Effects of hand-used on unilateral spatial neglect: a case study

Unilateral Spatial Neglect without Hemiplegia: The Output-Mode Effect Revisited

BACKGROUND

The occurrence of unilateral spatial neglect (USN) in non-hemiplegic right-hemisphere damaged patients is rare. Earlier studies of such patients revealed a significant advantage when typical neglect tests were performed by the patient's left hand as compared to the dominant right hand. The mechanism underlying this "output-mode effect" remains elusive.

METHODS

We analyzed the temporal dynamics of this effect using line-bisection task in 9 non-hemiplegic stroke patients with left-USN.

RESULTS

In 4 patients tested shortly after stroke onset (≤ 6 weeks), the impact of hand laterality was variable (left-hand advantage in one patient; right-hand advantage in 2 patients; similar performance in both hands in one patient). Only later (> 6 weeks) a clear advantage of the left hand emerged in the majority of patients, similar to the earlier reports which were all based on late testing.

CONCLUSIONS

We found variable dynamics in the expression of the output-mode effect in the first weeks following stroke onset, which may reflect changes of inter-hemispheric balance, related to recovery processes. We propose that therapeutic interventions aiming to manipulate the inter-hemispheric balance (e.g., by non-invasive brain stimulation) take into account the existence of such dynamics and their highly variate nature.

Bimanual-vertical hand movements

Patients often demonstrate attentional and action-intentional biases in both the transverse and coronal planes. In addition, when making forelimb movements in the transverse plane, normal participants also have spatial and magnitude asymmetries, but forelimb spatial asymmetries have not been studied in coronal space. Thus, to learn if when normal people make vertical movements they have right-left spatial and magnitude biases, seventeen healthy, blindfolded volunteers had their hands (holding pens) placed vertically in their midsagittal plane, 10 inches apart, on pieces of paper positioned above, below, and at eye-level. Participants were asked to move their hands together vertically and meet in the middle. Participants demonstrated less angular deviation in the below-eye condition than in the other spatial conditions, when moving down than up, and with their right than left hand. Movements toward eye level from upper or lower space were also more accurate than movements in the other directions. Independent of hand, lines were longer with downward than upward movements and the right hand moved more distance than the left. These attentional-intentional asymmetries may be related to gravitational force, hand-hemispheric dominance, and spatial "where" asymmetries; however, the mechanisms accounting for these asymmetries must be ascertained by future research.

Performance consistency of normal observers in forced-choice tachistoscopic visual line bisection

Pseudoneglect (PN) refers to the leftward error exhibited by normal observers on line bisection tasks (Bowers and Heilman, Neuropsychologia, 18, (1980) 491-8). Although a thorough review of the literature has shown PN to be relatively robust (Jewell and McCourt, Neuropsychologia, 38, (2000) 93-110), controversy remains concerning the reliability of the phenomenon, with some studies reporting a relatively high incidence of normal subjects with rightward bisection errors. The present experiment assesses the consistency of bisection performance in normal young observers. Right-handed subjects (N=22) participated in a tachistoscopic forced-choice line bisection task. Each subject participated in 7-16 experimental sessions separated by at least 24 h (total bisection measurements=317). Individual bisection performance could thus be evaluated with respect to within-subject variability measures. An eyetracker recorded gaze position during the task in one session. A highly significant mean group bisection error of -0.26 degrees (P<0.001) was obtained (left negative), and individual subject means ranged from -0.55 degrees to +0.03 degrees. Of the 317 total bisection measurements, 9% (28) deviated rightward. Significant (P<0.05) mean leftward errors occurred in 91% (20/22) of subjects. Mean bisection error in two subjects was not significantly different from zero. No subject possessed a significant rightward error. Mean gaze deviation from screen (and line) center ranged from +/-0.9 degrees, and was positively correlated (P<0.05) with bisection error. It is concluded that forced-choice tachistoscopic line bisection measures are highly reliable; a mean correlation of +0.87 exists between mean error based on 15 trials and means estimated from a random sample of only two trials. The incidence of true rightward bisection error in the population of normal right-handed subjects is thus estimated to be less than 5%.

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.