Effects of visible and invisible cueing on line bisection and Landmark performance in hemispatial neglect

A scoping review and critique of the Input-Output subtyping dimension of spatial neglect

Spatial neglect is a common and debilitating disorder after stroke whereby individuals have difficulty reporting, orienting, and/or responding to the contralesional side of space. Given the heterogeneity of neglect symptom presentation, various neglect subtypes have been proposed to better characterize the disorder. This review focuses on the distinction between Input neglect (i.e., difficulty perceiving and/or attending to contralesional stimuli) and Output neglect (i.e., difficulty planning and/or executing movements toward contralesional stimuli). Conceptualizations of Input and Output neglect have varied considerably. We provide a novel summary of the terminology, measurement approaches, and neural correlates of these subtypes. A protocol detailing our systematic scoping review strategy is registered on the Open Science Framework (https://osf.io/bvtxf/). For feasibility and greater comparability across studies, we limited our inclusion criteria to tasks focused on visual stimuli and upper-limb movements. A total of 110 articles were included in the review. Subtyping tasks were categorized based on whether they mainly manipulated aspects of the input (i.e., congruence of visual input with motor output, presence of visual input) or the output (i.e., modality, goal, or direction of output) to produce an Input-Output subtype dissociation. We used our review results to identify four main critiques of this literature: 1) lack of consistency/clarity in conceptual models; 2) methodological issues of dissociating Input and Output subtypes; 3) a need for updated neural theories; and 4) barriers to clinical application. We discuss the lessons learned from this subtyping dimension that can be applied to future research on neglect subtype assessment and treatment.

The Do's and Don'ts of Psychophysical Methods for Interpretability of Psychometric Functions and Their Descriptors

Many areas of research require measuring psychometric functions or their descriptors (thresholds, slopes, etc.). Data for this purpose are collected with psychophysical methods of various types and justification for the interpretation of results arises from a model of performance grounded in signal detection theory. Decades of research have shown that psychophysical data display features that are incompatible with such framework, questioning the validity of interpretations obtained under it and revealing that psychophysical performance is more complex than this framework entertains. This paper describes the assumptions and formulation of the conventional framework for the two major classes of psychophysical methods (single- and dual-presentation methods) and presents various lines of empirical evidence that the framework is inconsistent with. An alternative framework is then described and shown to account for all the characteristics that the conventional framework regards as anomalies. This alternative process model explicitly separates the sensory, decisional, and response components of performance and represents them via parameters whose estimation characterizes the corresponding processes. Retrospective and prospective evidence of the validity of the alternative framework is also presented. A formal analysis also reveals that some psychophysical methods and response formats are unsuitable for separation of the three components of observed performance. Recommendations are thus given regarding practices that should be avoided and those that should be followed to ensure interpretability of the psychometric function, or descriptors (detection threshold, difference limen, point of subjective equality, etc.) obtained with shortcut methods that do not require estimation of psychometric functions.

Intra- and inter-task reliability of spatial attention measures in healthy older adults

At present, there is a lack of systematic investigation into intra- and inter-task consistency effects in older adults, when investigating lateralised spatial attention. In young adults, spatial attention typically manifests itself in a processing advantage for the left side of space ("pseudoneglect"), whereas older adults have been reported to display no strongly lateralised bias, or a preference towards the right side. Building on our earlier study in young adults, we investigated older adults, aged between 60 to 86 years, on five commonly used spatial attention tasks (line bisection, landmark, grey and grating scales and lateralised visual detection). Results confirmed a stable test-retest reliability for each of the five spatial tasks across two testing days. However, contrary to our expectations of a consistent lack in bias or a rightward bias, two tasks elicited significant left spatial biases in our sample of older participants, in accordance with pseudoneglect (namely the line bisection and greyscales tasks), while the other three tasks (landmark, grating scales, and lateralised visual detection tasks) showed no significant biases to either side of space. This lack of inter-task correlations replicates recent findings in young adults. Comparing the two age groups revealed that only the landmark task was age sensitive, with a leftward bias in young adults and an eliminated bias in older adults. In view of these findings of no significant inter-task correlations, as well as the inconsistent directions of the observed spatial biases for the older adults across the five tested tasks, we argue that pseudoneglect is a multi-component phenomenon and highly task sensitive. Each task may engage slightly distinct neural mechanisms, likely to be impacted differently by age. This complicates generalisation and comparability of pseudoneglect effects across different tasks, age-groups and hence studies.

