Reappraising unilateral neglect

Navigation bicoded as functions of x-y and time?

Evidence from egocentric space is cited to support bicoding of navigation in three-dimensional space. Horizontal distances and space are processed differently from the vertical. Indeed, effector systems are compatible in horizontal space, but potentially incompatible (or chaotic) during transitions to vertical motion. Navigation involves changes in coordinates, and animal models of navigation indicate that time has an important role.

Prism adaptation overcomes pseudoneglect for the greyscales task

Visuomotor adaptation to left-shifting prisms can affect performance for a variety of tasks in neurologically intact (normal) participants. This study examined whether visuomotor adaptation affects performance on the greyscales task in normal participants. Forty-two normal participants completed a greyscales task before and after adaptation to either: left-shifting prisms, right-shifting prisms or control spectacles that did not shift the visual scene. Participants demonstrated a leftward bias (i.e., selected the stimulus that was darker on the left as being darker overall) that was reversed by a short period of visuomotor adaptation to left-shifting prisms. In contrast, this bias was unaffected by adaptation to right-shifting prisms and control spectacles. The findings demonstrate that a simple visuomotor task can alter the distribution of spatial attention for the greyscales task in normal participants.

Numerical processing overcomes left neglect for the greyscales task

This study examined whether numerical cues affect spatial attention in left neglect. Patients with right parietal damage (four with neglect, three without) completed a dual task. Stimuli consisted of two greyscales overlayed with high numbers (8, 9), low numbers (1, 2) or neutral stimuli (musical sharp, &). Participants identified if the overlay was high, low or neutral and then made a relative luminance judgement for the greyscales. Neglect patients demonstrated a rightward greyscales bias in the neutral overlay condition, which was overcome by processing low numbers. Control patients showed a leftward bias in the neutral condition, which was overcome by processing high numbers. The results demonstrate that the spatial architecture of numbers induces shifts of attention, which can overcome left neglect.

Rightward collisions and their association with pseudoneglect

Whereas right parietal damage can result in left hemineglect, the general population shows a subtle neglect of the right hemispace-known as pseudoneglect. A recent study has demonstrated that people collide to the right more often and attributed this bias to pseudoneglect. [Nicholls, M. E. R., Loftus, A., Meyer, K., & Mattingley, J.B. (2007). Things that go bump in the right: The effect of unimanual activity on rightward collisions. Neuropsychologia, 45, 1122-1126]. Nicholls examined the effect of unimanual activation by requiring participants to fire projectiles at a target whilst walking and found that the rightward bias was exaggerated or reversed when the left and right hands were active, respectively. However, the act of aiming at a target may have inadvertently biased walking trajectory to the right. The current study addressed this issue by requiring participants (n=149) to walk through a narrow doorway three times whilst entering text into a phone using the (a) left, (b) right or (c) both hands. Despite the fact that entering text into a phone should produce no rightward bias, participants bumped to the right more often. Unlike previous research, no effect of unimanual activation was observed. This lack of effect was attributed to the smaller hand movements for entering numbers compared to firing a toy gun. Finally, this study showed an association for the first time between biases in observable bumping and line bisection performance-suggesting that unilateral bumping is related to pseudoneglect.

Pseudoneglect and neglect for mental alphabet lines

While patients with right parietal damage neglect the left side of stimuli, the intact-brain population shows a slight neglect of the right side--known as pseudoneglect. Although pseudoneglect occurs for physical stimuli, it is not certain whether the bias extends to mental representations. To investigate this issue, we examined spatial distortions in the representation of length for mental alphabet lines, which are thought to have a left-to-right arrangement. In Expt. 1, participants (n=10) were presented with letter strings (e.g. C_H_P) and estimated whether the letter length was greater on the left or right side of the inner-letter. The strings were presented simultaneously along a line or sequentially in the centre of the screen in either an ascending (i.e. A-Z) or descending (i.e. Z-A) sequence. Participants reliably overestimated the length on the left regardless of presentation mode. In Expt. 2, participants (n=20) judged whether the inner-letter was the true centre. Responses were biased such that inner-letters shifted to the left of true centre were perceived to be the centre. Combined, both studies demonstrate that the length on left side of the mental alphabet line is overestimated relative to the right. In Expt. 3, a reversal of the bias towards the right was found for a group of neglect patients. The data demonstrate that letters have a left-to-right mental representation and that the left side of this representation is overrepresented in a manner similar to the overestimation associated with pseudoneglect for physical stimuli.

