Preserved leftward movement in left unilateral spatial neglect due to frontal lesions.

Three patients with left unilateral spatial neglect after predominantly frontal lobe lesions were asked to extend a horizontal line leftwards to double its original length. In this line extension task, they readily executed movements in or towards the contralesional left space. They performed the task in the left and right hemispaces as well as in the midline. The mean extension lengths did not differ significantly among these three spatial conditions. These results suggest that directional hypokinesia takes little part in left unilateral spatial neglect due to frontal lobe lesions. It is considered that the patients could execute leftward movements as the task oriented their attention sufficiently to the left. Two of the three patients, like reported cases with frontal neglect, showed a typical exploratory deficit for the left space in the line cancellation test. Such a deficit found in the traditional tasks, however, does not mean the presence of directional hypokinesia. All three patients showed visual extinction on double simultaneous stimulation. An attentional mechanism seems to play a predominant part in unilateral spatial neglect due to frontal lesions.     

Interhemispheric cooperation of left- and right-handers in mental calculation tasks

Relations between handedness and interhemispheric processing in cognitive tasks were examined. Thirty six right-handers and thirty left-handers (familial and nonfamilial left-handers) were asked to add two numbers which were presented tachistoscopically. Two numbers were displayed either to one visual field, or one to the left and one to the right visual field simultaneously. In Experiment 1, the numbers were displayed in Arabic numerals, and in Experiment 2 one of the numbers was displayed in Kanji and one in Arabic numerals. The results of Experiment 1 showed a bilateral advantage, however no subject group difference was shown in the performance of the three (left unilateral, right unilateral, and bilateral) presentation conditions. Though familial left-handers showed a weaker tendency to different patterns than right and non-familial left-handers, the results of Experiment 2 were largely similar to those of Experiment 1. These findings suggest that interhemispheric processing may not differ between left- and right-handers.     

Interhemispheric Cooperation of Left- and Righthanders in Mental Calculation Tasks

Relations between handedness and interhemispheric processing in cognitive tasks were examined. Thirty six right-handers and thirty left-handers (familial and nonfamilial left-handers) were asked to add two numbers which were presented tachistoscopically. Two numbers were displayed either to one visual field, or one to the left and one to the right visual field simultaneously. In Experiment 1, the numbers were displayed in Arabic numerals, and in Experiment 2 one of the numbers was displayed in Kanji and one in Arabic numerals. The results of Experiment 1 showed a bilateral advantage, however no subject group difference was shown in the performance of the three (left unilateral, right unilateral, and bilateral) presentation conditions. Though familial left-handers showed a weaker tendency to different patterns than right and non-familial left-handers, the results of Experiment 2 were largely similar to those of Experiment 1. These findings suggest that interhemispheric processing may not differ between left- and righthanders.     

Numbers within our hands: modulation of corticospinal excitability of hand muscles during numerical judgment

Developmental and cross-cultural studies show that finger counting represents one of the basic number learning strategies. However, despite the ubiquity of such an embodied strategy, the issue of whether there is a neural link between numbers and fingers in adult, literate individuals remains debated. Here, we used transcranial magnetic stimulation to study changes of excitability of hand muscles of individuals performing a visual parity judgment task, a task not requiring counting, on Arabic numerals from 1 to 9. Although no modulation was observed for the left hand muscles, an increase in amplitude of motor-evoked potentials was found for the right hand muscles. This increase was specific for smaller numbers (1 to 4) as compared to larger numbers (6 to 9). These findings indicate a close relationship between hand/finger and numerical representations.     

Number representation deficit: a bilingual case of failure to access written verbal numeral representations

This study reports the case of a Greek–German bilingual patient (S.V.) with specific deficit in Arabic number production from written German number words. S.V. was able to successfully complete the reverse task, i.e. to convert Arabic numerals into written or oral German number words. She also showed preserved ability to produce both German and Greek numbers and to accurately make oral magnitude judgments in both languages. However, when transcoding two-digit numbers from German written numerals to Arabic numbers she consistently reversed the digits. A series of in-house tasks were used to test her general abilities of number processing, i.e. number synesthesia and calculation. Moreover, a number magnitude comparison task was developed specifically for pairs of numbers with reverse digits and we found that out of pairs of numbers with reverse digits with magnitude less than 100, there exist 19 pair combinations for which distance and relative distance are not concordant. The results suggest that S.V.’s performance was significantly worse as the absolute distance between the numbers in the number pairs increased. These investigations are discussed in analogy with a grammatical rule problem related to absolute and relative distance effects.     