Line Bisection and Rebisection: The Crossover Effect of Space Location

Objective. To investigate the relationship between the bisection test and the severity of behavioral hemineglect and to verify if this test can predict the behavioral hemineglect. Methods. Thirty stroke patients with left hemiparesis were divided into 4 groups according to the Catherine Bergego Scale, which assessed the behavioral hemineglect: severe unilateral neglect (UN), moderate UN, mild UN, and lack of UN. Eleven healthy subjects served as age-matched control subjects. In the bisection test, 18 lines were presented on the left, middle, and right of an A4 paper, respectively. The subjects were asked to place a short cross mark in the exact middle point of each line on the paper using their right hand. The middle 6 lines in the above bisection test were extracted on another sheet of A4 paper for the rebisection test. The subjects were asked to divide a line into 4 segments by successive bisections. The proportion of the right part to the length of line for bisecting was calculated. Results. In the bisection test, the main effect of space was significant in every group except the mild neglect group. The crossover effect of space location was found in the severe UN group, the group without UN, and the controls. In the severe UN group, the patients bisected the left and middle lines with rightward bias (<50%) but bisected the right lines with leftward bias (>50%). In the group without UN and the controls, the subjects bisected the left lines with leftward bias (>50%) but bisected the middle and right lines with rightward bias (<50%). Almost the same results were seen in the rebisection test. Conclusions. This study showed that if the spatial crossover effect occurred in the right space condition, it was strongly supported that this patient had moderate to severe behavioral hemineglect. The crossover effect of the space location was explained by a new model.

Prismatic Adaptation Induces Plastic Changes onto Spatial and Temporal Domains in Near and Far Space

A large literature has documented interactions between space and time suggesting that the two experiential domains may share a common format in a generalized magnitude system (ATOM theory). To further explore this hypothesis, here we measured the extent to which time and space are sensitive to the same sensorimotor plasticity processes, as induced by classical prismatic adaptation procedures (PA). We also exanimated whether spatial-attention shifts on time and space processing, produced through PA, extend to stimuli presented beyond the immediate near space. Results indicated that PA affected both temporal and spatial representations not only in the near space (i.e., the region within which the adaptation occurred), but also in the far space. In addition, both rightward and leftward PA directions caused opposite and symmetrical modulations on time processing, whereas only leftward PA biased space processing rightward. We discuss these findings within the ATOM framework and models that account for PA effects on space and time processing. We propose that the differential and asymmetrical effects following PA may suggest that temporal and spatial representations are not perfectly aligned.

What's in a line? Verbal, facial, and emotional influences on the line bisection task

In Bryden and MacRae's [(1988). Dichotic laterality effects obtained with emotional words. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 1(3), 171-176] dichotic listening task, attending to verbal (left hemisphere) or emotional (right hemisphere) auditory stimuli can result in opposite patterns of behaviour. We examined whether performance on the line bisection task might also be influenced in opposite ways by left- and right-lateralized functions. The line bisection task is a simple and effective measure of visuospatial bias. Pseudoneglect, a leftward bias, is typically found on this task, and appears to result from right hemisphere dominance for spatial processing. We investigated how emotion, verbal, and facial processing impacted line bisection performance, while also examining the influence of hand-use. Line type (face, word, and solid), valence (positive, negative, and neutral), and hand-use (left, right, and both) were manipulated. Results indicated that face and word lines decreased and increased the extent of pseudoneglect, respectively, and that valence accentuated these results. These results were in the opposite direction from our predictions. Hand-use had little influence. We discuss the impact that visual scanning, and local and global processing, may have had on line bisection performance. Until future research clarifies how lateralized functions affect line bisections, we suggest caution in adapting the line bisection task as a general measure of relative hemispheric activation.

