The Pointing Errors in Optic Ataxia Reveal the Role of "Peripheral Magnification" of the PPC

Unilateral resection of both cortical visual pathways in a pediatric patient alters action but not perception

The human cortical visual system consists of two major pathways, a ventral pathway that subserves perception and a dorsal pathway that primarily subserves visuomotor control. Previous studies have found that children with cortical resections of the ventral visual pathway retain largely normal visuoperceptual abilities. Whether visually guided actions, supported by computations carried out by the dorsal pathway, follow a similar pattern of preservation remains unknown. To address this question, we examined visuoperceptual and visuomotor behaviors in a pediatric patient, TC, who underwent a cortical resection that included portions of the left ventral and dorsal pathways. We collected kinematic data when TC used her right and left hands to perceptually estimate the width of blocks that varied in width and length, and, separately, to grasp the same blocks. TC's perceptual estimation performance was comparable to that of controls, independent of the hand used. In contrast, relative to controls, she showed reduced visuomotor sensitivity to object shape and this was more evident when she grasped the objects with her contralesional right hand. These results provide novel evidence for a striking difference in the competence of the two visual pathways to cortical injuries acquired in childhood.

Role of the Dorsal Posterior Parietal Cortex in the Accurate Perception of Object Magnitude in Peripheral Vision

Following superior parietal lobule and intraparietal sulcus (SPL-IPS) damage, optic ataxia patients underestimate the distance of objects in the ataxic visual field such that they produce hypometric pointing errors. The metrics of these pointing errors relative to visual target eccentricity fit the cortical magnification of central vision. The SPL-IPS would therefore implement an active “peripheral magnification” to match the real metrics of the environment for accurate action. We further hypothesized that this active compensation of the central magnification by the SPL-IPS contributes to actual object’ size perception in peripheral vision. Three optic ataxia patients and 10 age-matched controls were assessed in comparing the thickness of two rectangles flashed simultaneously, one in central and another in peripheral vision. The bilateral optic ataxia patient exhibited exaggerated underestimation bias and uncertainty compared to the control group in both visual fields. The two unilateral optic ataxia patients exhibited a pathological asymmetry between visual fields: size perception performance was affected in their contralesional peripheral visual field compared to their healthy side. These results demonstrate that the SPL-IPS contributes to accurate size perception in peripheral vision.

Anatomy and white-matter connections of the precuneus

Purpose Advances in neuroimaging have provided an understanding of the precuneus'(PCu) involvement in functions such as visuospatial processing and cognition. While the PCu has been previously determined to be apart of a higher-order default mode network (DMN), recent studies suggest the presence of possible dissociations from this model in order to explain the diverse functions the PCu facilitates, such as in episodic memory. An improved structural model of the white-matter anatomy of the PCu can demonstrate its unique cerebral connections with adjacent regions which can provide additional clarity on its role in integrating information across higher-order cerebral networks like the DMN. Furthermore, this information can provide clinically actionable anatomic information that can support clinical decision making to improve neurologic outcomes such as during cerebral surgery. Here, we sought to derive the relationship between the precuneus and underlying major white-mater bundles by characterizing its macroscopic connectivity. Methods Structural tractography was performed on twenty healthy adult controls from the Human Connectome Project (HCP) utilizing previously demonstrated methodology. All precuneus connections were mapped in both cerebral hemispheres and inter-hemispheric differences in resultant tract volumes were compared with an unpaired, corrected Mann-Whitney U test and a laterality index (LI) was completed. Ten postmortem dissections were then performed to serve as ground truth by using a modified Klingler technique with careful preservation of relevant white matter bundles. Results The precuneus is a heterogenous cortical region with five major types of connections that were present bilaterally. (1) Short association fibers connect the gyri of the precuneus and connect the precuneus to the superior parietal lobule and the occipital cortex. (2) Four distinct parts of the cingulum bundle connect the precuneus to the frontal lobe and the temporal lobe. (3) The middle longitudinal fasciculus from the precuneus connects to the superior temporal gyrus and the dorsolateral temporal pole. (4) Parietopontine fibers travel as part of the corticopontine fibers to connect the precuneus to pontine regions. (5) An extensive commissural bundle connects the precuneus bilaterally. Conclusion We present a summary of the anatomic connections of the precuneus as part of an effort to understand the function of the precuneus and highlight key white-matter pathways to inform surgical decision-making. Our findings support recent models suggesting unique fiber connections integrating at the precuneus which may suggest finer subsystems of the DMN or unique networks, but further study is necessary to refine our model in greater quantitative detail.