A unilateral defect of short-term visual memory in left hemineglect

Normal subjects and right- and left-brain-damaged patients with and without neglect performed a task of immediate visual memory and a task of same-different judgment on visual items. In both tasks, stimull consisted in geometrical patterns, which differed either on the right or on the left side. Only right-brain-damaged patients with neglect showed an impaired performance in these tasks. They performed worse on items differing on the left side than on items differing on the right side. This impairment was more severe on the memory task than on the same-different task, suggesting that a lateralized visual memory deficit contributes to the behavioural manifestations of left hemineglect.     

Visual,proprioceptive and tactile performance in left neglect patients

Patients with unilateral spatial neglect due to right-hemisphere lesions typically fail to attend to and explore left-sided stimulus objects. It has been postulated that in right-brain damaged (RBD) patients an ipsilesional displacement of the egocentric frame of reference (ER), whether visual or tactile, may be responsible for a contralesional supramodal spatial bias causing their left neglect behavior. However, this hypothesis had been proposed without testing, in the same patients, the position of the ER or their performance in the visual and tactile modalities. Thus, the aim of the present study was to test the hypothesis that an ipsilateral shift of the ER is responsible for a supramodal spatial bias in neglect.For this purpose, a within-subject design is required. Consequently, 12 left neglect patients and 12 control subjects were asked to perform a proprioceptive straight-ahead pointing task while blindfolded, as well as visual and tactile bisection tasks.In the left neglect patients, we found:no systematic deviation of the ER on the ipsilesional right side;a significant rightward bias in visual bisection, and normal performance in tactile bisection;no correlation among the three tasks;that only visual bisection correlated with the severity of neglect.These results are discussed with regard to the egocentric and attentional hypothesis of neglect.     

Bilateral field interactions and hemispheric asymmetry in number comparison

We investigated bilateral field interactions and hemispheric asymmetry in number comparison. A numerical comparison task with three different stimulus notations (Arabic numerals, word numerals and bar graphs) was used. In all conditions, a target was displayed in one visual field, simultaneously with a distractor of the same format in the other visual field. Participants had to indicate manually whether the magnitude of the target was small or large, ignoring the distractor stimulus. Only in the condition with Arabic numerals did we obtain some evidence for a LVF advantage, which argues against a strong laterality of number magnitude representations. Significant interactions between target and distractor values were observed, indicating rich interhemispheric interactions. The interactions were mainly situated at the response stage, but the presence of a bilateral identity effect also points to interactions at the input level.     

Intact verbal description of letters with diminished awareness of their forms

Visual processing and its conscious awareness can be dissociated. To examine the extent of dissociation between ability to read characters or words and to be consciously aware of their forms, reading ability and conscious awareness for characters were examined using a tachistoscope in an alexic patient. A right handed woman with 14 years of education presented with incomplete right hemianopia, alexia with kanji (ideogram) agraphia, anomia, and amnesia. Brain MRI disclosed cerebral infarction limited to the left lower bank of the calcarine fissure, lingual and parahippocampal gyri, and an old infarction in the right medial frontal lobe. Tachistoscopic examination disclosed that she could read characters aloud in the right lower hemifield when she was not clearly aware of their forms and only noted their presence vaguely. Although her performance in reading kanji was better in the left than the right field, she could read kana (phonogram) characters and Arabic numerals equally well in both fields. By contrast, she claimed that she saw only a flash of light in 61% of trials and noticed vague forms of stimuli in 36% of trials. She never recognised a form of a letter in the right lower field precisely. She performed judgment tasks better in the left than right lower hemifield where she had to judge whether two kana characters were the same or different. Although dissociation between performance of visual recognition tasks and conscious awareness of the visual experience was found in patients with blindsight or residual vision, reading (verbal identification) of characters without clear awareness of their forms has not been reported in clinical cases. Diminished awareness of forms in our patient may reflect incomplete input to the extrastriate cortex.     

The middle house or the middle floor: bisecting horizontal and vertical mental number lines in neglect

This study explores the processing of mental number lines and physical lines in five patients with left unilateral neglect. Three tasks were used: mental number bisection ('report the middle number between two numbers'), physical line bisection ('mark the middle of a line'), and a landmark task ('is the mark on the line to the left/right or higher/lower than the middle of the line?'). We manipulated the number line orientation purely by task instruction: neglect patients were told that the number-pairs represented either houses on a street (horizontal condition) or floors in a building (vertical condition). We also manipulated physical line orientation for comparison. All five neglect patients showed a rightward bias for horizontally oriented physical and number lines (e.g. saying 'five' is the middle house number between 'two' and 'six'). Only three of these patients also showed an upward bias for vertically oriented number lines. The remaining two patients did not show any bias in processing vertical lines. Our results suggest that: (1) horizontal and vertical neglect can associate or dissociate among different patients; (2) bisecting number lines operates on internal horizontal and vertical representations possibly analogous to horizontal and vertical physical lines; (3) at least partially independent mechanisms may be involved in processing horizontal and vertical number lines.     

