Transcutaneous electrical stimulation and vibration of neck muscles in neglect

Four neglect patients without visual field defects, one with a lesion of the right basal ganglia and three with a right, predominantly parietal lesion, were examined with a cancellation and a copying task before, during and after neck muscle vibration, during transcutaneous electrical stimulation of neck muscles and during vibration of hand muscles on the left side. In all patients, neck muscle vibration improved task performance, while transcutaneous electrical stimulation and hand vibration had little or no effect. The present results demonstrate that the effect of neck muscle vibration cannot be explained as arousal and activation due to unspecific sensory stimulation on the contralesional side of the body. They rather argue for the assumption that the compensatory effect of neck muscle vibration on neglect is an effect induced by the predominant activation of afferent Ia nerve fibres and their specific contribution to the central representation of egocentric space.     

Considering structural connectivity in the triple code model of numerical cognition: differential connectivity for magnitude processing and arithmetic facts

The current study provides a generalizable account of the anatomo-functional associations as well as the connectivity of representational codes underlying numerical processing as suggested by the triple code model (TCM) of numerical cognition. By evaluating the neural networks subserving numerical cognition in two specific and substantially different numerical tasks with regard to both grey matter localizations as well as white matter tracts we (1) considered the possibility of additional memory-related cortex areas crucial for arithmetic fact retrieval (e.g., the hippocampus); (2) specified the functional involvement of prefrontal areas in number magnitude processing, and, finally; (3) identified the connections between these anatomo-functional instantiations of the representations involved in number magnitude processing and arithmetic fact retrieval employing probabilistic fiber tracking. The resulting amendments to the TCM are summarized in a schematic update, and ideas concerning the possible functional interplay between number magnitude processing and arithmetic fact retrieval are discussed.     

Predictive value and reward in implicit classification learning

Learning efficacy depends on its emotional context. The contents learned and the feedback received during training tinges this context. The objective here was to investigate the influence of content and feedback on the efficacy of implicit learning and to explore using functional imaging how these factors are processed in the brain. Twenty-one participants completed 150 trials of a probabilistic classification task (predicting sun or rain based on combinations of playing cards). Smileys or frowneys were presented as feedback. In 10 of these subjects, the task was performed during functional magnetic resonance imaging. Card combinations predicting sun were remembered better than those predicting rain. Similarly, positive feedback fortified learning more than negative feedback. The presentation of smileys recruited bilateral nucleus accumbens, sensorimotor cortex, and posterior cingulum more than negative feedback did. The higher the predictive value of a card combination, the more activation was found in the lateral cerebellum. Both context and feedback influence implicit classification learning. Similar to motor skill acquisition, positive feedback during classification learning is processed in part within the sensorimotor cortex, potentially reflecting the activation of a dopaminergic projection to motor cortex (Hosp et al., 2011). Activation of the lateral cerebellum during learning of combinations with high predictive value may reflect the formation of an internal model.     

Right insula for our sense of limb ownership and self-awareness of actions

Normally, we are aware that our arms and legs belong to us and not to someone else. However, some stroke patients with hemiparesis/-plegia after right-sided stroke show a disturbed sensation of limb ownership and a disturbed self-awareness of actions and such patients with anosognosia for hemiparesis/plegia typically deny their paresis/-plegia and are convinced that their limbs function normally. They may experience their limb(s) as not belonging to them and may even attribute them to other persons. Modern lesion analyses techniques in such patients and recent neuroimaging results in healthy subjects suggest a prominent role of the right insula for our sense of limb ownership as well as for our feeling of being involved in a movement—our sense of agency. We thus hypothesize that the right insular cortex constitutes a central node of a network involved in human body scheme representation.     

A simple measure of neglect severity

Cancellation tasks are popular clinical and scientific tools for identifying spatial neglect, with neglect patients tending to miss targets on the contralesional side of the test. However, methods for analysis are not well established. Indeed, these tests are often used as a binary classifier to simply identify the presence or absence of spatial neglect, even though it is clear that there is a spectrum of disability on these tasks. We suggest that the Center of Cancellation (CoC) provides an intuitive, continuous and robust measure of neglect severity. First employed by Binder and colleagues [Archives of Neurology, 49, 1187-1194 (1992)], its use has not been replicated since. Our aim was to ease deployment of this measure through validation, development of software and focused exposition. To validate this index, we evaluated a group of 110 individuals with right-hemisphere injury. For two different cancellation tasks (the Bells Test and the Letter Cancellation Task) we predicted spatial neglect (as defined by independent measures) using the new CoC index. Examining each individual's performance on a single cancellation task, we were able to correctly determine with better than 98% accuracy whether three tests with binary classifiers would define them as having spatial neglect. Specifically, an acute CoC score greater than 0.081 on the Bells Test or 0.083 on the Letter Cancellation Task turned out to indicate neglect behavior after a right-hemisphere brain lesion. Finally, we provide free software allowing other groups not only to rapidly analyze new but also previously existing (paper-and-pencil based) datasets using this measure.     

