrast, colour, brightness) on patients' gaze. Independent of the different stimulus conditions, neglect patients showed decreased numbers of fixations in contralesional hemispace (ipsilesional fixation bias) and increased fixation durations in ipsilesional hemispace (disengagement deficit). However, in videos left-hemifield fixations of neglect patients landed on regions with particularly high dynamic contrast. Furthermore, dynamic scenes with few salient objects led to a significant reduction of the pathological ipsilesional fixation bias. In visual search, moving targets in the neglected hemifield were more frequently detected than stationary ones. The top-down influence (search instruction) could neither reduce the ipsilesional fixation bias nor the impact of bottom-up features. Our results provide evidence for a strong impact of dynamic bottom-up features on neglect patients' scanning behaviour. They support the neglect model of an attentional priority map in the brain being imbalanced towards ipsilesional hemispace, which can be counterbalanced by strong contralateral motion cues. Taking into account the lack of top-down control in neglect patients, bottom-up stimulation with moving real-world stimuli may be a promising candidate for future neglect rehabilitation schemes.

A case study of new assessment and training of unilateral spatial neglect in stroke patients: effect of visual image transformation and visual stimulation by using a Head Mounted Display system (HMD)

Background

Unilateral spatial neglect (USN) is most damaging to an older stroke patient who also has a lower performance in their activities of daily living or those elderly who are still working. The purpose of this study was to understand more accurately pathology of USN using a new HMD system.

Methods

Two stroke patients (Subject A and B) participated in this study after gaining their informed consent and they all had Left USN as determined by clinical tests. Assessments of USN were performed by using the common clinical test (the line cancellation test) and six special tests by using HMD system in the object-centered coordinates (OC) condition and the egocentric coordinates (EC) condition. OC condition focused the test sheet only by a CCD. EC condition was that CCD can always follow the subject's movement. Moreover, the study focused on the effect of the reduced image condition of real image and the arrows.

Results

In Patient A who performed the common test and special tests of OC and EC conditions, the results showed that for the line cancellation test under the common condition, both of the percentage of the correct answers at the right and left sides in the test sheet was 100 percent. However, in the OC condition, the percentage of the correct answers at the left side in the test sheet was 44 percent and the right side was 94 percent. In the EC condition, the left side was 61 percent and the right side was 67 percent. In Patient B, according to the result of the use of reduced image condition and the arrows condition by HMD system, these line cancellation scores more increased than the score of the common test.

Conclusions

The results showed that the assessment of USN using an HMD system may clarify the left neglect area which cannot be easily observed in the clinical evaluation for USN. HMD may be able to produce an artificially versatile environment as compared to the common clinical evaluation and treatment.