Neglected attention in apparent spatial compression

Visual and motor neglect: Clinical and neurocognitive aspects

Attention allows us to prioritize the processing of external information according to our goals, but also to cope with sudden, unforeseen events. Attention processes rely on the coordinated activity of large-scale brain networks. At the cortical level, these systems are mainly organized in fronto-parietal networks, with functional and anatomical asymmetries in favor of the right hemisphere. Dysfunction of these right-lateralized networks often produce severe deficit of spatial attention, such as visual neglect. Other brain-damaged patients avoid moving the limbs contralateral to their brain lesion, even in the absence of sensorimotor deficits (motor neglect). This paper first summarizes past and current evidence on brain networks of attention; then, it presents clinical and experimental findings on visual and motor neglect, and on the possible mechanisms of clinical recovery.

When brain damage "improves" perception: neglect patients can localize motion-shifted probes better than controls

When we look at bars flashed against a moving background, we see them displaced in the direction of the upcoming motion (flash-grab illusion). It is still debated whether these motion-induced position shifts are low-level, reflexive consequences of stimulus motion or high-level compensation engaged only when the stimulus is tracked with attention. To investigate whether attention is a causal factor for this striking illusory position shift, we evaluated the flash-grab illusion in six patients with damaged attentional networks in the right hemisphere and signs of left visual neglect and six age-matched controls. With stimuli in the top, right, and bottom visual fields, neglect patients experienced the same amount of illusion as controls. However, patients showed no significant shift when the test was presented in their left hemifield, despite having equally precise judgments. Thus, paradoxically, neglect patients perceived the position of the flash more veridically in their neglected hemifield. These results suggest that impaired attentional processes can reduce the interaction between a moving background and a superimposed stationary flash, and indicate that attention is a critical factor in generating the illusory motion-induced shifts of location.

Attentional routes to conscious perception

The relationships between spatial attention and conscious perception are currently the object of intense debate. Recent evidence of double dissociations between attention and consciousness cast doubt on the time-honored concept of attention as a gateway to consciousness. Here we review evidence from behavioral, neurophysiologic, neuropsychological, and neuroimaging experiments, showing that distinct sorts of spatial attention can have different effects on visual conscious perception. While endogenous, or top-down attention, has weak influence on subsequent conscious perception of near-threshold stimuli, exogenous, or bottom-up forms of spatial attention appear instead to be a necessary, although not sufficient, step in the development of reportable visual experiences. Fronto-parietal networks important for spatial attention, with peculiar inter-hemispheric differences, constitute plausible neural substrates for the interactions between exogenous spatial attention and conscious perception.

Dissecting the component deficits of perceptual imbalance in visual neglect: evidence from horizontal-vertical length comparisons

INTRODUCTION

Signs of left unilateral neglect often occur after damage to the right hemisphere and entail a left-right imbalance in stimulus processing. Typically, neglect patients deviate rightward when bisecting lines. An underestimation of the left portion of the line and/or a right overestimation could explain this effect.

METHODS

Here we dissected their respective contribution by asking participants to compare a vertical segment to a horizontal segment, either on the left or on the right. We also tested whether neglect patients exhibited the symmetry law, whereby normal participants underestimate symmetrically bisected lines as compared to asymmetrically bisected lines.

RESULTS

Controls and patients underestimated symmetric figures. Depending on the degree of left-right horizontal competition, neglect patients underestimated left-sided stimuli or overestimated right-sided stimuli.

CONCLUSIONS

We concluded that two independent deficits contribute to neglect signs: a deficit in attentional orienting to the left, which can be worsened by left hemianopia, perhaps depending on impaired functioning of right-hemisphere attentional networks, and a tendency for attention to be captured by right-sided stimuli, possibly resulting from the activity of an isolated left hemisphere. Finally, the symmetry law was preserved in neglect patients, and thus appears to be driven by pre-attentive mechanisms.

