Patterns of dissociation between left hemineglect and deviation of the egocentric reference

The Effect of Aerobic Exercise on Visuospatial Attention in Young Adults

Our objective in this study was to investigate the effect of moderate-intensity aerobic exercise on visuospatial attention bias. We examined line bisection performance at rest before exercise and then immediately after exercise in 20 young adults. Pre-exercise, there was a larger leftward bias in subjective midpoint judgment of all participants than post-exercise (p < .001). Thus, leftward error magnitude decreased according to aerobic exercise, as there were rightward shifts after the exercise. The participants' performancse were modulated by the hand used to perform manual bisection tasks (p < .02). Participants erred to the left of the true midpoint with the non-dominant hand and to the right of the true midpoint with the dominant hand. The use of the non-dominant hand led to greater leftward error than the errors obtained using the dominant hand, though there was no interaction effect between hand use and effort. These findings suggest that moderate aerobic exercise can benefit visuospatial attention in adults.

Exploring the effects of ecological activities during exposure to optical prisms in healthy individuals

Prism adaptation improves a wide range of manifestations of left spatial neglect in right-brain-damaged patients. The typical paradigm consists in repeated pointing movements to visual targets, while patients wear prism goggles that displace the visual scene rightwards. Recently, we demonstrated the efficacy of a novel adaptation procedure, involving a variety of every-day visuo-motor activities. This "ecological" procedure proved to be as effective as the repetitive pointing adaptation task in ameliorating symptoms of spatial neglect, and was better tolerated by patients. However, the absence of adaptation and aftereffects measures for the ecological treatment did not allow for a full comparison of the two procedures. This is important in the light of recent findings showing that the magnitude of prism-induced aftereffects may predict recovery from spatial neglect. Here, we investigated prism-induced adaptation and aftereffects after ecological and pointing adaptation procedures. Forty-eight neurologically healthy participants (young and aged groups) were exposed to rightward shifting prisms while they performed the ecological or the pointing procedures, in separate days. Before and after prism exposure, participants performed proprioceptive, visual, and visual-proprioceptive tasks to assess prism-induced aftereffects. Participants adapted to the prisms during both procedures. Importantly, the ecological procedure induced greater aftereffects in the proprioceptive task (for both the young and the aged groups) and in the visual-proprioceptive task (young group). A similar trend was found for the visual task in both groups. Finally, participants rated the ecological procedure as more pleasant, less monotonous, and more sustainable than the pointing procedure. These results qualify ecological visuo-motor activities as an effective prism-adaptation procedure, suitable for the rehabilitation of spatial neglect.

Reach endpoint errors do not vary with movement path of the proprioceptive target

Previous research has shown that reach endpoints vary with the starting position of the reaching hand and the location of the reach target in space. We examined the effect of movement direction of a proprioceptive target-hand, immediately preceding a reach, on reach endpoints to that target. Participants reached to visual, proprioceptive (left target-hand), or visual-proprioceptive targets (left target-hand illuminated for 1 s prior to reach onset) with their right hand. Six sites served as starting and final target locations (35 target movement directions in total). Reach endpoints do not vary with the movement direction of the proprioceptive target, but instead appear to be anchored to some other reference (e.g., body). We also compared reach endpoints across the single and dual modality conditions. Overall, the pattern of reaches for visual-proprioceptive targets resembled those for proprioceptive targets, while reach precision resembled those for the visual targets. We did not, however, find evidence for integration of vision and proprioception based on a maximum-likelihood estimator in these tasks.

Bisecting real and fake body parts: effects of prism adaptation after right brain damage

The representation of body parts holds a special status in the brain, due to their prototypical shape and the contribution of multisensory (visual and somatosensory-proprioceptive) information. In a previous study (Sposito et al., 2010), we showed that patients with left unilateral spatial neglect exhibit a rightward bias in setting the midpoint of their left forearm, which becomes larger when bisecting a cylindrical object comparable in size. This body part advantage, found also in control participants, suggests partly different processes for computing the extent of body parts and objects. In this study we tested 16 right-brain-damaged patients, and 10 unimpaired participants, on a manual bisection task of their own (real) left forearm, or a size-matched fake forearm. We then explored the effects of adaptation to rightward displacing prism exposure, which brings about leftward aftereffects. We found that all participants showed prism adaptation (PA) and aftereffects, with right-brain-damaged patients exhibiting a reduction of the rightward bias for both real and fake forearm, with no overall differences between them. Second, correlation analyses highlighted the role of visual and proprioceptive information for the metrics of body parts. Third, single-patient analyses showed dissociations between real and fake forearm bisections, and the effects of PA, as well as a more frequent impairment with fake body parts. In sum, the rightward bias shown by right-brain-damaged patients in bisecting body parts is reduced by prism exposure, as other components of the neglect syndrome; discrete spatial representations for real and fake body parts, for which visual and proprioceptive codes play different roles, are likely to exist. Multisensory information seems to render self bodily segments more resistant to the disruption brought about by right-hemisphere injury.