Can free-viewing perceptual asymmetries be explained by scanning, pre-motor or attentional biases?

Judgments of relative magnitude between the left and right sides of a stimulus are generally weighted toward the features contained on the left side. This leftward perceptual bias could be the result of, (a) left-to-right scanning biases, (b) pre-motor activation of the right hemisphere, or (c) a left hemispatial attentional bias. The relative merits of these explanations of perceptual asymmetry were investigated. In Experiment 1, English and Hebrew readers made luminance judgements for two left/right mirror-reversed luminance gradients (greyscales task). Despite different reading/scanning habits, both groups exhibited a leftward perceptual bias. English and Hebrew readers also performed a line bisection task. Scanning biases were controlled by asking participants to follow a marker as it moved left-to-right or right-to-left and then stop it as it reached the midpoint of the line. Despite controlling scanning, a leftward bias was observed in both groups. In Experiment 2, peripheral spatial cues were presented prior to the greyscales stimuli. English readers showed a reduction in the leftward bias for right-sided cues as compared to left-sided and neutral cues. Right-side cues presumably overcame a pre-existing leftward attentional bias. In both experiments, pre-motor activation was controlled using bimanual responses. Despite this control, a leftward bias was observed throughout the study. The data support the attentional bias account of leftward perceptual biases over the scanning and pre-motor activation accounts. Whether or not unilateral hemispheric activation provides an adequate account of this attentional bias is discussed.

Graphic Neglect—More Than the Sum of the Parts

Patients who seem to "ignore" objects or people on one side of space have been described in the medical literature for well over a century. The term "visuospatial neglect" is now used to describe the cluster of behaviors whereby patients after unilateral cerebral lesions (most frequently of right parietal cortex) fail to attend or explore (predominantly) the side of space contralateral to the lesion. Although the condition comprises a complex disruption of space-related behaviors, the prevailing view was that the different symptoms could be accommodated in terms of damage to one of three different cognitive mechanisms mediating attention (e.g., K. M. Heilman and E. Valenstein, Ann. Neurol. 5: 166-170, 1979), intention (R. T. Watson, E. Valenstein, and K. Heilman, Ann. Neurol. 3: 505-508, 1978), and/or representation (E. Bisiach, Q. J. Exp. Psychol. 46: 435-461, 1993). The general consensus favors an attentional deficit but the notion of attention has always proved conceptually slippery and difficult to operationalize (P. W. Halligan and J. C. Marshall, Cogn. Neuropsychol. 11: 167-206, 1994a). In this paper, we consider how drawing performance after right brain damage in patients with "visual neglect" reveals the involvement and interplay of several cognitive deficits, including aspects of mental representation and spatial awareness.

The effects of unilateral visuospatial neglect on perception of Müller-Lyer illusory figures

Left visuospatial neglect after right hemisphere damage is a lateralised disorder of spatial perception and cognition. A study is reported of the extent to which patients with left visuospatial neglect are susceptible to the illusory effects normally elicited by Müller-Lyer figures, in which inducing fins are located on one end or on both ends of a horizontal line. Seven patients with left visuospatial neglect and seven normal controls were tested on a task of horizontal-line bisection in which stimuli consisted of plain lines of three lengths (100, 150, and 200 mm), randomly interleaved with lines with unilateral or bilateral fins. As a group, normals made accurate bisection judgments in the baseline (no-fins) condition, and exhibited significant illusory effects in both the unilateral-fin and the bilateral-fin conditions. In contrast, patients made substantial rightward errors in the baseline condition, consistent with their neglect of the left end of the line. However, as a group, patients still exhibited significant illusory effects with left-sided outward-projecting fins on 100 mm lines and with left-sided inward-projecting fins on 150 mm lines. Moreover, at least one patient exhibited consistent illusory effects both for inward-projecting and for outward-projecting left-sided fins at all line lengths. Normal illusory effects in patients were also obtained with stimuli containing unilateral right-sided and bilateral fins. The existence of such effects with inducing elements on the contralesional extremity of horizontal line stimuli suggests preservation of low-level, perhaps preattentive, perceptual mechanisms responsible for coding elementary visual features. The results may be relevant for an understanding of the influence of attentional factors on illusory perception.