Bálint syndrome

This chapter starts by reviewing the various interpretations of Bálint syndrome over time. We then develop a novel integrative view in which we propose that the various symptoms, historically reported and labeled by various authors, result from a core mislocalization deficit. This idea is in accordance with our previous proposal that the core deficit of Bálint syndrome is attentional (Pisella et al., 2009, 2013, 2017) since covert attention improves spatial resolution in visual periphery (Yeshurun and Carrasco, 1998); a deficit of covert attention would thus increase spatial uncertainty and thereby impair both visual object identification and visuomotor accuracy. In peripheral vision, we perceive the intrinsic characteristics of the perceptual elements surrounding us, but not their precise localization (Rosenholtz et al., 2012a,b), such that without covert attention we cannot organize them to their respective and recognizable objects; this explains why perceptual symptoms (simultanagnosia, neglect) could result from visual mislocalization. The visuomotor symptoms (optic ataxia) can be accounted for by both visual and proprioceptive mislocalizations in an oculocentric reference frame, leading to field and hand effects, respectively. This new pathophysiological account is presented along with a model of posterior parietal cortex organization in which the superior part is devoted to covert attention, while the right inferior part is involved in visual remapping. When the right inferior parietal cortex is damaged, additional representational mislocalizations across saccades worsen the clinical picture of peripheral mislocalizations due to an impairment of covert attention.

The posterior parietal cortex processes visuo-spatial and extra-retinal information for saccadic remapping: A case study

Optimally collecting information and controlling behaviour require that we constantly scan our visual environment through eye movements. How the dynamic interaction between short-lived retinal images and extra-retinal signals of eye motion results in our subjective experience of visual stability remains a major issue in Cognitive Neuroscience. The present study aimed to assess and determine the nature of the contribution of the posterior parietal cortex (PPC) to the saccadic remapping mechanisms which contribute to such perceptual visual constancy. Perceptual responses in transsaccadic visual localization tasks were measured in a patient presenting with a PPC lesion and manifesting optic ataxia in the left hemifield with no neglect. Two perceptual localization tasks, each with versus without an intervening saccade, were used: the saccadic suppression of displacement (SSD) task (Ostendorf, Liebermann, & Ploner, 2010) and the peri-saccadic flash localization (LOC) task (Zimmerman & Lappe, 2010). Compared to a group of age-matched healthy subjects, the patient showed a specific pattern of perceptual deficits in the ataxic (left) hemifield. First, a significant impairment occurred in the stationary eye conditions, attesting for an alteration of visuo-spatial encoding. Second, in the saccade conditions, an additional perceptual deficit (an error of ~5° along the saccade direction) was observed in both tasks and mainly in conditions where extra-retinal signals are thought to be critically involved, revealing a constant underestimation by extra-retinal signals of the saccade size, despite preserved saccade accuracy. These findings highlight a crucial role of the PPC in saccadic remapping processes underlying perceptual visual constancy and provide empirical evidence for models such as Ziesche and Hamker's (2014).

Attention attracts action in healthy participants: An insight into optic ataxia?

Patients with optic ataxia following lesions to superior parts of the posterior parietal cortex make large errors when reaching to targets in the peripheral visual field. These errors are characterised by a contraction, or attraction, towards the point of fixation. These patients also have a reduced ability to allocate visual attention away from the point of fixation, but it is unclear whether the core symptom of misreaching is related to these attentional problems. In neurologically-intact adults, we tested the effect of an attention-demanding dual-task performed at fixation upon visually-guided reaching to peripheral targets. The dual task was associated with delayed movement initiation, and a shortened deceleration phase of movement suggesting a reduced ability to benefit from online control. It also induced a small but consistent shift of reaching endpoints towards the side of fixation. Our experimental restriction of visual attention thus impaired both the programming and control of reaching, and induced a spatial pattern of errors that was qualitatively reminiscent of optic ataxia, albeit much less severe. These findings are consistent with a close functional link between attention and action in the healthy brain, and suggest that attentional disturbances could be a core component of optic ataxia following parietal lesions.