Neglect: a multisensory deficit?

Neglect is a neurological syndrome characterised by a lack of conscious perception of events localised in the contralesional side of space. Here, we consider the possible multisensory nature of this disorder, critically reviewing the literature devoted to multisensory manifestations and processing in neglect. Although its most striking manifestations have been observed in the visual domain, a number of studies demonstrate that neglect can affect virtually any sensory modality, in particular touch and audition. Furthermore, a few recent studies have reported a correlation in severity between visual and non-visual neglect-related deficits evaluated in the same patients, providing some preliminary support for a multisensory conception of neglect. Sensory stimulation and sensorimotor adaptation techniques, aimed at alleviating neglect, have also been shown to affect several sensory modalities, including some that were not directly affected by the intervention. Finally, in some cases neglect can bias multisensory interactions known to occur in healthy individuals, leading to abnormal behaviour or uncovering multisensory compensation mechanisms. This evidence, together with neurophysiological and neuroimaging data revealing the multisensory role played by the areas that are most commonly damaged in neglect patients, seems to speak in favour of neglect as a multisensory disorder. However, since most previous studies were not conducted with the specific purpose of systematically investigating the multisensory nature of neglect, we conclude that more research is needed to appropriately assess this question, and suggest some methodological guidelines that we hope will help clarify this issue. At present, the conception of neglect as a multisensory disorder remains a promising working hypothesis that may help define the pathophysiology of this syndrome.

Parkinson's disease as a disconnection syndrome

Parkinson's disease (PD) is a major neurodegenerative disorder that is usually considered in terms of midbrain and basal ganglia dysfunction. Regarding PD instead as a disconnection syndrome may prove beneficial to understanding aspects of cognition, perception, and other neuropsychological domains in the disease. PD is usually of unilateral onset, providing evidence of intrahemispheric dissociations and an imbalance in the usual relative strengths of the right and left hemispheres. Hence, in order to appreciate the neuropsychology of PD, it is important to apply to this disease our understanding of hemispheric lateralization effects and within-hemisphere circuitry from brainstem to higher-order association cortex. The focus of this review is on the relevance of PD-related disconnections among subcortical and cortical structures to cognition, perception, emotion, and associated brainstem-based domains such as sleep and mood disturbance. Besides providing information on disease characteristics, regarding PD as a disconnection syndrome allows us to more completely understand normal brain-behavior relations in general.

Long lasting egocentric disorientation induced by normal sensori-motor spatial interaction

BACKGROUND

Perception of the cardinal directions of the body, right-left, up-down, ahead-behind, which appears so absolute and fundamental to the organisation of behaviour can in fact, be modified. Perhaps unsurprisingly, it has been shown that prolonged distorted perception of the orientation of body axes can be a consequence of disordered sensori-motor signals, including long-term prismatic adaptation and lesions of the central nervous system. We report the novel and surprising finding that a long-lasting distortion of perception of personal space can also be induced by an ecological pointing task without the artifice of distorting normal sensori-motor relationships.

METHODOLOGY/PRINCIPAL FINDINGS

Twelve right-handed healthy adults performed the task of pointing with their arms, without vision, to indicate their subjective 'straight ahead', a task often used to assess the Egocentric Reference. This was performed before, immediately, and one day after a second task intended to 'modulate' perception of spatial direction. The 'modulating' task lasted 5 minutes and consisted of asking participants to point with the right finger to targets that appeared only in one (right or left) half of a computer screen. Estimates of the 'straight-ahead' during pre-test were accurate (inferior to 0.3 degrees deviation). Significantly, up to one day after performing the modulating task, the subjective 'straight-ahead' was deviated (by approximately 3.2 degrees) to the same side to which subjects had pointed to targets.

CONCLUSION/SIGNIFICANCE

These results reveal that the perception of directional axes for behaviour is readily influenced by interactions with the environment that involve no artificial distortion of normal sensori-motor-spatial relationships and does not necessarily conform to the cardinal directions as defined by the anatomy of orthostatic posture. We thus suggest that perceived space is a dynamic construction directly dependent upon our past experience about the direction and/or the localisation of our sensori-motor spatial interaction with environment.