Visual search patterns in neglect: comparison of peripersonal and extrapersonal space

Previous studies of visual search patterns in visuospatial neglect have analyzed shifts of attention during search tasks using eye tracking technology and verbal reports. The purpose of the present study was to replicate and extend upon reported parameters of visual scanning patterns of neglect patients in peripersonal space (within arms reach) and to examine whether similar patterns of visual search are also apparent in extrapersonal space (beyond arms reach). Using a simple verbal visual search and target detection paradigm right-hemisphere stroke participants, with and without neglect, and healthy older volunteers named targets on scanning sheets placed in peripersonal and extrapersonal space. The healthy controls and right-hemisphere stroke group without neglect showed similar 'reading' type strategies, while the neglect group displayed an unsystematic search pattern, during search in both peripersonal and extrapersonal space. Group comparisons of search parameters support the presence of multiple cognitive deficits affecting the complex visual search patterns of neglect patients, including a rightward attentional bias, a reduced spatial scale of attention (local processing bias), and a deficit of working memory affecting both near and far space search. Ventral visual stream damage and neglect, however, were related to slower target report rate and more misidentification errors in extrapersonal space. The ease of administration of this verbal target detection task in both peripersonal and extrapersonal space, and the relationship of the measures produced to theorized attentional and executive deficits in neglect, provide impetus for further research on the severity and independence of individual scanning deficits in neglect.

Differential and co-involvement of areas of the temporal and parietal streams in visual tasks

Transcranial magnetic stimulation (TMS) is particularly useful in teasing apart the contrasting contributions of different anatomical and functional systems in particular aspects of behaviour, for example the involvement of the dorsal and ventral visual streams in tasks involving the perception of distance, shape and colour. In order to investigate the dual involvement of two areas, namely right posterior parietal cortex (PPC) and lateral occipital cortex (LO), in a distance discrimination task, neural processing in both areas was concurrently disrupted using dual site TMS. Although there was no change in error rates, reaction time was significantly lengthened over that seen with TMS over either site alone. This additive effect indicates that both PPC and LO are concurrently active and essential for efficient processing of this task. The second experiment investigated the specificity of function within the ventral stream. Performance was assessed for distance and shape discrimination when TMS was applied to our original LO site and an area rostral to V5 but still part of the lateral occipital complex (rostral LOC) that is activated in form and colour discrimination. Performance deficits were restricted to TMS over LO; no significant impairment for either task followed TMS at the rostral LOC site.

Left visual neglect: is the disengage deficit space- or object-based?

Attention can be directed to spatial locations or to objects in space. Patients with left unilateral spatial neglect are slow to respond to a left-sided target when it is preceded by a right-sided "invalid" cue, particularly at short cue-target intervals, suggesting an impairment in disengaging attention from the right side in order to orient it leftward. We wondered whether this deficit is purely spatial, or it is influenced by the presence of a right-sided visual object. To answer this question, we tested 10 right brain-damaged patients with chronic left-neglect and 41 control participants on a cued response time (RT) detection task in which targets could appear in either of two lateral boxes. In different conditions, non-informative peripheral cues either consisted in the brightening of the contour of one lateral box (onset cue condition), or in the complete disappearance of one lateral box (offset cue condition). The target followed the cue at different stimulus-onset asynchronies (SOAs). If the disengagement deficit (DD) is purely space-based, then it should not vary across the two cueing conditions. With onset cues, patients showed a typical DD at short SOAs. With offset cues, however, the DD disappeared. Thus, patients did not show any DD when there was no object from which attention must be disengaged. These findings indicate that the attentional bias in left-neglect does not concern spatial locations per se, but visual objects in space.

Visual neglect

PURPOSE OF REVIEW

Left visual neglect is a frequent and dramatic consequence of right hemisphere lesions. Diagnosis is important because behavioural and pharmacological treatments are available. Furthermore, neglect raises important issues concerning the brain mechanisms of consciousness, perception and attention.

RECENT FINDINGS

Recent behavioural findings and new techniques, such as transcranial magnetic stimulation, direct cortical and subcortical stimulation during brain surgery, and diffusion tensor imaging tractography, have provided evidence relevant to the debate concerning the functional mechanisms and the anatomical bases of neglect.

SUMMARY

Several component deficits appear to interact in producing different forms of neglect. Rather than lesions at single cortical levels, dysfunction of large-scale brain networks, often induced by white matter disconnection, may constitute the crucial antecedent of neglect signs.

