Attention in action: Evidence from on-line corrections in left visual neglect

Peripheral and bimanual reaching in a stroke survivor with left visual neglect and extinction

Whether attentional deficits are accompanied by visuomotor impairments following posterior parietal lesions has been debated for quite some time. This single-case study investigated reaching in a stroke survivor (E.B.) with left visual neglect and visual extinction following right temporo-parietal-frontal strokes. Unlike most neglect patients, E.B. did not present left hemiparesis, homonymous hemianopia nor show evidence of motor neglect or extinction allowing us to examine, for the first time, if lateralised attentional deficits co-occur with deficits in peripheral and bimanual reaching. First, we found a classic optic ataxia field effect: E.B.'s accuracy was impaired when reaching to peripheral targets in her neglected left visual field (regardless of the hand used). Second, we found a larger bimanual cost for movement time in E.B. than controls when both hands reached to incongruent locations. E.B.'s visuomotor profile is similar to the one of patients with optic ataxia showing that attentional deficits are accompanied by visuomotor deficits in the affected field.

A robot-based interception task to quantify upper limb impairments in proprioceptive and visual feedback after stroke

BACKGROUND

A key motor skill is the ability to rapidly interact with our dynamic environment. Humans can generate goal-directed motor actions in response to sensory stimulus within ~ 60-200ms. This ability can be impaired after stroke, but most clinical tools lack any measures of rapid feedback processing. Reaching tasks have been used as a framework to quantify impairments in generating motor corrections for individuals with stroke. However, reaching may be inadequate as an assessment tool as repeated reaching can be fatiguing for individuals with stroke. Further, reaching requires many trials to be completed including trials with and without disturbances, and thus, exacerbate fatigue. Here, we describe a novel robotic task to quantify rapid feedback processing in healthy controls and compare this performance with individuals with stroke to (more) efficiently identify impairments in rapid feedback processing.

METHODS

We assessed a cohort of healthy controls (n = 135) and individuals with stroke (n = 40; Mean 41 days from stroke) in the Fast Feedback Interception Task (FFIT) using the Kinarm Exoskeleton robot. Participants were instructed to intercept a circular white target moving towards them with their hand represented as a virtual paddle. On some trials, the arm could be physically perturbed, the target or paddle could abruptly change location, or the target could change colour requiring the individual to now avoid the target.

RESULTS

Most participants with stroke were impaired in reaction time (85%) and end-point accuracy (83%) in at least one of the task conditions, most commonly with target or paddle shifts. Of note, this impairment was also evident in most individuals with stroke when performing the task using their unaffected arm (75%). Comparison with upper limb clinical measures identified moderate correlations with the FFIT.

CONCLUSION

The FFIT was able to identify a high proportion of individuals with stroke as impaired in rapid feedback processing using either the affected or unaffected arms. The task allows many different types of feedback responses to be efficiently assessed in a short amount of time.

Peripheral reaching in Alzheimer's disease and mild cognitive impairment

Recent evidence has implicated areas within the posterior parietal cortex (PPC) as among the first to show pathophysiological changes in Alzheimer's disease (AD). Focal brain damage to the PPC can cause optic ataxia, a specific deficit in reaching to peripheral targets. The present study describes a novel investigation of peripheral reaching ability in AD and mild cognitive impairment (MCI), to assess whether this deficit is common among these patient groups. Individuals with a diagnosis of mild-to-moderate AD, or MCI, and healthy older adult controls were required to reach to targets presented in central vision or in peripheral vision using two reaching tasks; one in the lateral plane and another presented in radial depth. Pre-registered case–control comparisons identified 1/10 MCI and 3/17 AD patients with significant peripheral reaching deficits at the individual level, but group-level comparisons did not find significantly higher peripheral reaching error in either AD or MCI by comparison to controls. Exploratory analyses showed significantly increased reach duration in both AD and MCI groups relative to controls, accounted for by an extended Deceleration Time of the reach movement. These findings suggest that peripheral reaching deficits like those observed in optic ataxia are not a common feature of AD. However, we show that cognitive decline is associated with a generalised slowing of movement which may indicate a visuomotor deficit in reach planning or online guidance.

