Statistical learning as a tool for rehabilitation in spatial neglect

Repeated application of the covert shift of attention task improves endogenous but not exogenous attention in patients with unilateral visuospatial inattention

BACKGROUND

Most neglect treatment studies focus on automatic re-orientation procedures, assuming a deficit in automatic processes. We compare an automatic- and a controlled procedure, using the endogenous and exogenous variants of Posner's covert shift of attention task.

METHOD

In two experiments, neglect patients and patients with a right hemispherical stroke without neglect performed three blocks of Posner's covert shift of attention task (Posner Task) on two days. In Study 1 we used endogenous cues, in Study 2, exogenous cues.

RESULTS

In the endogenous task, neglect patients improved significantly with valid left-sided cues between block 1 and 2 on Day 1, subsequently showing a plateauing. They also showed a gradual improvement on invalid trials on both days. In the exogenous condition, all participants responded only increasingly faster on trials with a long stimulus onset asynchrony. Practicing on both tasks led to fewer omissions for left-sided targets, minimally in the exogenous and clearly in the endogenous condition.

CONCLUSION

In line with prior neuroanatomical studies, our study shows that practicing an endogenous, but not an exogenous, visuospatial attention task leads to significant improvements in neglect patients, especially for invalid trials, suggesting that neglect treatments based on top-down strategies should be given more attention.

Statistical Learning Impairments as a Consequence of Stroke

Statistical learning is the implicit learning of the contingencies between sequential stimuli, typically from mere exposure. It is present from infancy onward, and plays a role in functions from language learning to selective attention. Despite these observations, there are few data on whether statistical learning capacity changes with age or after brain injury. In order to examine how brain injury affects the ability to learn and update statistical representations, we had young control and healthy elder participants, as well as participants with either left or right brain injury, perform an auditory statistical learning task. Participants listened to two languages with made-up words that were defined by the transition probability between syllables. Following passive listening, learning was assessed with a two-alternative forced choice test for the most familiar word. As in previous studies, we found that young controls have a learning capacity limitation for statistical learning; a second language is less well learned than the first, and this statistical learning capacity limit is attenuated with age. Additionally, we found that brain damaged patients, whether with left or right hemispheric damage, showed impaired statistical learning. This impairment was not explained by aphasia or cognitive deficits. As statistical learning is a critical skill for daily life, a better appreciation of the nature of this impairment will improve our understanding of the cognitive effects of brain injury and could lead to new rehabilitation strategies.

Neurophysiological Markers of Statistical Learning in Music and Language: Hierarchy, Entropy, and Uncertainty

Statistical learning (SL) is a method of learning based on the transitional probabilities embedded in sequential phenomena such as music and language. It has been considered an implicit and domain-general mechanism that is innate in the human brain and that functions independently of intention to learn and awareness of what has been learned. SL is an interdisciplinary notion that incorporates information technology, artificial intelligence, musicology, and linguistics, as well as psychology and neuroscience. A body of recent study has suggested that SL can be reflected in neurophysiological responses based on the framework of information theory. This paper reviews a range of work on SL in adults and children that suggests overlapping and independent neural correlations in music and language, and that indicates disability of SL. Furthermore, this article discusses the relationships between the order of transitional probabilities (TPs) (i.e., hierarchy of local statistics) and entropy (i.e., global statistics) regarding SL strategies in human's brains; claims importance of information-theoretical approaches to understand domain-general, higher-order, and global SL covering both real-world music and language; and proposes promising approaches for the application of therapy and pedagogy from various perspectives of psychology, neuroscience, computational studies, musicology, and linguistics.

Post-stroke visual neglect affects goal-directed locomotion in different perceptuo-cognitive conditions and on a wide visual spectrum

BACKGROUND

Unilateral spatial neglect (USN), a highly prevalent and disabling post-stroke deficit, has been shown to affect the recovery of locomotion. However, our current understanding of USN role in goal-directed locomotion control, and this, in different cognitive/perceptual conditions tapping into daily life demands, is limited.

OBJECTIVES

To examine goal-directed locomotion abilities in individuals with and without post-stroke USN vs. healthy controls.

METHODS

Participants (n = 45, n = 15 per group) performed goal-directed locomotion trials to actual, remembered and shifting targets located 7 m away at 0° and 15° right/left while immersed in a 3-D virtual environment.

RESULTS

Greater end-point mediolateral displacement and heading errors (end-point accuracy measures) were found for the actual and the remembered left and right targets among those with post-stroke USN compared to the two other groups (p <  0.05). A delayed onset of reorientation to the left and right shifting targets was also observed in USN+ participants vs. the other two groups (p <  0.05). Results on clinical near space USN assessment and walking speed explained only a third of the variance in goal-directed walking performance.

CONCLUSION

Post-stroke USN was found to affect goal-directed locomotion in different perceptuo-cognitive conditions, both to contralesional and ipsilesional targets, demonstrating the presence of lateralized and non-lateralized deficits. Beyond neglect severity and walking capacity, other factors related to attention, executive functioning and higher-order visual perceptual abilities (e.g. optic flow perception) may account for the goal-directed walking deficits observed in post-stroke USN+. Goal-directed locomotion can be explored in the design of future VR-based evaluation and training tools for USN to improve the currently used conventional methods.