Evaluating visual bias and effect of proprioceptive feedback in unilateral neglect

We propose modified versions of the line-bisection task for assessing visual bias and effect of proprioceptive feedback in unilateral neglect; that is, the verbal line-bisection (VLB) task and the VLB plus pointing task. The VLB task requires only a verbal response to assess pure visual bias. Conversely, the VLB plus pointing task requires both a verbal response and pointing to assess visual and proprioceptive bias. Ten patients with unilateral neglect were administered these tasks on a computer using presentation software. Eight participants showed obvious rightward deviation in the VLB task, and were thus classified as patients with visual neglect. Four participants showed significantly greater deviation in the VLB plus pointing task than in the VLB task, and were thus classified as patients with proprioceptive bias. Visual bias and effect of proprioceptive feedback in unilateral neglect were successfully assessed by these tasks.     

Hemispheric differences in the judgment of number

Two manual reaction-time experiments examined visual field differences for the judgment of number. All told, three tasks (recognition/enumeration, magnitude judgment and oddity judgment) were performed on three nonverbal indicators of number (dot clusters, bargraphs and dials) and two verbal indicators (word names of numbers and digits). The results indicated that field differences depended largely on display format, not on the task. Thus, dot clusters, bargraphs and dials all showed a left visual field superiority, while words showed a right visual field superiority. There was no evidence of lateralization for digits.     

Psychophysical properties of line bisection and body midline perception in unilateral neglect

Past research associated unilateral neglect with a systematic ipsilesional shift of the perceived position of the body midline; however, this was not confirmed by recent experiments. We used the constant stimuli method to control for potential artifacts intrinsic to the techniques used in previous studies. Body midline perception was measured in the visual and proprioceptive modalities in ten patients with left unilateral neglect, ten control patients and ten normal subjects and compared with a visual line bisection task, also using the constant stimuli method. Neglect patients showed a significant rightward bias in the line bisection task, but no consistent directional bias either in the proprioceptive or in the visual body midline task. These results clearly counter the association between neglect and an ipsilesional shift of the body midline. However, in the body midline tasks neglect patients made more errors in judgement on both sides of their subjective midline, both with respect to the control groups and with respect to the line bisection task. This may imply that a specific impairment of body-centered representations is indeed present and manifests as a non directional increase in response variability, rather than as a systematic shift. It is suggested that body- and object-related tasks (such as line bisection) may be processed by independent cognitive computations. This interpretation is discussed with reference to a recent neuroimaging study investigating the same kinds of tasks.     

Visual attentional disturbance with unilateral lesions in the basal ganglia and deep white matter.

To elucidate the role of the basal ganglia and deep white matter in the visual attention mechanism, a new visual attention task was carried out by 15 patients, 9 with left-side and 6 with right-side basal ganglia and/or deep white matter damage without visual field defects, and by 12 normal subjects. Their reaction times were recorded in response to a random visual stimulation by pushing a button with the hand ipsilateral to the side of the lesion. All the patients with damage to the right side of the brain had a longer reaction time in the left space than in the right or middle space. With conventional test, only one of them showed left unilateral spatial neglect. Seven of the 9 patients with a left lesion had a significantly longer reaction time in the right space than in the left. None had unilateral spatial neglect. Both the right and left brain-damaged groups showed longer reaction times in both spaces, compared to the normal groups. There was no significant difference in reaction time among the control subjects. These findings suggest that the basal ganglia and deep white matter in each hemisphere play some role in directing visual attentional factors into both spaces. Visual attentional disturbance was highly evident even with left-side brain damage, and this kind of disturbance is not usually revealed with the current tasks used for testing unilateral spatial neglect.     

Negligence de l'hemi-espace gauche dans des epreuves visuo-constructives (influence de la complexite spatiale et de la methode de compensation)

The results obtained by 10 patients who exhibited neglect of the left half of extra-personal visual space on visuo-contructional tasks appeared to indicate an influence of the complexity of the task upon both the incidence and significance of unilateral neglect. The contribution of points of reference is revealed in a certain degree of effective compensation though that of a programme of realisation in three stages showed itself to be ineffective. These results are discussed in relation to earlier findings reported in the literature.     