Adaptation to Laterally Asymmetrical Visuomotor Delay Has an Effect on Action But Not on Perception

When interacting with the environment, the sensorimotor system faces temporal and spatial discrepancies between sensory inputs, such as delay in sensory information transmission, and asymmetrical visual inputs across space. These discrepancies can affect motor control and the representation of space. We recently showed that adaptation to a laterally asymmetric delay in the visual feedback induces neglect-like effects in blind drawing movements, expressed by asymmetrical elongation of circles that are drawn in different workspaces and directions; this establishes a possible connection between delayed feedback and asymmetrical spatial processing in the control of action. In the current study, we investigate whether such adaptation also influences visual perception. In addition, we examined transfer to another motor task – a line bisection task that is commonly used to detect spatial disorders, and extend these results to examine the mapping of these neglect-like effects. We performed two sets of experiments in which participants executed lateral reaching movements, and were exposed to visual feedback delay only in the left workspace. We examined transfer of adaptation to a perceptual line bisection task – answers about the perceived midline of lines that were presented in different directions and workspaces, and to a blind motor line bisection task – reaching movements toward the centers of similar lines. We found that the adaptation to the asymmetrical delay transferred to the control of lateral movements, but did not affect the perceived location of the midlines. Our results clarify the effect of asymmetrical delayed visual feedback on perception and action, and provide potential insights on the link between visuomotor delay and neurological disorders such as the hemispatial neglect syndrome.

Post-stroke visual neglect affects goal-directed locomotion in different perceptuo-cognitive conditions and on a wide visual spectrum

BACKGROUND

Unilateral spatial neglect (USN), a highly prevalent and disabling post-stroke deficit, has been shown to affect the recovery of locomotion. However, our current understanding of USN role in goal-directed locomotion control, and this, in different cognitive/perceptual conditions tapping into daily life demands, is limited.

OBJECTIVES

To examine goal-directed locomotion abilities in individuals with and without post-stroke USN vs. healthy controls.

METHODS

Participants (n = 45, n = 15 per group) performed goal-directed locomotion trials to actual, remembered and shifting targets located 7 m away at 0° and 15° right/left while immersed in a 3-D virtual environment.

RESULTS

Greater end-point mediolateral displacement and heading errors (end-point accuracy measures) were found for the actual and the remembered left and right targets among those with post-stroke USN compared to the two other groups (p <  0.05). A delayed onset of reorientation to the left and right shifting targets was also observed in USN+ participants vs. the other two groups (p <  0.05). Results on clinical near space USN assessment and walking speed explained only a third of the variance in goal-directed walking performance.

CONCLUSION

Post-stroke USN was found to affect goal-directed locomotion in different perceptuo-cognitive conditions, both to contralesional and ipsilesional targets, demonstrating the presence of lateralized and non-lateralized deficits. Beyond neglect severity and walking capacity, other factors related to attention, executive functioning and higher-order visual perceptual abilities (e.g. optic flow perception) may account for the goal-directed walking deficits observed in post-stroke USN+. Goal-directed locomotion can be explored in the design of future VR-based evaluation and training tools for USN to improve the currently used conventional methods.