Updating impairments and the failure to explore new hypotheses following right brain damage

We have shown recently that damage to the right hemisphere impairs the ability to update mental models when evidence suggests an old model is no longer appropriate. We argue that this deficit is generic in the sense that it crosses multiple cognitive and perceptual domains. Here, we examined the nature of this updating impairment to determine more precisely the underlying mechanisms. We had right (RBD, N = 12) and left brain damaged (LBD, N = 10) patients perform versions of our picture-morphing task in which pictures gradually morph from one object (e.g., shark) to another (e.g., plane). Performance was contrasted against two groups of healthy older controls, one matched on age (HCO-age-matched, N = 9) and another matched on general level of cognitive ability (HCO-cognitively-matched, N = 9). We replicated our earlier findings showing that RBD patients took longer than LBD patients and HCOs to report seeing the second object in a sequence of morphing images. The groups did not differ when exposed to a morphing sequence a second time, or when responding to ambiguous images outside the morphing context. This indicates that RBD patients have little difficulty alternating between known representations or labeling ambiguous images. Instead, the difficulty lies in generating alternate hypotheses for ambiguous information. Lesion overlay analyses, although speculative given the sample size, are consistent with our fMRI work in healthy individuals in implicating the anterior insular cortex as critical for updating mental models.

Implicit learning: A way to improve visual search in spatial neglect?

Studies have shown that neglect patients are able to use stimulus regularities to orient faster toward the neglected side, without necessarily being aware of that information, or at the very least without being able to verbalize their knowledge. In order to better control for the involvement of explicit processes, the present study sought to test neglect patients' ability to detect more complex associations between stimuli using tasks similar to those used in implicit learning studies. Our results demonstrate that neglect patients had difficulties implicitly learning complex associations, contrary to what we found with controls. The possible influence of attentional and working memory impairments are discussed.

Can the exploration of left space be induced implicitly in unilateral neglect?

The purpose of the present study was to explore the ability of neglect patients to detect and exploit the predictive value of a cue to respond more quickly and accurately to targets on their contralesional side in a Posner spatial cueing task. The majority of the cues (i.e. 80%) were invalid, indicating that the target would appear on the opposite side, although patients were not informed of this bias. Our results demonstrate that some neglect patients were able to extract the cue's predictability and use it to orient faster toward the left. This cueing effect was present even in patients who were subsequently unable to describe the predictive character of the cues, and thus was not modulated by reportable awareness of the cue-target relation.

Modelling the differential effects of prisms on perception and action in neglect

Damage to the right parietal cortex often leads to a syndrome known as unilateral neglect in which the patient fails to attend or respond to stimuli in left space. Recent work attempting to rehabilitate the disorder has made use of rightward-shifting prisms that displace visual input further rightward. After a brief period of adaptation to prisms, many of the symptoms of neglect show improvements that can last for hours or longer, depending on the adaptation procedure. Recent work has shown, however, that differential effects of prisms can be observed on actions (which are typically improved) and perceptual biases (which often remain unchanged). Here, we present a computational model capable of explaining some basic symptoms of neglect (line bisection behaviour), the effects of prism adaptation in both healthy controls and neglect patients and the observed dissociation between action and perception following prisms. The results of our simulations support recent contentions that prisms primarily influence behaviours normally thought to be controlled by the dorsal stream.

Sequential decisions: a computational comparison of observational and reinforcement accounts

Right brain damaged patients show impairments in sequential decision making tasks for which healthy people do not show any difficulty. We hypothesized that this difficulty could be due to the failure of right brain damage patients to develop well-matched models of the world. Our motivation is the idea that to navigate uncertainty, humans use models of the world to direct the decisions they make when interacting with their environment. The better the model is, the better their decisions are. To explore the model building and updating process in humans and the basis for impairment after brain injury, we used a computational model of non-stationary sequence learning. RELPH (Reinforcement and Entropy Learned Pruned Hypothesis space) was able to qualitatively and quantitatively reproduce the results of left and right brain damaged patient groups and healthy controls playing a sequential version of Rock, Paper, Scissors. Our results suggests that, in general, humans employ a sub-optimal reinforcement based learning method rather than an objectively better statistical learning approach, and that differences between right brain damaged and healthy control groups can be explained by different exploration policies, rather than qualitatively different learning mechanisms.

The nonspatial side of spatial neglect and related approaches to treatment

In addition to deficits in spatial attention, individuals with persistent spatial neglect almost universally exhibit nonspatially lateralized deficits in sustained and selective attention, and working memory. However, nonspatially lateralized deficits in neglect have received considerably less attention in the literature than deficits in spatial attention. This is in spite of the fact that nonspatially lateralized deficits better predict the chronicity and functional disability associated with neglect than spatially lateralized deficits. Furthermore, only a few treatment studies have specifically targeted nonspatially lateralized deficits as a means to improve spatial neglect. In this chapter, we will briefly review several models of spatial attention bias in neglect before focusing on nonspatial deficits and the mechanisms of nonspatial-spatial interactions and implications for treatment. Treatment approaches that more completely address nonspatial deficits and better account for their interactions with spatial attention will likely produce better outcomes.