Impact of optic flow perception and egocentric coordinates on veering in Parkinson's disease

Spatial navigation is a complex process requiring integration of visuoperceptual information. The present study examined how visuospatial function relates to navigational veering in Parkinson's disease, a movement disorder in which visuospatial cognition is affected by the degeneration of the basal ganglia and resulting dysfunction of the parietal lobes. We hypothesized that patients whose initial motor symptoms start on the left versus right side of the body (LPD, predominant right-hemisphere dysfunction; RPD, predominant left-hemisphere dysfunction) would display distinct patterns of navigational veering associated with the groups' dissimilar visuospatial profiles. Of particular interest was to examine the association of navigational veering (lateral deviation along the medio-lateral axis) with perception of egocentric coordinates and of radial optic flow patterns, both of which are mediated by the parietal lobes. Thirty-one non-demented Parkinson's disease patients (16 LPD, 15 RPD) and 18 healthy control (HC) adults received visuospatial tests, of whom 23 Parkinson's disease patients and 17 HC also underwent veering assessment. The participants were examined on three visual-feedback navigation conditions: none (eyes closed), natural, and optic flow supplied by a virtual-reality headset. All groups veered to the left when walking with eyes closed, women with Parkinson's disease more so than the other participants. On the navigation assessments with visual feedback, only LPD patients deviated right of centre. On tests of visuospatial function, the perceived midline was shifted rightward in LPD (men and women), increasingly so with the addition of visual input. In contrast, men with RPD showed leftward deviation. RPD patients and HC perceived optic flow in the left hemifield as faster than in the right hemifield, with a trend for the opposite pattern for LPD. Navigational veering in LPD was associated with deviation of the perceived egocentric midline and not with perception of optic flow speed asymmetries, and in RPD it was also associated with visual dependence, though in fact LPD subjects were more visually dependent than those with RPD. Our results indicate that (i) parietal-mediated perception of visual space is affected in Parkinson's disease, with both side of motor symptom onset and gender affecting spatial performance, and (ii) visual input affects veering.

Egocentric reference in bidirectional readers as measured by the straight-ahead pointing task

The present study aimed to show that bidirectional reading and language exposure influence the position of egocentric reference (ER), the perceived direction of the body's sagittal axis proposed to act as an anchor for movements in extracorporeal space. Directional factors (e.g., visual scanning bias and reading habits) have been proposed to influence visuospatial performance, such as in line bisection and figure drawing. In past studies, bidirectional readers have been less consistent in demonstrating a bias compared to unidirectional readers. Using a straight-ahead pointing task to assess egocentric reference, we compared 14 unidirectional left-to-right readers (Uni-LR) to three bidirectional reading groups that differed in the reading direction of their native language and/or the level of their second language literacy: 16 low-English literate, native right-to-left, bidirectional readers (Lo-Bi-RL), 13 high-English literate, native right-to-left, bidirectional readers (Hi-Bi-RL), and 15 native left-to-right, bidirectional readers (Bi-LR). Participants were asked to point straight-ahead while blindfolded using either a left-to-right or a right-to-left scanning direction to approach the subjective sagittal midline. Uni-LRs showed left-side spatial bias when scanning left-to-right and right-side bias during right-to-left scanning, Bi-LRs and Lo-Bi-RLs (i.e., intermediate level or less in their second language) demonstrated the opposite pattern, and Hi-Bi-RLs showed left-side spatial bias regardless of scanning direction. Results are discussed in terms of accuracy and spatial bias regarding the interaction between reading direction and spatial cognition based on the level of bidirectional literacy and language exposure.

Prism adaptation aftereffects in stroke patients with spatial neglect: pathological effects on subjective straight ahead but not visual open-loop pointing

Prism adaptation to rightward optical shifts during visually guided pointing is considered a promising intervention in right-hemisphere stroke patients with left spatial neglect. Conventionally, prism adaptation is assessed via aftereffects, on subjective straight ahead (SSA) pointing with eyes closed; or by visual open-loop pointing (VOL), i.e. pointing to a visual target without seeing the hand. Previous data suggest indirectly that prism aftereffects in neglect patients may be larger (pathologically so) when assessed by SSA than by VOL. But these measures have never been directly compared within the same patients after identical prism exposure. Accordingly we implemented both measures here within the same group of 13 neglect patients and 13 controls. Prism aftereffects were much larger for SSA than VOL in neglect patients, falling outside the normative range only for SSA. This may arise because the SSA task can itself involve aspects of neglect that may be ameliorated by the prism intervention, hence showing abnormal changes after prisms. The extent of SSA change after prisms varied between patients, and correlated with improvements on a standard cancellation measure for neglect. The lesions of patients who did versus did not show neglect improvement immediately after prisms provide an initial indication that lack of improvement may potentially relate to cortical damage in right intraparietal sulcus and white matter damage in inferior parietal lobe and middle frontal gyrus. Future studies of possible rehabilitative impact from prisms upon neglect may need to consider carefully how to measure prism adaptation per se, separately from any impact of such adaptation upon manifestations of neglect.