Line bisection in left neglect: the importance of starting right

When marking the subjective midpoint of a horizontal line, patients with left unilateral neglect typically deviate rightward. Different accounts of this pattern of performance refer either to a biased competition between the two hemi-segments of the line, with the right part being subjectively perceived as longer than the left part, or to a distortion of a cognitive representation of space, with spatial coordinates progressively relaxing from the right to the left. These accounts make different predictions about the role of the right part of the line, which is crucial in the biased competition account, but less important in the distortion account. To test these predictions, we asked participants to set the endpoints and the centre of perceived and imaginary lines. Contrary to previous studies, we controlled for the direction of performance of the endpoint task, with left-to-right trials and right-to-left trials being performed in separate blocks. Five patients with right-hemisphere lesions and left neglect demonstrated the typical asymmetries when a right-sided stimulus (segment or endpoint) was present, but showed either normal performance or a reversed (leftward) bias while setting the endpoints and the centre of an imaginary line starting from the left side, when no right-sided visual stimulus was present until completion of each trial. We concluded that the right-sided portion of the line has a crucial importance in determining patients' rightward deviations in line bisection, consistent with the biased competition hypothesis and with neurocognitive models of attentional orienting.

Modeling orienting behavior and its disorders with "ecological" neural networks

Computational modeling is a useful tool for spelling out hypotheses in cognitive neuroscience and testing their predictions in artificial systems. Here we describe a series of simulations involving neural networks that learned to perform their task by self-organizing their internal connections. The networks controlled artificial agents with an orienting eye and an arm. Agents saw objects with various shapes and locations and learned to press a key appropriate to their shape. The results showed the following: (1) Despite being able to see the entire visual scene without moving their eye, agents learned to orient their eye toward a peripherally presented object. (2) Neural networks whose hidden layers were previously partitioned into units dedicated to eye orienting and units dedicated to arm movements learned the identification task faster and more accurately than did nonmodular networks. (3) Nonetheless, even nonmodular networks developed a similar functional segregation through self-organization of their hidden layer. (4) After partial disconnection of the hidden layer from the input layer, the lesioned agents continued to respond accurately to single stimuli, wherever they occurred, but on double simultaneous stimulation they oriented toward and responded only to the right-sided stimulus, thus simulating extinction/neglect. These results stress the generality of the advantages provided by orienting processes. Hard-wired modularity, reminiscent of the distinct cortical visual streams in the primate brain, provided further evolutionary advantages. Finally, disconnection is likely to be a mechanism of primary importance in the pathogenesis of neglect and extinction symptoms, consistent with recent evidence from animal studies and brain-damaged patients.

Time course of the involvement of the ventral and dorsal visual processing streams in a visuospatial task

A previous transcranial magnetic stimulation (TMS) study [Ellison, A., & Cowey, A. (2006). TMS can reveal contrasting functions of the dorsal and ventral visual processing streams. Experimental Brain Research, 175, 618-625] showed that both the dorsal and ventral cortical visual processing streams are involved in the processing of a task in which judgement of relative spatial position is required. In order to determine whether both streams are active in a parallel or serial manner, a double pulse TMS (20 Hz) experiment was carried out to expose peaks of disruption, indicative of when each of the areas under investigation is most potently involved. Results show that TMS over lateral occipital cortex produces greater disruption of performance than that provoked by TMS over posterior parietal cortex, significantly so when applied at 50 and 100 ms post-visual array onset. Both areas showed peaks of disruption up to 350 ms after visual stimulus onset. The results are discussed with respect to why each of these areas is involved in this task and what the pattern of their involvement reveals.

Négligence spatiale unilatérale : une conséquence dramatique mais souvent négligée des lésions de l’hémisphère droit

INTRODUCTION

Unilateral Spatial Neglect (USN) is a common consequence of right brain damage. In the most severe cases, behavioral signs of USN can last several years and compromise patients' autonomy and social rehabilitation. These clinical facts stress the need for reliable procedures of diagnosis and rehabilitation.

STATE OF THE ART

The last 3 decades have witnessed an explosion of studies on USN, which raises issues related to complex cognitive activities such as mental representation, spatial attention and consciousness. USN is probably a heterogeneous syndrome, but some of its underlying mechanisms might be understood as an association of disorders of spatial attention. A bias of automatic orienting towards right-sided objects seems typical of left USN. Afterwards, patients find it difficult to disengage their attention in order to explore the rest of the visual scene. Neglected objects are sometimes processed in an "implicit" way.