A rightward shift in the visuospatial attention vector with healthy aging

The study of lateralized visuospatial attention bias in non-clinical samples has revealed a systematic group-level leftward bias (pseudoneglect), possibly as a consequence of right hemisphere (RH) dominance for visuospatial attention. Pseudoneglect appears to be modulated by age, with a reduced or even reversed bias typically present in elderly participants. It has been suggested that this shift in bias may arise due to disproportionate aging of the RH and/or an increase in complementary functional recruitment of the left hemisphere (LH) for visuospatial processing. In this study, we report rightward shifts in subjective midpoint judgment relative to healthy young participants whilst elderly participants performed a computerized version of the landmark task (in which they had to judge whether a transection mark appeared closer to the right or left end of a line) on three different line lengths. This manipulation of stimulus properties led to a similar behavioral pattern in both the young and the elderly: a rightward shift in subjective midpoint with decreasing line length, which even resulted in a systematic rightward bias in elderly participants for the shortest line length (1.98° of visual angle, VA). Overall performance precision for the task was lower in the elderly participants regardless of line length, suggesting reduced landmark task discrimination sensitivity with healthy aging. This rightward shift in the attentional vector with healthy aging is likely to result from a reduction in RH resources/dominance for attentional processing in elderly participants. The significant rightward bias in the elderly for short lines may even suggest a reversal of hemisphere dominance in favor of the LH/right visual field under specific conditions.

On the neural origin of pseudoneglect: EEG-correlates of shifts in line bisection performance with manipulation of line length

Healthy participants tend to show systematic biases in spatial attention, usually to the left. However, these biases can shift rightward as a result of a number of experimental manipulations. Using electroencephalography (EEG) and a computerized line bisection task, here we investigated for the first time the neural correlates of changes in spatial attention bias induced by line-length (the so-called line-length effect). In accordance with previous studies, an overall systematic left bias (pseudoneglect) was present during long line but not during short line bisection performance. This effect of line-length on behavioral bias was associated with stronger right parieto-occipital responses to long as compared to short lines in an early time window (100-200ms) post-stimulus onset. This early differential activation to long as compared to short lines was task-independent (present even in a non-spatial control task not requiring line bisection), suggesting that it reflects a reflexive attentional response to long lines. This was corroborated by further analyses source-localizing the line-length effect to the right temporo-parietal junction (TPJ) and revealing a positive correlation between the strength of this effect and the magnitude by which long lines (relative to short lines) drive a behavioral left bias across individuals. Therefore, stimulus-driven left bisection bias was associated with increased right hemispheric engagement of areas of the ventral attention network. This further substantiates that this network plays a key role in the genesis of spatial bias, and suggests that post-stimulus TPJ-activity at early information processing stages (around the latency of the N1 component) contributes to the left bias.

Spatial attention: differential shifts in pseudoneglect direction with time-on-task and initial bias support the idea of observer subtypes

Asymmetry in human spatial attention has long been documented. In the general population the majority of individuals tend to misbisect horizontal lines to the left of veridical centre. Nonetheless in virtually all previously reported studies on healthy participants, there have been subsets of people displaying rightward biases. In this study, we report differential time-on task effects depending on participants' initial pseudoneglect bias: participants with an initial left bias in a landmark task (in which they had to judge whether a transection mark appeared closer to the right or left end of a line) showed a significant rightward shift over the course of the experimental session, whereas participants with an initial right bias shifted leftwards. We argue that these differences in initial biases as well as the differential shifts with time-on task reflect genuine observer subtypes displaying diverging behavioural patterns. These observer subtypes could be driven by differences in brain organisation and/or lateralisation such as varying anatomical pathway asymmetries (Thiebaut de Schotten et al., 2011).

Stimulus- and state-dependence of systematic bias in spatial attention: additive effects of stimulus-size and time-on-task

Systematic biases in spatial attention are a common finding. In the general population, a systematic leftward bias is typically observed (pseudoneglect), possibly as a consequence of right hemisphere dominance for visuospatial attention. However, this leftward bias can cross-over to a systematic rightward bias with changes in stimulus and state factors (such as line length and arousal). The processes governing these changes are still unknown. Here we tested models of spatial attention as to their ability to account for these effects. To this end, we experimentally manipulated both stimulus and state factors, while healthy participants performed a computerized version of a landmark task. State was manipulated by time-on-task (>1 h) leading to increased fatigue and a reliable left- to rightward shift in spatial bias. Stimulus was manipulated by presenting either long or short lines which was associated with a shift of subjective midpoint from a reliable leftward bias for long to a more rightward bias for short lines. Importantly, we found time-on-task and line length effects to be additive suggesting a common denominator for line bisection across all conditions, which is in disagreement with models that assume that bisection decisions in long and short lines are governed by distinct processes (Magnitude estimation vs Global/local distinction). Our findings emphasize the dynamic rather than static nature of spatial biases in midline judgement. They are best captured by theories of spatial attention positing that spatial bias is flexibly modulated, and subject to inter-hemispheric balance which can change over time or conditions to accommodate task demands or reflect fatigue.