Bimanual visually guided movements are more than the sum of their parts: Evidence from optic ataxia

Many reaching actions involve both hands. An open question is whether two-handed reaching involves two simultaneous, independent unimanual reaches, or recruits additional or different processes than those mediating one-handed reaching. We tested optic ataxic patient MDK on a set of unimanual and bimanual reaching tasks. Although MDK was impaired in both types of reaching task, his bimanual reaching was considerably better than his unimanual reaching. These results imply that bimanual reaching involves different or additional processes relative to unimanual reaching. We suggest that bimanual reaching may involve monitoring of the distance between the two hands relative to the distance between the two targets.

Motor Program Transformation of Throwing Dart from the Third-Person Perspective

The perspective of perceiving one's action affects its speed and accuracy. In the present study, we investigated the change in accuracy and kinematics when subjects throw darts from the first-person perspective and the third-person perspective with varying angles of view. To model the third-person perspective, subjects were looking at themselves as well as the scene through the virtual reality head-mounted display (VR HMD). The scene was supplied by a video feed from the camera located to the up and 0, 20 and 40 degrees to the right behind the subjects. The 28 subjects wore a motion capture suit to register their right hand displacement, velocity and acceleration, as well as torso rotation during the dart throws. The results indicated that mean accuracy shifted in opposite direction with the changes of camera location in vertical axis and in congruent direction in horizontal axis. Kinematic data revealed a smaller angle of torso rotation to the left in all third-person perspective conditions before and during the throw. The amplitude, speed and acceleration in third-person condition were lower compared to the first-person view condition, before the peak velocity of the hand in the direction toward the target and after the peak velocity in lowering the hand. Moreover, the hand movement angle was smaller in the third-person perspective conditions with 20 and 40 angle of view, compared with the first-person perspective condition just preceding the time of peak velocity, and the difference between conditions predicted the changes in mean accuracy of the throws. Thus, the results of this study revealed that subject's localization contributed to the transformation of the motor program.

Comparing three portable, tablet-based visuomotor tasks to laboratory versions: An assessment of test validity

The assessment of visuomotor function can provide important information about neurological status. Many tasks exist for testing visuomotor function in the laboratory, but the availability of portable, easy-to-use versions that allow reliable, accurate, and precise measurement of movement timing and accuracy has been limited. We developed a tablet application that uses three laboratory visuomotor tests: the double-step task, interception task, and stop-signal task. We asked the participants to perform both the lab and tablet versions of each task and compared their response patterns across equipment types to assess the validity of the tablet versions. On the double-step task, the participants adjusted to the displaced target adequately in both the lab and tablet versions. On the interception task, the participants intercepted nonaccelerating targets and performed worse on accelerating targets in both versions of the task. On the stop-signal task, the participants successfully inhibited their reaching movements on short stop-signal delays (50–150 ms) more frequently than on long stop-signal delays (200 ms) in both versions of the task. Our findings suggest that the tablet version of each task assesses visuomotor processing in the same way as their respective laboratory version, thus providing the research community with a new tool to assess visuomotor function.

Optic ataxia: beyond the dorsal stream cliché

This chapter reviews clinical and scientific approaches to optic ataxia. This double historic track allows us to address important issues such as the link between Bálint syndrome and optic ataxia, the alleged double dissociation between optic ataxia and visual agnosia, and the use of optic ataxia to argue for a specific vision-for-action occipitoposterior parietal stream. Clinical cases are described and reveal that perceptual deficits have been long shown to accompany ataxia. Importantly, the term ataxia appears to be misleading as patients exhibit a combination of visual and nonvisual perceptual, attentional, and visuomotor guidance deficits, which are confirmed by experimental approaches. Three major features of optic ataxia are described. The first is a spatial feature whereby the deficits exhibited by patients appear to be specific to peripheral vision, akin to the field effect. Visuomotor field examination allows us to quantify this deficit and reveals that it consists of a highly reliable retinocentric hypometria. The third is a temporal feature whereby these deficits are exacerbated under temporal constraints, i.e., when attending to dynamic stimuli. These two aspects combine in a situation where patients have to quickly respond to a target presented in peripheral vision that is experimentally displaced upon movement onset. In addition to the field effect, a hand effect can be described in conditions where the hand is not visible. Spatial and temporal aspects as well as field and hand effects may rely on several posterior parietal modules that remain to be precisely identified both anatomically and functionally. It is concluded that optic ataxia is not a visuomotor deficit and there is no dissociation between perception and action capacities in optic ataxia, hence a fortiori no double dissociation between optic ataxia and visual agnosia. Future directions for understanding the basic pathophysiology of optic ataxia are proposed.