Clinical aspects and mechanisms of visual-spatial neglect

Several interpretations have been advanced to explain the nature of unilateral spatial neglect. According to some authors, unilateral neglect could be due to a sensory deficit or to an oculomotor disorder hampering the patient from completely exploring the half space contralateral to the damaged hemisphere. According to other authors, the unilateral neglect syndrome could result either from a mutilation of the inner representation of the outside space or from a lack of attention for stimuli falling in the half space opposite to the hemispheric locus of lesion. We have wondered whether the relationships between unilateral neglect and hemispheric lateralization could not help to understand the nature of the neglect phenomena. A retrospective analysis of data gathered in neuropsychological literature, and results of an experimental study in which we had contrasted results obtained on an "overlapping figures" task and on a visual search task and a qualitative analysis of neglect phenomena observed in right brain-damaged patients, have led to the following conclusions: a) unilateral neglect is specifically linked to right hemisphere lesions in tasks requiring extraction of information from the central part of the visual field, whereas no difference between right-sided and left-sided lesions is observed on tasks requiring a full exploration of extra-personal space; b) tasks selectively affected in right brain-damaged patients require an automatic orienting of attention toward the more peripheral parts of the stimuli, which could be partly impaired owing to an early orientation of attention toward the right side of the pattern and a subsequent difficulty to detach attention from this early focus to orient it toward parts fo the stimulus lying in the left half space.     

Preserved obstacle avoidance during reaching in patients with left visual neglect

We asked 12 patients with left visual neglect to bisect the gap between two cylinders or to reach rapidly between them to a more distal target zone. Both tasks demanded a motor response but these responses were quite different in nature. The bisection response was a communicative act whereby the patient indicated the perceived midpoint. The reaching task carried no imperative to bisect the gap, only to maintain a safe distance from either cylinder while steering to the target zone. Optimal performance on either task could only be achieved by reference to the location of both cylinders. Our analysis focused upon the relative influence of the left and right cylinders on the lateral location of the response. In the bisection task, all neglect patients showed qualitatively the same asymmetry, with the left cylinder exerting less influence than the right. In the reaching task, the neglect group behaved like normal subjects, being influenced approximately equally by the two cylinders. This was true for all bar two of the patients, who showed clear neglect in both tasks. We conclude that the visuomotor processing underlying obstacle avoidance during reaching is preserved in most patients with left visual neglect.     

Comparison of auditory deficits associated with neglect and auditory cortex lesions

In contrast to lesions of the visual and somatosensory cortex, lesions of the auditory cortex are not associated with self-evident contralesional deficits. Only when two or more stimuli are presented simultaneously to the left and right, contralesional extinction has been observed after unilateral lesions of the auditory cortex. Because auditory extinction is also considered a sign of neglect, clinical separation of auditory neglect from deficits caused by lesions of the auditory cortex is challenging. Here, we directly compared a number of tests previously used for either auditory-cortex lesions or neglect in 29 controls and 27 patients suffering from unilateral auditory-cortex lesions, neglect, or both. The results showed that a dichotic-speech test revealed similar amounts of extinction for both auditory cortex lesions and neglect. Similar results were obtained for words lateralized by inter-aural time differences. Consistent extinction after auditory cortex lesions was also observed in a dichotic detection task. Neglect patients showed more general problems with target detection but no consistent extinction in the dichotic detection task. In contrast, auditory lateralization perception was biased toward the right in neglect but showed considerably less disruption by auditory cortex lesions. Lateralization of auditory-evoked magnetic fields in auditory cortex was highly correlated with extinction in the dichotic target-detection task. Moreover, activity in the right primary auditory cortex was somewhat reduced in neglect patients. The results confirm that auditory extinction is observed with lesions of the auditory cortex and auditory neglect. A distinction can nevertheless be made with dichotic target-detection tasks, auditory-lateralization perception, and magnetoencephalography.     

The importance of time limits in detecting signs of left visual peripersonal neglect: a multiple single-case,pilot study

ABSTRACT

We developed a new visual search test to assess signs of left visual peripersonal neglect. Five right-hemisphere-damaged patients, 10 healthy controls, and 10 orthopedic controls were administered the test in four conditions: easy task (no distractors)/time-limited (45’’), easy task (no distractors)/time-unlimited, difficult task (distractors)/time-limited (45’’), difficult task (distractors)/time-unlimited. With respect to controls, most RHDP showed signs of left visual peripersonal neglect in the time-limited condition, but not in the time-unlimited condition, particularly on the difficult task. We suggest that the presence of appropriate time limits, in difficult visual search tasks, could considerably improve the diagnosis of left visual peripersonal neglect.     

The lighthouse strategy: Improving the functional status of patients with unilateral neglect after stroke and brain injury using a visual imagery intervention

This study extends the work of J. Niemeier (1998) by using visual imagery for amelioration of the devastating impact of visual inattention or neglect on recovery from stroke or other brain injuries. Ten individuals with unilateral visual neglect who were undergoing acute physical rehabilitation after brain injury were cued by their interdisciplinary treatment team members to "be like" horizon-illuminating lighthouses and turn their heads left and right during functional and therapy training tasks. These treatment group patients, in comparison with waiting list controls, performed significantly better and more safely on route finding (p <.001), walking or wheelchair (p <.05), and problem solving (p <.05) tasks. The use of visual imagery techniques in rehabilitation of brain injuries is discussed.