Veering in hemi-Parkinson's disease: Primacy of visual over motor contributions

Veering while walking is often reported in individuals with Parkinson's disease (PD), with potential mechanisms being vision-based (asymmetrical perception of the visual environment) or motoric (asymmetry in stride length between relatively affected and non-affected body side). We examined these competing hypotheses by assessing veering in 13 normal control participants (NC) and 20 non-demented individuals with PD: 9 with left-side onset of motor symptoms (LPD) and 11 with right-side onset (RPD). Participants walked in a corridor under three conditions: eyes-open, egocentric reference point (ECRP; walk toward a subjectively perceived center of a target at the end of the corridor), and vision-occluded. The visual hypothesis predicted that LPD participants would veer rightward, in line with their rightward visual-field bias, whereas those with RPD would veer leftward. The motor hypothesis predicted the opposite pattern of results, with veering toward the side with shorter stride length. Results supported the visual hypothesis. Under visual guidance, RPD participants significantly differed from NC, veering leftward despite a shorter right- than left-stride length, whereas LPD veered rightward (not significantly different from NC), despite shorter left- than right-stride length. LPD participants showed significantly reduced rightward veering and stride asymmetry when they walked in the presence of a visual landmark (ECRP) than in the eyes-open condition without a target. There were no group differences in veering in the vision-occluded condition. The findings suggest that interventions to correct walking abnormalities such as veering in PD should incorporate vision-based strategies rather than solely addressing motor asymmetries, and should be tailored to the distinctive navigational profiles of LPD and RPD.

Detection of EEG-resting state independent networks by eLORETA-ICA method

Recent functional magnetic resonance imaging (fMRI) studies have shown that functional networks can be extracted even from resting state data, the so called "Resting State independent Networks" (RS-independent-Ns) by applying independent component analysis (ICA). However, compared to fMRI, electroencephalography (EEG) and magnetoencephalography (MEG) have much higher temporal resolution and provide a direct estimation of cortical activity. To date, MEG studies have applied ICA for separate frequency bands only, disregarding cross-frequency couplings. In this study, we aimed to detect EEG-RS-independent-Ns and their interactions in all frequency bands. We applied exact low resolution brain electromagnetic tomography-ICA (eLORETA-ICA) to resting-state EEG data in 80 healthy subjects using five frequency bands (delta, theta, alpha, beta and gamma band) and found five RS-independent-Ns in alpha, beta and gamma frequency bands. Next, taking into account previous neuroimaging findings, five RS-independent-Ns were identified: (1) the visual network in alpha frequency band, (2) dual-process of visual perception network, characterized by a negative correlation between the right ventral visual pathway (VVP) in alpha and beta frequency bands and left posterior dorsal visual pathway (DVP) in alpha frequency band, (3) self-referential processing network, characterized by a negative correlation between the medial prefrontal cortex (mPFC) in beta frequency band and right temporoparietal junction (TPJ) in alpha frequency band, (4) dual-process of memory perception network, functionally related to a negative correlation between the left VVP and the precuneus in alpha frequency band; and (5) sensorimotor network in beta and gamma frequency bands. We selected eLORETA-ICA which has many advantages over the other network visualization methods and overall findings indicate that eLORETA-ICA with EEG data can identify five RS-independent-Ns in their intrinsic frequency bands, and correct correlations within RS-independent-Ns.

The influence of visual target information on the online control of movements

The continuously changing properties of our environment require constant monitoring of our actions and updating of our motor commands based on the task goals. Such updating relies upon our predictions about the sensory consequences of our movement commands, as well as sensory feedback received during movement execution. Here we focus on how visual information about target location is used to update and guide ongoing actions so that the task goal is successfully achieved. We review several studies that have manipulated vision of the target in a variety of ways, ranging from complete removal of visual target information to changes in visual target properties after movement onset to examine how such changes are accounted for during motor execution. We also examined the specific role of a critical neural structure, the parietal cortex, and argue that a fundamental challenge for the future is to understand how visual information about target location is integrated with other streams of information, during movement execution, to estimate the state of the body and the environment in order to ensure optimal motor performance.

Prisms and neglect: what have we learned?

Since Rossetti et al. (1998) reported that prism adaptation (PA) can lead to a substantial reduction of neglect symptoms PA has become a hot topic in neglect-research. More than 280 articles have been published in this area. Not all of those studies investigated the therapeutic potential of this technique, many studies examined the responsiveness to PA as a way to subdivide neglect into separate subsyndromes, other studies focussed on the process of PA itself in an effort to illuminate its underlying neurobiological mechanisms. In this article we will review research in all of these three areas to determine whether and to what extent research on PA in neglect patients has fulfilled its promise as a new way to improve the treatment of neglect, enhance our understanding of this complex syndrome and provide new insights into the neurobiology of sensorimotor learning.