Experimental remission of unilateral spatial neglect

Over the past several decades a growing amount of research has focused on the possibility of transiently reducing left neglect signs in right brain-damaged patients by using vestibular and/or visuo-proprioceptive stimulations. Here we review seminal papers dealing with these visuo-vestibulo-proprioceptive stimulations in normal controls, right brain-damaged (RBD) patients, and animals. We discuss these data in terms of clinical implications but also with regards to theoretical frameworks commonly used to explain the unilateral neglect syndrome. We undermine the effect of these stimulations on the position of the egocentric reference and extend the notion that the positive effects of these stimulation techniques may stem from a reorientation of attention towards the neglected side of space or from a recalibration of sensori-motor correlations. We conclude this review with discussing the possible interaction between experimental rehabilitation, models of neglect and basic spatial cognition research.

The egocentric reference deviation of neglect patients is influenced by visuospatial attention

The right deviation of the subjective straight-ahead (SSA), representing a deviation of the body centered spatial reference frame (egocentric reference), is a frequent phenomenon in spatial neglect. Little is known about the influence of visuo-spatial attention on this SSA shift. The aim of this study was to investigate the influence of eye direction (overt attention) and perception of the visual background (covert attention) on the SSA pointing. We included 12 patients with right hemisphere stroke. Six were classified as neglect (N+) and compared to the six non neglect (N-) patients and 19 normal control subjects (C). They had to point straight-ahead (right hand) on an horizontal board. Pointing was performed in the light or in darkness, first with spontaneous eye direction, then while fixating a visual target (-15 degrees , 0 degrees , +15 degrees ). A first ANOVA of factors group, eye direction (left, center, right fixation) and visual context (light, darkness) showed a right SSA deviation in N+ patients only, which was more severe in the light than in darkness. In this group, the SSA was shifted in the same direction as the target, while that of N- and C groups was mildly shifted in the opposite direction. The comparison of spontaneous and central fixation conditions also showed an eye direction by group interaction, as the spontaneous right SSA deviation was reduced by central fixation in N+ patients only. These results suggest that, in neglect patients, the egocentric reference deviation is not a fixed phenomenon, and that it can be influenced by manipulation of both overt and covert spatial attention.

Poor hand-pointing to sounds in right brain-damaged patients: Not just a problem of spatial-hearing

We asked 22 right brain-damaged (RBD) patients and 11 elderly healthy controls to perform hand-pointing movements to free-field unseen sounds, while modulating two non-auditory variables: the initial position of the responding hand (left, centre or right) and the presence or absence of task-irrelevant ambient vision. RBD patients suffering from visual neglect, unlike RBD patients without neglect and healthy controls, showed a systematic rightward error in sound localisation, which was modulated by the non-auditory variables. Localisation errors were exacerbated by initial hand-position to the right of the body-midline, and reduced by the leftwards initial hand-position. Moreover, for the visual neglect patients, mere presence of ambient vision worsened localisation errors. These results demonstrate that although hand-pointing to sounds has often been considered a straightforward approach to investigate sound-localisation abilities in brain-damaged patients, in some patients it may actually reveal localisation deficits that reflect a combination of impaired spatial-hearing and spatial biases from other sensory modalities (i.e., vision and proprioception).

Revisiting unilateral neglect

Unilateral neglect, a neurological disorder in which patients fail to detect or respond to contralesional stimuli, has long been considered a failure of attentional orienting mechanisms. This review provides a selective overview of the prominent biases in spatial orienting and exploratory motor behaviour observed in these patients before considering the impact of other factors on the presentation of the disorder and how those factors might inform current neurological models of neglect. In the latter part of the review, we intend to suggest that neglect is likely to be a combination of distinct but interacting impairments including biases in attentional orienting, exploratory motor behaviours and a deficit of spatial working memory. That is, we suggest that the cardinal symptom of neglect - a loss of awareness for contralesional stimuli and events - arises as a result of a combination of these impairments rather than being associated solely with the more dramatic and immediately evident biases in spatial attention.

