Is the middle between both halves?: midpoint location and segment size estimation in neglect

Memory for Spatial Locations in a Patient with Near Space Neglect and Optic Ataxia: Involvement of the Occipitotemporal Stream

Previous studies suggested that the occipitoparietal stream orients attention toward the near/lower space and is involved in immediate reaching, whereas the occipitotemporal stream orients attention toward the far/upper space and is involved in delayed reaching. In the present study, we investigated the role of the occipitotemporal stream in attention orienting and delayed reaching in a patient (GP) with bilateral damage to the occipitoparietal areas and optic ataxia. GP and healthy controls took part in three experiments. In the experiment 1, the participants bisected lines oriented along radial, vertical, and horizontal axes. GP bisected radial lines farther, and vertical lines more above, than the controls, consistent with an attentional bias toward the far/upper space and near/lower space neglect. The experiment 2 consisted of two tasks: (1) an immediate reaching task, in which GP reached target locations under visual control and (2) a delayed visual reaching task, in which GP and controls were asked to reach remembered target locations visually presented. We measured constant and variable distance and direction errors. In immediate reaching task, GP accurately reached target locations. In delayed reaching task, GP overshot remembered target locations, whereas the controls undershot them. Furthermore, variable errors were greater in GP than in the controls. In the experiment 3, GP and controls performed a delayed proprioceptive reaching task. Constant reaching errors did not differ between GP and the controls. However, variable direction errors were greater in GP than in the controls. We suggest that the occipitoparietal damage, and the relatively intact occipitotemporal region, produced in GP an attentional orienting bias toward the far/upper space (experiment 1). In turns, the attentional bias selectively shifted toward the far space remembered visual (experiment 2), but not proprioceptive (experiment 3), target locations. As a whole, these findings further support the hypothesis of an involvement of the occipitotemporal stream in delayed reaching. Furthermore, the observation that in both delayed reaching tasks the variable errors were greater in GP than in the controls suggested that in optic ataxia is present not only a visuo- but also a proprioceptivo-motor integration deficit.

Rehabilitation of spatial neglect

Spatial neglect is a frequent cause of disability associated with high costs and duration of hospital stay, increased family burden, and requirements for skilled chronic care. This condition is disproportionately more frequent with right than left hemispheric injury and it is characterized by perceptual, representational, and behavioral deficits involving or directed towards the left hemispace or the left hemibody. Spatial dysfunction is conceptualized into two major components: the perceptual/representational "where" component that results mainly from injury to posterior brain regions and the premotor/intentional "aiming" component that results mostly from damage to anterior brain regions. Additionally, deficits in arousal, vigilance, affective symptoms, and disorders of emotional communication may compound the clinical manifestations of spatial neglect. Evidence-based sources that evaluate the effectiveness of rehabilitation treatments for neglect are, unfortunately, unable to provide a unified consensus for the efficacy of a given treatment approach. The reasons for this failure are related to internal inconsistencies defining appropriate criteria for treatment success and lack of characterization of neglect mechanisms and considerations of patient characteristics related to treatment failure. In this chapter we advocate the use of visual scanning, limb activation therapy, and "general treatment" because we believe that they are appropriately supported by different sources and they may be useful for experimental trials and standardized clinical care. We advocate an integrative approach that takes advantage of the same rehabilitation strategy or task to treat different perceptual, representational, and premotor components of neglect. A variety of therapies that may be familiar to the rehabilitation team may be useful as long as they are applied in a systematized program and are based on good clinical judgment. Information regarding adjuvant pharmacological therapy is sparse but different agents with aminergic and cholinergic activity may be useful. Medication with sedative, antidopaminergic or anticholinergic properties may interfere with the rehabilitation process and should be avoided.

Pseudoneglect for the bisection of mental number lines

Patients with unilateral neglect of the left side bisect physical lines to the right whereas individuals with an intact brain bisect lines slightly to the left (pseudoneglect). Similarly, for mental number lines, which are arranged in a left-to-right ascending sequence, neglect patients bisect to the right. This study determined whether individuals with an intact brain show pseudoneglect for mental number lines. In Experiment 1, participants were presented with visual number triplets (e.g., 16, 36, 55) and determined whether the numerical distance was greater on the left or right side of the inner number. Despite changing the spatial configuration of the stimuli, or their temporal order, the numerical length on the left was consistently overestimated. The fact that the bias was unaffected by physical stimulus changes demonstrates that the bias is based on a mental representation. The leftward bias was also observed for sets of negative numbers (Experiment 2)--demonstrating not only that the number line extends into negative space but also that the bias is not the result of an arithmetic distortion caused by logarithmic scaling. The leftward bias could be caused by a rounding-down effect. Using numbers that were prone to large or small rounding-down errors, Experiment 3 showed no effect of rounding down. The task demands were changed in Experiment 4 so that participants determined whether the inner number was the true arithmetic centre or not. Participants mistook inner numbers shifted to the left to be the true numerical centre--reflecting leftward overestimation. The task was applied to 3 patients with right parietal damage with severe, moderate, or no spatial neglect (Experiment 5). A rightward bias was observed, which depended on the severity of neglect symptoms. Together, the data demonstrate a reliable and robust leftward bias for mental number line bisection, which reverses in clinical neglect. The bias mirrors pseudoneglect for physical lines and most likely reflects an expansion of the space occupied by lower numbers on the left side of the line and a contraction of space for higher numbers located on the right.

Line bisection: does introspection inform cognitive strategy?