Vestibular influence on human auditory space perception

We investigated the effect of vestibular stimulation on the lateralization of dichotic sound by cold-water irrigation of the external auditory canal in human subjects. Subjects adjusted the interaural level difference of the auditory stimulus to the subjective median plane of the head. In those subjects in whom dizziness and nystagmus indicated sufficient vestibular stimulation, these adjustments were significantly shifted toward the cooled ear compared with the control condition (irrigation with water at body temperature); i.e., vestibular stimulation induced a shift of the sound image toward the nonstimulated side. The mean magnitude of the shift was 7.3 dB immediately after vestibular stimulation and decreased to 2.5 dB after 5 min. As shown by an additional control experiment, this effect cannot be attributed to a unilateral hearing loss induced by cooling of the auditory periphery. The results indicate the involvement of vestibular afferent information in the perception of sound location during movements of the head and/or the whole body. We thus hypothesize that vestibular information is used by central-nervous mechanisms generating a world-centered representation of auditory space.     

Prognosis of contraversive pushing

Stroke patients with ‘pusher syndrome’ actively push away from the non-hemiparetic side leading to a loss of postural balance and falling towards the paralysed side. The behaviour is due to an altered perception of the body's orientation in relation to gravity. Here, we studied the prognosis of the disorder. Twelve pusher patients first investigated immediately after the stroke were re-examined 6 months later. Pusher symptoms had nearly completely recovered. The aim for physiotherapy of patients with contraversive pushing thus is to shorten the period of necessary treatment and enable earlier discharge from residential care. Received: 30 November 2001, Received in revised form: 15 March 2002, Accepted: 18 March 2002     

The effect of whole-body tilt on sound lateralization

The effect of passive whole-body tilt in the frontal plane on the lateralization of dichotic sound was investigated in human subjects. Pure-tone pulses (1 kHz, 100 ms duration) with various interaural time differences were presented via headphones while the subject was in an upright position or tilted 45 degrees or 90 degrees to the left or right. Subjects made two-alternative forced-choice (left/right) judgements on the intracranial sound image. During body tilt, the auditory median plane of the head, computed from the resulting psychometric functions, was always shifted to the upward ear, indicating a shift of the auditory percept to the downward ear, that is, in the direction of gravitational linear acceleration. The mean maximum magnitude of the auditory shift obtained with 90 degrees body tilt was 25 micro s. On the one hand, these findings suggest a certain influence of the otolith information about body position relative to the direction of gravity on the representation of auditory space. However, in partial contradiction to previous work, which had assumed existence of a significant 'audiogravic illusion', the very slight magnitude of the present effect rather reflects the excellent stability in the neural processing of auditory spatial cues in humans. Thus, it might be misleading to use the term 'illusion' for this quite marginal effect.     

Pressure support ventilation combined with volume guarantee versus synchronized intermittent mandatory ventilation: a pilot crossover trial in premature infants in their weaning phase.

OBJECTIVE: To compare pressure support ventilation combined with volume guarantee (PSV-VG) to synchronized intermittent mandatory ventilation (SIMV) regarding safety, course of blood gases, and infant-ventilator interaction in premature infants. DESIGN: Prospective, two-treatment, crossover pilot study. SETTING: Tertiary care neonatal unit. PATIENTS: Twenty-five ventilated premature infants: median (range) gestational age 26.1 wks (23.1-35.7), birth weight 765 g (450-3170), age at study 5 days (2-27), in their weaning phase. INTERVENTIONS: Infants were studied for three 30-min periods, starting from SIMV, followed by PSV-VG, and back again to SIMV. After concluding the last period, all infants were switched back to PSV-VG. On the next day, infants were studied in the opposite direction. During each period, vital parameters, ventilation parameters, degree of physical activity, duration of rhythmic breathing, and the number of vital signs monitor alarms were recorded. MEASUREMENTS AND MAIN RESULTS: Nineteen infants (84%) could be successfully ventilated with PSV-VG till the next day. PSV-VG achieved a similar oxygenation level as SIMV but with significantly lower ventilation pressures. Comparable ventilation was achieved, but infants with strong respiratory drive were more liable to hyperventilation episodes during PSV-VG. Although infants breathed more rhythmically during PSV-VG, suggesting better infant-ventilator synchrony, the infants' behavioral state and the fluctuations in blood gases did not differ. CONCLUSIONS: The potentials of PSV-VG to improve infant-ventilator synchrony and to decrease pressure needed to ventilate premature lungs are promising, even though the changes were small. However, its benefits during acute illness and on the final outcome remain to be proven.