Selective rotation of egocentric spatial representation following right putaminal hemorrhage

Although the role of frontoparietal cortex in spatial egocentric processing is well established, recent animal-lesion and human functional imaging studies have suggested that the neostriatum may also be a critical modulator in the processing of body-centred spatial orientation. We describe here a patient with right putamen-centred hemorrhage who exhibited a consistent counterclockwise rotation of approximately 90 degrees when drawing and writing from memory. A more detailed assessment with a series of representational clock tests demonstrated that the rotation was present only in tasks requiring the use of egocentric cues. In the absence of external cues the patient would adopt and maintain a stable but incorrectly-oriented egocentric representation of the imagined or recollected object. By contrast, performance could be rectified by presentation of correctly-oriented stimuli. These findings suggest that the putamen is part of a circuit underlying egocentric, as opposed to allocentric, representation of space in humans.

Active versus passive proprioceptive straight-ahead pointing in normal subjects

Eighty blindfolded healthy female subjects participated in an active and a passive straight-ahead pointing task to study the estimation of the subjective sagittal middle in the presence or absence of an active haptic exploration. Subjects were to point straight-ahead with their left or right index finger starting from different right- or left-sided locations, while performing either an active movement or with the hand being passively moved by the examiner. Results showed: (i) a significant effect of the hand used only on the active straight-ahead pointing task performance; (ii) a significant effect of the starting position both on the active and passive pointing performance; (iii) a significant correlation between the two protocols only in terms of spatial bias (algebraic error) but not in terms of precision (absolute errors). These results are discussed with regards to normal and neuropsychological studies of the egocentric frame of reference.

Right parietal lesions, unilateral spatial neglect, and the egocentric frame of reference

Recently, the hypothesis has been proposed that the crucial mechanism leading to neglect is the disturbed transformation of sensory input into a supramodal egocentric frame of reference (ER), which causes in turn a deviation of this reference frame toward the side ipsilateral to the brain lesion. This egocentric coordinate system is normally centered on the midsagittal plane, but a unilateral brain lesion may cause a deviation of the egocentric reference due to an imbalance between the differentially lateralized neural processes which build this representation. Although neglect signs are often defined in an egocentric frame, and an ER shift may be observed in some right-brain-damaged patients (RBD), I present here several data that rule out any causal link between the deviation of the egocentric reference and the presence and/or severity of left-neglect signs in RBD patients.

Disturbed Sound Lateralization in Patients with Spatial Neglect

Previous studies on auditory space perception in patients with neglect have investigated localization of free-field-sound stimuli or lateralization of dichotic stimuli that are perceived intracranially. Since those studies in part revealed contradictory results, reporting either systematic errors to the left or systematic errors to the right, we reassessed the ability of auditory lateralization in patients with right hemispheric lesions with and without neglect. Unexpectedly, about half of the patients with neglect showed erratic judgments on sound position, that is, they were completely unable to lateralize sounds. The remaining neglect patients only showed a small deviation of the auditory median plane to the left side, indicating that they perceived the sounds as slightly shifted to the right side. The comparison between both groups revealed higher severity of neglect in the group of neglect patients who were unable to perform the task, suggesting that the inability of sound lateralization was associated with the strength of clinical neglect. However, we also observed 1 out of 9 patients with left brain damage who was not able to lateralize spatial sounds. This patient did not show any symptoms of spatial neglect. Thus, it may be that a spatial auditory deficit, such as that observed here in right-braindamaged patients, only co-occurs with spatial neglect if the right superior temporal cortex is lesioned.

Visual, proprioceptive and tactile performance in left neglect patients

Patients with unilateral spatial neglect due to right-hemisphere lesions typically fail to attend to and explore left-sided stimulus objects. It has been postulated that in right-brain damaged (RBD) patients an ipsilesional displacement of the egocentric frame of reference (ER), whether visual or tactile, may be responsible for a contralesional supramodal spatial bias causing their left neglect behavior. However, this hypothesis had been proposed without testing, in the same patients, the position of the ER or their performance in the visual and tactile modalities. Thus, the aim of the present study was to test the hypothesis that an ipsilateral shift of the ER is responsible for a supramodal spatial bias in neglect. For this purpose, a within-subject design is required. Consequently, 12 left neglect patients and 12 control subjects were asked to perform a proprioceptive straight-ahead pointing task while blindfolded, as well as visual and tactile bisection tasks. In the left neglect patients, we found:no systematic deviation of the ER on the ipsilesional right side;a significant rightward bias in visual bisection, and normal performance in tactile bisection;no correlation among the three tasks;that only visual bisection correlated with the severity of neglect. These results are discussed with regard to the egocentric and attentional hypothesis of neglect.