Recovery from directional hypokinesia and bradykinesia in unilateral neglect

Patients with acute right hemisphere (RH) damage and left unilateral neglect may exhibit slowness in both the initiation and execution of goal-directed movements toward the contralesional side (respectively, directional hypokinesia and directional bradykinesia). We retested 13 patients with RH damage, who on initial testing 1 year earlier had shown these impairments on a visually cued sequential movement task. Initiation and execution times were measured separately for leftward and rightward movement sequences, performed in either hemispace and across the body midline. Patients with anterior/subcortical lesions exhibited directional hypokinesia and bradykinesia on initial testing, but no longer showed either after 12 months. It is suggested that the recovery exhibited by these patients was determined conjointly by residual functioning of flexible anterior/subcortical structures involved in response production, in addition to the resolution of transient secondary dysfunction (i.e., diaschisis) of posterior (parietal) areas responsible for attentional orienting and target selection. In contrast, patients with posterior (parietal) lesions continued to exhibit directional hypokinesia after 12 months, probably as a result of permanent damage to a region whose dedicated or specialised functions cannot readily be compensated by other brain areas. These results support the notion that spatial attention and goal-directed movement are subserved by a distributed network involving separate but interconnected brain regions. Distinct functional losses may be predicted, in both the acute and chronic stages postinjury, on the basis of temporary or permanent dysfunction of discrete components of this network.

Impairments of movement execution in unilateral neglect: a kinematic analysis of directional bradykinesia

A kinematic analysis was performed on goal-directed movements made by 14 patients with right hemisphere damage and left unilateral neglect (seven mild, seven severe), and 14 healthy controls. Leftward and rightward pen strokes of varying extents were made to targets of varying size on a centrally located digitising tablet. While mild unilateral neglect patients performed like controls, patients with severe unilateral neglect were slower to initiate leftward than rightward strokes and were slow and inefficient in movement execution. Leftward strokes made by severe unilateral neglect patients were characterised by prolonged movement time, lower peak velocity and departed from optimal bell-shaped velocity profiles. Their leftward strokes also showed prolonged accelerative phases, implying difficulties in force production, while the high proportion of their total movement time spent in decelerating with rightward strokes suggested an abnormal emphasis on terminal visual guidance. Leftward strokes made by these patients also contained more submovements than rightward strokes, suggesting poor force control. An impaired internal representation of the location of left-sided targets and desired movement trajectories in severe unilateral neglect causes breakdown in the temporal control of goal-directed movements.

Can task specific perceptual bias be distinguished from unilateral neglect?

The present study examined visuoperceptual bias in 12 right hemisphere damaged patients, eight of whom showed left unilateral neglect on standard clinical tests, and in 30 normal controls. In the chimeric faces task, subjects were required to judge which of a pair of faces appeared happier. Stimuli comprising each pair were mirror images, with the smiling half on the left of one face and on the right of the other. In the grey scales task, subjects were required to indicate which of two shaded rectangles appeared to be darker overall. Again, stimuli were mirror images, with the darker end appearing either on the left or on the right. Patients exhibited a significant rightward bias on both experimental tasks, in contrast to the significant leftward bias exhibited by controls. There was no significant correlation between patients' performances on standard clinical tests and the extent of bias on the two experimental tasks, suggesting that such patients exhibit distinct impairments of spatial cognition which are differentially indexed by the two types of task. Moreover, for both patients and controls, scores obtained on the two perceptual bias tasks were unrelated, suggesting that they may engage stimulus-specific processes which have different underlying patterns of asymmetrical processing. These data provide further support for models which propose that the heterogeneity of disorders of spatial cognition arise from disruption of distinct neural mechanisms.

To see or not to see: the effects of visible and invisible cues on line bisection judgements in unilateral neglect

Patients with left unilateral neglect and matched controls were tested in two experiments to examine the effects of lateralized cues on line bisection judgements. Unlike previous studies in which letter or number cues were placed beyond the endpoint(s) of each line, we adopted a procedure which maintained the perceptual point of balance in the horizontal axis of each line. We also related the cueing task more closely to the act of bisection by requiring subjects to place a small mark in direct alignment with the endpoint(s) of each line. In the first experiment, it was found that, for controls, the presence or absence of visible lateralized cues did not differentially affect the magnitude of bisection errors. However, the magnitude of bisection errors made by neglect patients was significantly reduced (and reversed) in the presence of a visible left-sided cue, but remained well to the right of the midpoint in the absence of such cues. In a second experiment, subjects engaged in an otherwise identical cueing procedure, except that no visible marks appeared on the stimulus lines. Neither subject group was affected by the presence or absence of right-sided cues. However, the presence of left-sided cues again reduced the magnitude of bisection errors in neglect patients, but not in controls. These results indicate that the extent of the attentional bias exhibited by neglect patients can be ameliorated even in the absence of lateralized visible cues.