PERSPECTIVES

The development of behavioural paradigms and of neuroimaging techniques and their application to the study of USN has advanced our understanding of the functional mechanisms of attention and spatial awareness, as well as of their neural bases. A number of new procedures for rehabilitation have recently been proposed.

CONCLUSION

The present review describes the clinical presentation of USN, its anatomical basis and some of possible accounts of different aspects of neglect behavior. Results of computer simulations and of rehabilitation techniques are also presented with implications for the functioning of normal neurocognitive systems.

TMS can reveal contrasting functions of the dorsal and ventral visual processing streams

In order to investigate the functional specificity of the dorsal and ventral visual processing steams we used transcranial magnetic stimulation (TMS) to briefly disrupt one or the other while subjects performed three tasks, involving discrimination of colour or shape or relative position. TMS was delivered over right posterior parietal cortex (PPC) or right lateral occipital (LO) cortex, regions known to have visuo-spatial and object processing properties respectively. LO but not PPC stimulation had a significant effect on reaction time when subjects were asked to make a discrimination of relative shape. PPC stimulation had a significant effect when subjects were asked to discriminate relative position of the same shapes. Stimulation of LO also lengthened reaction times on the position task. There were no effects of stimulation at either site on colour discrimination. Results are discussed within the framework of how the dorsal stream and ventral stream are dissociated following their damage in neurological patients and possible ways in which they may interact in the normal brain.

Unilateral Neglect is not Unilateral: Evidence for Additional Neglect of Extreme Right Space

Six patients with visuospatial neglect following right hemisphere lesions were given three tasks that assessed performance in areas of space ranging from extreme left to extreme right. A line bisection task required the patients to detect and bisect lines of four different lengths at seven left-right spatial locations, a number report task required the patients to name 11 two-digit numbers in a left-right array, and a tiling task required patients to place small black tiles over the black squares of a grid that stretched from 65 degrees left to 65 degrees right. Performance was compared with that of 20 age-matched controls. The patients showed the characteristic signs of left-side neglect in left space, extending to the central midline. Performance was relatively normal in centre-right space but all 6 patients showed signs of neglect of extreme right space (60 degrees to the right of the midline and beyond). We propose that neglect is best characterised as a bilateral, asymmetrical compression of experienced space in which the constriction extends further from the left than from the right but nevertheless affects both sides of space.

Prism adaptation and unilateral neglect: Review and analysis

Theory and data from normal prism adaptation are applied toward understanding the ameliorating effects of prism adaptation for left unilateral neglect patients. Neglect is proposed to be, at least in part, a dysfunction in selection of the region of space appropriate for the task at hand. Normally, a task-work space is strategically sized and positioned (calibrated) around the task-relevant objects. Patients show deficits in both strategic abilities: the task-work space is pathologically reduced in size and patients cannot strategically shift its position. Prism adaptation (spatial realignment) ameliorates dysfunctional positioning, but not sizing of the task-work space. Realignment shifts the egocentric coordinates of a sensory-motor reference frame, thereby bringing at least part of the neglected hemispace into the dysfunctional task-work space: prism adaptation substitutes for dysfunctional positioning, but not sizing of a task-work space. However, such amelioration of dysfunctional positioning may enable relearning of strategic processes (calibration), perhaps, even partially restoring the ability to appropriately size the task-space. Investigation of therapeutic prism adaptation requires methods that permit identification of both the calibration dysfunction and ameliorating realignment.

Underestimation of contralateral space in neglect: a deficit in the “where” task

Space perception was investigated in right brain damaged patients with ( N=13) and without neglect ( N=5; control group). Patients were requested to localise a target tachistoscopically flashed at various eccentricities along the horizontal meridian. All patients had an intact visual field and spared ability to manually point to a target. To segregate magno- and parvo-pathway activity, stimuli modulated in either luminance or chromatic contrast were used. Patients were required to verbally report the stimulus position (verbal task) or to manually point to the stimulus (pointing task). Neglect patients reported the stimuli in the left visual field closer to the centre than they actually were. In the verbal test, underestimation was about 7 deg at the most eccentric position tested (20 deg), and decreased linearly for smaller eccentricities. The effect was similar but less marked in the pointing task. No difference was found for stimuli with luminance or chromatic contrast. Space underestimation was confined to the contralesional space; no evidence of misperception was detected in the ipsilesional hemifield. The present findings are consistent with the view that contralesional space representation is compressed in neglect patients.