Mood and Balance are Associated with Free-Living Physical Activity of People after Stroke Residing in the community

Purpose. To determine which characteristics are most associated with free-living physical activity in community-dwelling ambulatory people after stroke. Method. Factors (age, gender, side of stroke, time since stroke, BMI, and spouse), sensory-motor impairments (weakness, contracture, spasticity, coordination, proprioception, and balance), and non-sensory-motor impairments (cognition, language, perception, mood, and confidence) were collected on 42 people with chronic stroke. Free-living physical activity was measured using an activity monitor and reported as time on feet and activity counts. Results. Univariate analysis showed that balance and mood were correlated with time on feet (r = 0.42, 0.43, P < 0.01) and also with activity counts (r = 0.52, 0.54, P < 0.01). Stepwise multiple regression showed that mood and balance accounted for 25% of the variance in time on feet and 40% of the variance in activity counts. Conclusions. Mood and balance are associated with free-living physical activity in ambulatory people after stroke residing in the community.

Spatial cues affect mental number line bisections

Numerical magnitude is coded left-to-right along a mental number line (MNL). The MNL can be distorted by an attentional bias directed to the left side, known as pseudoneglect - making the left of the MNL appear longer. We investigated whether this distortion can be corrected using spatial cues. Participants (n = 17) made forced-choice discriminations of relative numerical length while spatial cues were presented to the left, right, and both sides. Overall, participants overestimated the leftward length of the MNL, consistent with the effect of pseudoneglect. The bias was present for left- and neutral-cues, but was eliminated by right-cues. The results demonstrate that low-level manipulation of attention in physical space affects attention for high-level mental representations. The effect of cueing may reflect common activation of overlapping neural circuits that are thought to underlie attention in physical and representational space.

Orientation illusions vary in size and direction as a function of task-dependent attention

Adding an upright inner square frame to an outer tilted square frame causes a central rod's perceived orientation to be directionally opposite the usual rod-and-frame illusion (RFI). Zoccolotti, Antonucci, Daini, Martelli, and Spinelli (1997) attributed this double RFI (DRFI) to Rock's (1990) hierarchical organization principle. In Experiment 1, this explanation predicted results for small (11 degrees ) but not larger (22 degrees and 33 degrees ) outer frame orientations. In two experiments with the DRFI, bottom-up, goal-driven attention was varied and direct and indirect measures of the framework's influence were compared. In Experiment 2, the RFI angular function was compared with two other DRFI conditions: a direct measure of perceived rod orientation and an indirect measure of the inner frame. These conditions induced directionally opposite effects. In Experiment 3, direct and indirect measures of the inner frame's perceived tilt were compared. Angular functions differing in size and direction were obtained. Experiment 4 replicated the previous results, using a different psychophysical procedure. All the results were consistent with the hierarchical organization mechanism but suggested different processing strategies due to different attentional weights. They were also consistent with other recent findings based on the Bayesian approach to accounts of illusory phenomena (e.g., Jazayeri & Movshon, 2006, 2007; Weiss, Simoncelli, & Adelson, 2002).

Non-lateralised deficits of drawing production in hemispatial neglect

Spatially lateralised deficits that typically define the hemispatial neglect syndrome have been shown to co-occur with other non-lateralised deficits of attention, memory, and drawing. However even a simple graphic task involves multiple planning components, including the specification of drawing start position and drawing direction. In order to investigate the influence of these factors in neglect we presented patients with a circle-copying task, and specified the drawing start point. The ability to draw from the instructed location was strongly related to tests that measure constructional abilities, but not related to start point laterality. In contrast, the direction in which patients drew the circle was affected by start point laterality: patients with neglect were less likely to draw in a typical direction when the cue was on the affected side of space and this was strongly related to severity of the neglect. Patients with neglect consistently produced circles that were smaller than the model; however, the scaling was not affected by the laterality of the start point, nor was the proportion of drawings correctly started at the cue. These findings demonstrate the complex relationship between neglect and even the simplest test for the syndrome.