Line bisection is widely used to diagnose and quantify hemispatial neglect, yet there is little consensus as to the cognitive mechanisms used to perform this simple task. Current cognitive accounts have been deduced solely from behavioural measures. The aim of this study was to discover if subject's own knowledge of the mental strategies used to perform the task actually informs behavioural performance. One hundred and forty healthy volunteers bisected a set of lines and were asked to describe the mental strategies used. Three distinct strategies were identified. These were (1) comparing two segments, (2) computing the centre of mass, and (3) externally centred strategies. Strategies 1 and 2 have previously been described but externally centred strategies have not been reported as a distinct strategy in bisection. Although none of the three strategies predicted performance this may have been due to the fact that 44% of subjects failed to describe any strategy. Men and women bisected lines equally well, however more men than women reported use of externally centred strategies.

The effects of movement direction and hemispace on estimates of distance traveled

BACKGROUND/HYPOTHESIS

The degree of attention directed to a stimulus and the presence of anisometric representations can alter the perception of the magnitude of a stimulus. We wanted to learn if normal right-handed subjects' estimates of distance traveled are influenced by the right-left direction or hemispace of movements.

METHODS

We had blindfolded participants estimate the distance their arm was moved in a rightward or leftward direction, in right and left hemispace. Since we wanted subjects to estimate the distance traveled rather than compute the distance between the start and finish points, the subjects' arms were passively moved in sinusoidal trajectories at a constant speed.

RESULTS

Subjects estimated leftward movements as longer than rightward movements, but there was no effect of hemispace. COMMENTS/CONCLUSIONS: People often attend more to novel than routine conditions and therefore participants might have overestimated the distance associated with leftward versus rightward movement because right-handed people more frequently move their right hand in a rightward direction and learn to read and write using rightward movements. Thus, leftward movements might be more novel and more attended than rightward movements and this enhanced directional attention might have influenced estimates of magnitude (distance).

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.

The effect of strategy on pseudoneglect for luminance judgements

When judging the relative magnitude of the left and right sides of a stimulus, normal participants overestimate the leftward features (pseudoneglect). Although pseudoneglect and clinical neglect operate in opposite directions, the two phenomena may have a common cognitive and neural basis. For neglect, two strategies may be employed when inspecting horizontally aligned stimuli: (1) A global strategy where the stimuli are treated as a gestalt and asymmetries are detected or, (2) a comparison strategy where the qualities on the left and right sides of the stimuli are explicitly compared. To investigate the effect of these strategies on pseudoneglect, normal dextrals (n = 25 and 17) made two-alternative, forced-choice luminance discriminations between two mirror-reversed luminance gradients (greyscales). In an unseparated form, the stimuli are amenable to a global strategy. A comparison strategy was imposed by separating the stimuli into halves (Experiment 1) or quarters (Experiment 2). Despite the fact that the stimuli were equiluminant, participants predominantly chose the stimulus that was dark on the left as being darker overall in the unseparated condition. Response times were also faster for leftward responses. When the stimuli were separated into halves or quarters, the leftward bias was reduced, but not eliminated. The results demonstrate that both strategies contribute to pseudoneglect--though the global strategy may produce stronger pseudoneglect.

The effects of focal and global attentional systems on spatial biases

The background page on which a stimulus is presented can influence the allocation of attention to that stimulus. The purpose of this study was to learn if there are hemispheric asymmetries in how background distraction affects attentional processing. Asymmetries were investigated by having right eye dominant subjects perform line bisections and manipulating the side of background distraction (right versus left), the eye of regard (right versus left), and the type of attention allocated (focal versus global). Overall subjects bisected lines to the left of center (pseudoneglect) and when viewing with the right eye (versus left) deviated more to the left. Subjects had more background distraction when viewing symbol than solid lines. Although overall, bias did not differ with the side of background distraction or the line being on one side or the other, when subjects viewed symbol, but not solid lines, this leftward bias was increased when the line was displaced to the right, thereby increasing the size of the left sided background. These findings suggest that when engaging the left hemisphere by using focused attention and placing the line on the right side, there is more distraction than when the right hemisphere is engaged.

Pseudoneglect in Solid-Line Versus Character-Line Bisection Tasks

OBJECTIVE

Normal subjects tend to bisect lines slightly to the left of the true midpoint, a phenomenon termed pseudoneglect. To test whether pseudoneglect relates to the right hemisphere's dominance for spatial attention or to the hemispheric difference in processing global-local stimulus properties, we administered conventional solid-line (SBT) and novel character-line (CBT) bisection tasks to normal subjects of different ages.

METHODS

Normal subjects, consisting of 40 young and 40 older individuals, received 3 experimental tasks, a standard SBT and 2 types of CBT. Each subject completed 10 consecutive trials of each task presented in counterbalanced order between subjects.

RESULTS

Across age groups, deviations on CBT were further to the right than those of SBT, and the leftward bias (pseudoneglect) was significant only in SBT.

CONCLUSION

These results indicate that the bisection errors in normal subjects depend on the characteristics demanded by the specific task. Thus, our findings argue against the attention dominance theory and support a "task specificity" theory for pseudoneglect.

Stimulus symmetry affects the bisection of figures but not lines: evidence from event-related fMRI

Many geometric shapes retain their symmetry when bisected, but appear asymmetrical when misbisected. We have previously shown that this correspondence can guide the accuracy and speed of perceptual bisection (Landmark) judgments. Using event-related fMRI, here we examined whether the behavioural effects of symmetry are also evident at the neural level. The data showed that the presence/absence of symmetry modulates the activity of right anterior cingulate gyrus, an area associated with a variety of higher level attentional functions. A previous visual half-field study also showed that bisected lines are apprehended more quickly and accurately than misbisected lines in right, but not left, visual field. We were able to localise this advantage to right superior temporal gyrus. Significantly, we found no evidence that symmetry played a role in apprehending the midpoint of the line stimuli traditionally used to assess visual neglect. The data clarify the effects of visual symmetry on bisection behaviour, and highlight novel dissociations within the neural systems thought to underline Landmark performance.