Visual and Tactile Length Matching in Spatial Neglect

Attention upturned: Bias toward and away from the affected side of the body and near space in a case of complex regional pain syndrome

People with Complex Regional Pain Syndrome (CRPS) following limb injury can show neuropsychological symptoms in the absence of observable brain pathologies. These can include sensory changes, distorted body representation, and inattention to their affected limb and its surrounding space, resembling post-stroke hemispatial neglect. The precise nature and mechanisms of these neuropsychological symptoms are unclear, however insights could be gained by testing for dissociations and associations that have been observed in stroke patients. Drawing from clinical and experimental methods for investigating spatial attention bias and related symptoms in stroke patients, we conducted a detailed investigation of neuropsychological symptoms in a woman with CRPS of her left arm who initially presented to us with pronounced inattention to her affected side. The patient showed visual and tactile neglect and extinction on her affected side on confrontation tests, but no attention deficits on "bedside" tests of neglect. On sensitive computer-based measures, attention biases were found in the patient's body and near space (in Temporal Order Judgements), but not far or imagined space (on the Greyscales task and Mental Number Line Bisection). Unique to the current literature, the patient showed a reversal in her Temporal Order Judgement bias across time, from inattention (first and second session) to hyperattention (third session) to her affected side. In contrast, pain and self-reported body representation distortion were similar across the three sessions. The patient had reduced central and peripheral visual acuity, however these deficits were near symmetrical and therefore could not explain her performance on the visual attention tasks. Given that spatial attention bias has been linked to imbalance in relative activation of the two cerebral hemispheres, we administered a Global-Local processing task to test for hemispheric asymmetry. This revealed no difference in global compared to local interference refuting any hemispheric imbalance. Instead, the patient showed impaired performance (compared to controls) on incongruent trials regardless of trial type, consistent with executive impairment. We conclude that spatial attention bias in CRPS can generalize across different sensory modalities and extend beyond the affected limb to the external space around it, independent of any low-level sensory disturbances. This bias is not necessarily directed away from the affected side or stable over time. People with CRPS can also demonstrate more generalized neuropsychological changes in sensory and executive functions. Our observations refute several existing theories about the mechanisms of attention bias in CRPS, and their relationship to pain, and have potential implications for treatment.

Neurobiology of Unilateral Spatial Neglect

Hemispatial neglect is a common and disabling consequence of stroke. Earlier studies aimed to identify a single area of the brain where damage caused neglect and sought a single disrupted process that could account for the symptoms. Recent studies have shifted toward identifying component processes and representations underlying spatial attention required for various tasks and identifying areas of the brain responsible for each component that together constitute the network of regions responsible for neglect. This review focuses on recent insights into the mechanisms of neglect, regions of neural dysfunction that cause disruption of particular components or forms of neglect, and potential means of ameliorating neglect. Converging evidence supporting these insights comes from new imaging modalities in acute stroke, functional imaging, transcranial magnetic stimulation, electrophysiological studies in humans, and single-cell recording studies in nonhuman primates.

The Modulation of Haptic Line Bisection by a Visual Illusion and Optokinetic Stimulation

Research has shown that a variety of different sensory manipulations, including visual illusions, transcutaneous nerve stimulation, vestibular caloric stimulation, optokinetic stimulation, and prism adaptation, can all influence people's performance on spatial tasks such as line bisection. It has been suggested that these manipulations may act upon the ‘higher-order’ levels of representation used to code spatial information. We investigated whether we could influence haptic line bisection in normal participants crossmodally by varying the visual background that participants viewed. In experiment 1, participants haptically bisected wooden rods while looking at a variant of the Oppel–Kundt visual illusion. Haptic-bisection judgments were influenced by the orientation of the visual illusion (in line with previous unimodal visual findings). In experiment 2, haptic-bisection judgments were also influenced by the presence of a leftward or rightward moving visual background. In experiments 3 and 4, the position of the to-be-bisected stimuli was varied with respect to the participant's body midline. The results confirmed an effect of optokinetic stimulation, but not of the Oppel–Kundt illusion, on participants' tactile-bisection errors, suggesting that the two manipulations might differentially affect haptic processing. Taken together, these results suggest that the ‘higher-order’ levels of spatial representation upon which perceptual judgments and/or motor responses are made may have multisensory or amodal characteristics.