Characterizing exploration behavior in spatial neglect: omissions and repetitive search

In search tasks, patients with spatial neglect typically fail to respond to stimuli on the contralesional side. Such behavior has been associated with hyperattention to the ipsilesional side and a deficit in disengaging from attended stimuli. The present study investigated whether such explanations can also account for a further kind of behavior frequently shown by neglect patients: repetitive returns to previously indicated stimuli, particularly on the ipsilesional side. A group of neglect patients was tested along with a group of healthy participants and a patient control group without neglect. Participants performed an exploration task in which they searched for targets defined by their shape or for all stimuli either with the aid of vision or blindfolded. The results showed differential effects of reducing the salience of visual stimuli by blindfolding. For a subgroup of patients, detection rate improved, while for others the percentage of omissions increased. However, contrary to the control groups, blindfolding had no effect on repetitive search in the neglect group, inconsistent with hyperattention, a disengage or impaired working memory deficits. The rate of repetitive returns to previously indicated locations did not seem to be associated with the percentage of omitted stimuli, suggesting that repetitive returns may be best explained by a disruption of systematic search and lack of volitional control in spatial neglect. The results further underline the importance of considering repetitive search behavior in addition to omissions in standard neglect assessments.

Effects of emotional face cueing on line bisection in neglect: a single case study

One patient with left neglect (FM) and four right brain-damaged controls were tested on a line bisection task with pictures of neutral and emotional faces as unilateral cues. We thus manipulated the attentional salience of the cues (higher for emotional and lower for neutral faces) while keeping constant their physical dimensions. Our findings showed that left emotional faces were more effective than left neutral faces in reducing bisection errors only in FM. These data indicate that in the neglected hemispace cues bias attention rather than simply altering the perceptual point of balance of the line in the horizontal plane.

The effect of hemispatial neglect on the perception of centre

Highly variable bisection performance in neglect patients has been attributed to an increased 'zone of indifference'. The indifference zone indicates the discrepancy between two line lengths which are judged as equal in length. Following this argumentation, the central area of a line should be expanded in neglect patients. The present two experiments investigated for the first time the expansion of the central area using a modified version of the Landmark Task. The location of a central or asymmetrical bisection mark on a horizontal line had to be judged (centre/left/right). In both experiments neglect patients, unlike healthy and patient controls, showed clear deficits in judging the location of the mark correctly and tended to judge asymmetrical marks of up to 4 cm as centrally positioned. The results are in agreement with and provide the first clear evidence of an enlarged perceptual zone of indifference in patients with hemispatial visual neglect.

Trunk- and head-centred spatial coordinates do not affect free-viewing perceptual asymmetries

Turning the trunk or head to the left can reduce the severity of leftward neglect. This study sought to determine whether turning the trunk or head to the right would reduce pseudoneglect: A phenomenon where normal participants underestimate the rightward features of a stimulus. Participants made luminance judgements of two mirror-reversed greyscales stimuli. A preference for selecting the stimulus dark on the left was found. The effect of trunk-centred coordinates was examined in Expt. 1 by facing the head toward the display and turning the trunk to the left, right or toward the display. Head-centred coordinates were examined in Expt. 2 by directing the eyes toward the display and then turning the head and trunk. No effect of rotation was observed. It was concluded that the leftward bias for the greyscales task could be based on an object-centred attentional bias or left-to-right eye scanning habits.

Eye-movement patterns do not mediate size distortion effects in hemispatial neglect: looking without seeing

Over the last decade a range of studies have shown that some patients with hemispatial neglect subjectively underestimate the size of objects presented in their contralesional hemispace. Recently, it has been suggested that the effect is simply due to either hemianopia [Brain 124 (2001) 527], or the combination of neglect and hemianopia [Neurology 52 (1999) 1845]. In the current study we asked right hemisphere lesioned patients with and without neglect and hemianopia as well as healthy controls to judge either two horizontal or vertical lines presented simultaneously in right and left hemispace and monitored their eye movements. Three out of the six patients showed the predicted size distortion effect for horizontal lines. We found no evidence that the effect was mediated by eye movements. The two neglect patients who showed the strongest left side underestimation showed symmetrical (left, right) scanning of the lines both in terms of number of fixations and fixation time, yet they still failed to judge the relative size veridically. In addition, we did not find strong evidence for a link with hemianopia. We therefore propose that the effect reflects a computational/representational failure of processing for horizontal extent.