Visuomotor adaptation to optical prisms: a new cure for spatial neglect?

In this issue, McIntosh and colleagues show that visual and haptic deficits in spatial neglect can be improved following a brief period of visuomotor adaptation to rightward displacing optical prisms. Their paper is the latest in a series of recent studies that have demonstrated the utility of prismatic adaptation in reducing the clinical symptoms of unilateral spatial neglect (Pisella et al., 2002; Rode et al., 1999; Rossetti et al., 1998; Rossetti et al., 1999). The technique has great promise as a rehabilitative tool, and may provide unique insights into the underlying mechanisms of spatial perception and action in normality and pathology. In this article I provide an introduction to the neuropsychological syndrome of spatial neglect, highlighting the significant rehabilitative challenges it poses for clinicians. I then outline the prism adaptation procedure, and consider the possible reasons for its beneficial effects in patients with spatial neglect. I conclude with some open questions and suggestions for future research.

Dissociated long lasting improvements of straight-ahead pointing and line bisection tasks in two hemineglect patients

In this experiment, we evaluated over a longer time period the previously demonstrated effects of a short prism adaptation on hemispatial neglect. We followed two patients (PE and SA), during a period of 5 days (1 day before and 4 days after the prism adaptation procedure), repeatedly measuring their performances on a straight-ahead pointing task and a line bisection task. We also assessed the comparative temporal evolution of the rightward biased egocentric reference frame (as measured by the straight-ahead demonstration) and a classical neuropsychological symptom of neglect, namely the rightward bias observed on line bisection. Firstly, the results showed that prismatic effect could be maintained for 4 days, on the two tasks (separately straight-ahead for PE, line bisection for SA). This long-term effect implies a very profound action of prism adaptation based on active processes and opens large possibilities for clinical applications. Secondly, no correlation was found between the evolution of the performances on the two tasks, neither for patient PE, nor for patient SA (within-subject double-dissociation). Moreover, a double-dissociation between subjects was demonstrated on long-term effects. A new conception has thus to be found to explain the various symptoms manifested in neglect and more investigations have to be performed in order to establish to what extent they can be considered independent. It can be concluded that elucidating the mechanism through which prism adaptation affects neglect could lead to a better understanding of the neglect syndrome.

Laterally directed arm movements and right unilateral neglect after left hemisphere damage

Signs of unilateral neglect for events occurring in one hemispace most often result from right hemisphere lesions. Right unilateral neglect after left hemisphere damage is much rarer, and has received less attention. The present study explores the relationships between right unilateral neglect and asymmetries in producing laterally directed arm movements in the horizontal plane in left brain-damaged (LBD) patients. Participants produced right- or left-directed arm movements with their left arm in response to centrally located visual stimuli. Results showed that LBD patients with signs of right unilateral neglect were consistently slowed when producing arm movements toward the right (neglected) side, as compared to left-directed movements. Taking into account patients with and without signs of neglect, this directional asymmetry positively correlated with a reaction-time measure of perceptual spatial bias. These findings stand in contrast with previous results obtained with the same experimental paradigm in right brain-damaged patients, in whom a consistent slowing of leftward-directed movements was rare and apparently unrelated to the presence and severity of left neglect. These conflicting results are discussed with respect to the hypothesis that different mechanisms may underlie left and right unilateral neglect.

Position of the egocentric reference and performance in line bisection and subjective vertical estimation tasks

Egocentric body coordinates such as the sagittal midline have been proposed to act as a reference for ballistic movements in extracorporeal space. Symmetrical functioning of the multiple neural structures processing sensory information would account for the normal sagittal position of the egocentric reference. According to this hypothesis a unilateral parietal lesion would induce a ipsilesional deviation which would prevent neglect patients from responding to stimuli that occur on that side. In this line of reasoning, an experimental manipulation of the position of the egocentric reference by way of a postural perturbation should have an effect on visuospatial tasks performance in normal subjects. Seventeen right-handed subjects were submitted in the dark to two visuomotor tasks: the adjustment of a luminescent rod to the vertical and the bisection of a luminescent line, either with the trunk and the head aligned at 0 degrees or with a 30 degrees trunk rotation to the right or to the left. Results revealed no significant effect of trunk rotation on the performance in both tasks. We discuss these findings and their implication for the understanding of the neglect syndrome.

Significance of paradoxical leftward error of line bisection in left unilateral spatial neglect

We intended to determine if leftward error of line bisection means "right" or "left" neglect in a patient with left unilateral spatial neglect. The patient placed the subjective midpoint to the left of the true center when bisecting lines without cueing. By contrast, when cued to the left endpoint, he showed typical rightward errors that became greater as longer lines were presented. Cueing to the right endpoint increased leftward errors compared with the bisections without cueing. The results suggest that paradoxical leftward error of line bisection is a form of "left" unilateral spatial neglect in that the shortness of the left extent is ignored.