Capturing peripersonal spatial neglect: an electronic method to quantify visuospatial processes

Computerized as well as paper-and-pencil tasks are applied in mapping visuospatial neglect in experimental research and clinical practice. This article presents a new kind of computer-based assessment method, using an electronic pen display and user-friendly software. The approach is tailored to specific spatial processes and highlights the usefulness of a pen display in neglect patients. The advantages of the introduced method are illustrated by a recently designed battery of classic, as well as new, types of tests. The development of the appropriate stimuli and the assorted scoring systems is addressed, as well as the resulting types of task implementation and data generation. The diagnostic value of the different visuospatial neglect tests is demonstrated by comparative analyses between a neglect group and a control group. Among the benefits of the proposed assessment method are (1) the opportunity to perform standardized repeated measurements to quantify recovery, (2) online performance monitoring, (3) flexible employment, (4) the collection of exact data over a short period, and (5) the easy availability of more refined quantitative as well as interesting qualitative information, especially as compared to classic or paper-and-pencil tasks. To indicate that this method also lends itself well to measures for treatment procedures, an illustration is given with respect to specific measurements during prism adaptation. The tasks of the Visuospatial Neglect Test Battery and the prism adaptation measures are illustrated by a case study. The outlined applications are discussed with respect to experimental as well as clinical purposes.

Attention in neglect and extinction: assessing the degree of correspondence between visual and auditory impairments using matched tasks

Claims have been made for associated degrees of impairment on both visual and auditory performance in unilateral neglect and extinction. Since this evidence is primarily based on different tests in each modality, it is difficult to properly quantify the degree of association between performance in vision and audition. The current study compares visual and auditory extinction and temporal order judgments (TOJs) in two cases with clinical visual neglect. Stimuli in both modalities were precisely matched in their temporal and spatial parameters. The results reveal a mixed pattern of association between different auditory tests and their visual counterparts. This suggests that associations between visual and auditory neglect can occur but these are neither obligatory nor pervasive. Instead, our data support models of spatial impairment in neglect and extinction that acknowledge differences in the contribution of spatial information to performance in each modality in responses to changing task demands.

Touching base: The effect of participant and stimulus modulation factors on a haptic line bisection task

Acquiring information about our environment through touch is vital in everyday life. Yet very little literature exists about factors that may influence haptic or tactile processing. Recent neuroimaging studies have reported haptic laterality effects that parallel those reported in the visual literature. With the use of a haptic variant of the classical line bisection task, the present study aimed to determine the presence of laterality effects on a behavioural level. Specifically, three handedness groups including strong dextrals, strong sinistrals, and-the to-date largely neglected group of-mixed-handers were examined in their ability to accurately bisect stimuli constructed from corrugated board strips of various lengths. Stimulus factors known to play a role in visuospatial perception including stimulus location, the hand used for bisection, and direction of exploration were systematically varied through pseudo-randomisation. Similar to the visual domain, stimulus location and length as well as participants' handedness and the hand used for bisection exerted a significant influence on participants' estimate of the centre of haptically explored stimuli. However, these effects differed qualitatively from those described for the visual domain, and the factor direction of exploration did not exert any significant effect. This indicates that laterality effects reported on a neural level are sufficiently pronounced to result in measurable behavioural effects. The results, first, add to laterality effects reported for the visual and auditory domain, second, are in line with supramodal spatial processing and third, provide additional evidence to a conceptualisation of pseudoneglect and neglect as signs of hemispheric attentional asymmetries.

Right parietal dominance in spatial egocentric discrimination

Egocentric tactile perception is crucial for skilled hand motor control. In order to better understand the brain functional underpinnings related to this basic sensorial perception, we performed a tactile perception functional magnetic resonance imaging (fMRI) experiment with two aims. The first aim consisted of characterizing the neural substrate of two types of egocentric tactile discrimination: the spatial localization (SLD) and simultaneity succession discrimination (SSD) in both hands to define hemispheric dominance for these tasks. The second goal consisted of characterizing the brain activation related to the spatial attentional load, the functional changes and their connectivity patterns induced by the psychometric performance (PP) during SLD. We used fMRI in 25 right-handed volunteers, applying pairs of sinusoidal vibratory stimuli on eight different positions in the palmar surface of both hands. Subjects were required either to identify the stimulus location with respect to an imaginary midline (SLD), to discriminate the simultaneity or succession of a stimuli pair (SSD) or to simply respond to stimulus detection. We found a fronto-parietal network for SLD and frontal network for SSD. During SLD we identified right hemispheric dominance with increased BOLD activation and functional interaction of the right supramarginal gyrus with contralateral intra-parietal sulcus for right and left hand independently. Brain activity correlated to spatial attentional load was found in bilateral structures of intra-parietal sulcus, precuneus extended to superior parietal lobule, pre-supplementary motor area, frontal eye fields and anterior insulae for both hands. We suggest that the right supramarginal gyrus and its interaction with intra-parietal lobule may play a pivotal role in the phenomenon of tactile neglect in right fronto-parietal lesions.

Evaluating visual bias and effect of proprioceptive feedback in unilateral neglect

We propose modified versions of the line-bisection task for assessing visual bias and effect of proprioceptive feedback in unilateral neglect; that is, the verbal line-bisection (VLB) task and the VLB plus pointing task. The VLB task requires only a verbal response to assess pure visual bias. Conversely, the VLB plus pointing task requires both a verbal response and pointing to assess visual and proprioceptive bias. Ten patients with unilateral neglect were administered these tasks on a computer using presentation software. Eight participants showed obvious rightward deviation in the VLB task, and were thus classified as patients with visual neglect. Four participants showed significantly greater deviation in the VLB plus pointing task than in the VLB task, and were thus classified as patients with proprioceptive bias. Visual bias and effect of proprioceptive feedback in unilateral neglect were successfully assessed by these tasks.

Somatosensory processes subserving perception and action

The functions of the somatosensory system are multiple. We use tactile input to localize and experience the various qualities of touch, and proprioceptive information to determine the position of different parts of the body with respect to each other, which provides fundamental information for action. Further, tactile exploration of the characteristics of external objects can result in conscious perceptual experience and stimulus or object recognition. Neuroanatomical studies suggest parallel processing as well as serial processing within the cerebral somatosensory system that reflect these separate functions, with one processing stream terminating in the posterior parietal cortex (PPC), and the other terminating in the insula. We suggest that, analogously to the organisation of the visual system, somatosensory processing for the guidance of action can be dissociated from the processing that leads to perception and memory. In addition, we find a second division between tactile information processing about external targets in service of object recognition and tactile information processing related to the body itself. We suggest the posterior parietal cortex subserves both perception and action, whereas the insula principally subserves perceptual recognition and learning.

The influence of illusory motion on line bisection performance in normal subjects

The present study examines whether illusory movement (IM) of a horizontal line, induced by a moving background (MB), influences line-bisection performance in normal subjects. The first experiment attempted to identify the speeds of MB that induce IM. We found that when speed is increased from 1.53 degrees to 13.3 degrees/sec, IM increases, but that with further speed increases, IM decreases. Leftward MB induces rightward IM, and vice versa. In the second experiment, we had subjects bisect lines at MB speeds that had been shown to induce IM in the first experiment. We found that leftward MB induced a rightward bias, and vice versa. We also found that there was a relationship between the magnitude of IM and the degree of bias. In the third experiment, by making the target line larger than the MB, we made the conditions where IM was presumably absent. Unlike the results of bisection performed with IM, subjects showed a bias in the direction of the MB. Overall, these experiments demonstrated that the perception of motion induces subjects to attend in the direction of movement.