The influence of unimanual response on pseudoneglect magnitude

Various factors influence the degree of leftward error (pseudoneglect) (Bowers & Heilman, 1980) that typifies the performance of normal subjects in line bisection tasks (Jewell & McCourt, 2000). The results of this experiment show that unimanual responding also exerts a subtle but significant modulating influence on spatial attention, as indexed by the differential magnitude of pseudoneglect. Using a forced-choice tachistoscopic line bisection protocol, 184 subjects (92 male and 92 female) bisected horizontally oriented lines (22.3 degrees wide x 0.39 degrees height) presented to central vision in two conditions, in which bisection responses were executed via button presses using the first two fingers of either the left (LH) or right (RH) hand. Perceived line midpoint deviated significantly leftward of veridical (p <.05) in both conditions. There was no significant influence of subject sex (p >.05). A significant influence of unimanual response was revealed (p <.05) where pseudoneglect magnitude was greater in the LH than the RH condition. The results are interpreted within the framework of the activation-orientation theory of attentional asymmetry.

Effektivität experimenteller und rehabilitativer Interventionen bei visuellem Neglect - Eine Metaanalyse

Zusammenfassung: Präsentiert wird eine Metaanalyse zur Wirksamkeit neuropsychologischer Interventionen bei visuellem Hemineglect. Es wurden die publizierten Outcome-Ergebnisse Experimental- und Rehabilitationsstudien zur Modifikation und Modulation des Neglectsyndroms quantitativ integriert. 133 identifizierte Studien wurden in sechs Klassen eingeteilt. Studien-, Interventions- und Patientenmerkmale dienten zur Bestimmung moderierender Einflüsse, über Sensitivitätsanalysen wurde die Robustheit der Ergebnisse abgeschätzt. Die mittlere Gesamteffektivität der Interventionen liegt um 0.8 Standardeinheiten Symptomverbesserung gegenüber dem Prä-Niveau bei Patienten mit chronischem Neglect. Spontanremissionseffekte sind aufgrund der durchschnittlichen Erkrankungsdauer als gering zu veranschlagen und konnten empirisch nicht nachgewiesen werden. Explorationstrainings, personale Intervention und Hinweisreiz-Verfahren stellen sich als überdurchschnittlich effektiv und signifikant effektiver als bloße Reduktion der Umweltanforderungen heraus.

Pseudoneglect: a review and meta-analysis of performance factors in line bisection tasks

An exhaustive qualitative (vote-counting) review is conducted of the literature concerning visual and non-visual line bisection in neurologically normal subject populations. Although most of these studies report a leftward bisection error (i.e., pseudoneglect), considerable between-study variability and inconsistency characterize this literature. A meta-analysis of this same literature is performed in which the total quantitative data set, comprising 73 studies (or sub-studies) and 2191 subjects, is analyzed with respect to 26 performance factors. The meta-analytic results indicate a significant leftward bisection error in neurologically normal subjects, with an overall effect size of between -0.37 and -0.44 (depending on integration method), which is significantly modulated to varying degrees by a number of additional task or subject variables. For example, visual bisection tasks, midsagittal-pointing tasks and tactile bisection tasks all lead to leftward errors, while kinesthetic tasks result in rightward errors. Tachistoscopic forced-choice testing methods reveal much greater estimates of bisection error (effect size = -1.32) than do manual method-of-adjustment procedures (effect size= -0.40). Subject age significantly modulates line bisection performance such that older subjects err significantly rightward compared to younger subjects, and to veridical line midpoint. Male subjects make slightly larger leftward errors than do female subjects. Handedness has a small effect on bisection errors, with dextrals erring slightly further to the left than sinistral subjects. The hand used to perform manual bisection tasks modulated performance, where use of the left hand lead to greater leftward errors than those obtained using the right hand. One of the most significant factors modulating bisection error is the direction in which subjects initiate motor scanning (with either eye or hand), where a left-to-right scan pattern leads to large leftward errors while a right-to-left scan pattern leads to rightward errors.

Parietal and occipital lobe contributions to perception of straight ahead orientation

OBJECTIVES

Several studies have investigated how peripheral stimulation affects the perception of body orientation in healthy subjects. The studies showed that opposing stimulation of two different input modalities can cancel out, leaving perception of body orientation unchanged. It was ascertained whether a comparable phenomenon could be found in brain damaged patients with two distinct disorders which individually lead to opposing shifts of the perceived midline.

METHODS

The visual subjective straight ahead was measured in patients with pure neglect, pure hemianopia, or a combination of neglect and hemianopia.

RESULTS

As in previous studies, patients with pure neglect displayed an ipsilesional displacement of the perceived straight ahead. Patients with pure hemianopia showed a contralesional shift. By contrast, no significant midline shift occurred in the patients with both neglect and hemianopia.

CONCLUSIONS

Neglect and hemianopia interact so that opposing biases in the perception of body orientation neutralise each other. Both parietal and occipital areas seem to contribute to the perception of straight ahead body orientation and seem to have counteracting effects when lesioned in the same hemisphere.

Scanning direction and line bisection: a study of normal subjects and unilateral neglect patients with opposite reading habits

Sixty normal dextrals (30 left-to-right and 30 right-to-left readers) and two left unilateral neglect patient with opposite reading habits performed a passive line bisection task. In order to study the effect of scanning direction on performance, subjects had to stop a mark moving on the to-be-bisected line either from the left to the right or in the opposite direction. Results showed that the position of the subjective middle was dependent upon the scanning direction of the line for all the subjects. A leftward deviation appeared for left to right scanning, whereas a rightward shift occurred when the mark moved from the right to the left. These results emphasize the role of scanning direction in space organization and are discussed with respect to the explanatory hypotheses of unilateral neglect.

Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect

A large proportion of right-hemisphere stroke patients show hemispatial neglect-a neurological deficit of perception, attention, representation, and/or performing actions within their left-sided space, inducing many functional debilitating effects on everyday life, and responsible for poor functional recovery and ability to benefit from treatment. The frequent parietal locus of the lesion producing neglect reflects the impairment of coordinate transformation used by the nervous system to represent extrapersonal space. Given that adaptation to a visual distortion can provide an efficient way to stimulate neural structures responsible for the transformation of sensorimotor coordinates, the aim of our study was to investigate the effect of prism adaptation on various neglect symptoms, including the pathological shift of the subjective midline to the right. All patients exposed to the optical shift of the visual field to the right were improved on their manual body-midline demonstration and on classical neuropsychological tests. Unlike other physiological manipulations used to improve neglect, this improvement lasted for at least two hours after prism removal and thus could be useful in rehabilitation programmes. The positive effect found for both sensorimotor and more cognitive spatial functions suggests that they share or depend on a common level of space representation linked to multisensory integration.

Position of the egocentric reference and directional arm movements in right-brain-damaged patients

We asked 12 right-brain-damaged patients (6 with left neglect signs and 6 without left neglect signs) to perform a straight ahead pointing task and a visual detection task with lateralized motor response, in order to investigate the relationship between the position of the egocentric reference and response time and accuracy in producing lateralized arm movements. Results showed that there was no correlation between the position of the egocentric reference and neglect signs, nor between the position of the egocentric reference and the latencies to direct a motor response toward either side of space. These findings were interpreted within the context of egocentric hypotheses of neglect. In particular, it was suggested that attentional or intentional neglect signs cannot be considered as a direct consequence of an ipsilesional deviation of the egocentric reference.

In search of biased egocentric reference frames in neglect

The present study was aimed at assessing, by means of visual as well as proprioceptive-kinaesthetic straight-ahead tasks, the possible causal role of the ipsilesional deviation of the egocentric reference frame in determining neglect syndrome. The hypothesis, originally proposed by Ventre et al. [3], that an alteration of the representation of body-centred space can be a cause of asymmetrical spatial behaviour in humans has been recently revived by Karnath and co-workers [24]. The results of the present study seem to challenge the view that a systematic ipsilesional displacement of the egocentric reference is the crucial mechanism responsible for unilateral visual neglect. Under visual conditions, in which patients were required to stop a moving spot as it crossed their perceived midline, the ipsilesional deviation of the egocentric reference frame was dependent upon the direction of visual scanning. Right to left visual scanning direction produced a rightward displacement of the egocentric reference. In contrast, left to right visual scanning direction allowed neglect patients to correctly locate their perceived egocentre with an accuracy which did not differ from controls. The notion that the effect of a deviation of the egocentric reference frame is actually dependent on a bias in the visual scanning orienting response was also confirmed in the proprioceptive straight-ahead pointing tasks, in which the patients were blindfolded and therefore no visual information was available. In these conditions, in which patients were required to judge the subjective midline by using head, trunk and shoulder co-ordinate systems, the displacement of the subjective egocentric midline was not present.