Visual information processing in hemispatial neglect

Hemispatial neglect is a complex neuropsychological disorder characterized by a severe attentional deficit that produces a lack of awareness for information appearing in contralesional hemispace. Despite this lack of phenomenal awareness, recent studies suggest that a great deal of visual information processing does occur and can influence the performance of patients in certain tasks. The current review will present this evidence and suggest a new theoretical framework that may help to direct future research into uncovering the underlying mechanism(s).     

Non-lateralised deficits of drawing production in hemispatial neglect

Spatially lateralised deficits that typically define the hemispatial neglect syndrome have been shown to co-occur with other non-lateralised deficits of attention, memory, and drawing. However even a simple graphic task involves multiple planning components, including the specification of drawing start position and drawing direction. In order to investigate the influence of these factors in neglect we presented patients with a circle-copying task, and specified the drawing start point. The ability to draw from the instructed location was strongly related to tests that measure constructional abilities, but not related to start point laterality. In contrast, the direction in which patients drew the circle was affected by start point laterality: patients with neglect were less likely to draw in a typical direction when the cue was on the affected side of space and this was strongly related to severity of the neglect. Patients with neglect consistently produced circles that were smaller than the model; however, the scaling was not affected by the laterality of the start point, nor was the proportion of drawings correctly started at the cue. These findings demonstrate the complex relationship between neglect and even the simplest test for the syndrome.     

Updating of locations during whole-body rotations in patients with hemispatial neglect

Posterior parietal cortex lesions have been associated with both hemispatial neglect and spatialupdating deficits. Currently, the relation between these processes remains poorly understood. We tested the ability of parietal patients with neglect to update remembered target locations during passive whole-body rotations. The rotations and manual pointing responses were executed with and without vision. During the rotation, the remembered location stayed on the same side of the body midline or crossed the midline. Parietal patients generally underestimated rotations, as compared with control groups, but updated targets equally well on either side of the body midline, regardless of the amount of updating required. Once parietal patients have localized a target, they can use self-motion information to update its location, even if it passes into the region they typically neglect. This lack of contralesional updating effects contrasts with impairments in eye position updating found in previous work with parietal patients.     

The effect of hemispatial neglect on the perception of centre

Highly variable bisection performance in neglect patients has been attributed to an increased 'zone of indifference'. The indifference zone indicates the discrepancy between two line lengths which are judged as equal in length. Following this argumentation, the central area of a line should be expanded in neglect patients. The present two experiments investigated for the first time the expansion of the central area using a modified version of the Landmark Task. The location of a central or asymmetrical bisection mark on a horizontal line had to be judged (centre/left/right). In both experiments neglect patients, unlike healthy and patient controls, showed clear deficits in judging the location of the mark correctly and tended to judge asymmetrical marks of up to 4 cm as centrally positioned. The results are in agreement with and provide the first clear evidence of an enlarged perceptual zone of indifference in patients with hemispatial visual neglect.     

Disrupting somatosensory processing impairs motor execution but not motor imagery

While motor imagery (MI) is thought to be ‘functionally equivalent’ with motor execution (ME), the equivalence of feedforward and feedback mechanisms between the two modalities is unexplored. Here, we tested the equivalence of these mechanisms between MI and ME via two experiments designed to probe the role of somatosensory processing (Exp 1), and cognitive processing (Exp 2). All participants were engaged in a previously established force-matching task adapted for MI. A reference force was applied (on scale of 1–10, with higher numbers indicative of greater force) to one index finger while participants matched the force with their opposite index finger via ME or MI (control conditions). Participants then rated the force on the same scale of 1–10. Exp 1: Participants (N = 27) performed the task with tactile stimulation (ME+TAC, MI+TAC) in addition to control conditions. Exp 2: Participants (N = 26) performed the task in dual-task conditions (ME+COG, MI+COG) in addition to control conditions. Results indicate that (Exp 1) tactile stimulation impaired performance in ME but not MI. Dual-task conditions (Exp 2) were not shown to impair performance in either practice modality. Findings suggest that while somatosensory processing is critical for ME, it is not for MI. Overall we indicate a functional equivalence between feedforward/back mechanisms in MI and ME may not exist.     

The influence of contralesional targets on the cancellation of ipsilesional targets in unilateral neglect

Neglect of contralesional stimuli and perseverative behavior on ipsilesional stimuli may co-occur on a target cancellation task. Our aim was to investigate whether the presence vs. absence of contralesional targets can modify perseveration on ipsilesional targets. We studied four right brain-damaged patients with left neglect and perseverative behavior on screening cancellation tasks. We compared their cancellation performance in two conditions: (i) targets equally distributed on both sides of space and (ii) targets confined to the right side. One patient showed no significant difference in perseveration between these two conditions; in contrast, three patients perseverated significantly more in condition (i) than in condition (ii). These results suggest that, at least in some patients, information from the 'neglected' targets is not completely lost, but rather it affects behavior in the ipsilesional side. The traditional dichotomy 'bad space-good space' would not apply here.     

The planning and execution of sequential eye movements: saccades do not show the one target advantage

The present experiment examined the one-target advantage (OTA) with regard to saccadic eye movements. The OTA, previously found with manual pointing responses, refers to the finding that movements are executed faster when the limb is allowed to stop on the target compared to the situation where it has to proceed and hit a second target. Using an adapted limb movement OTA task, saccades of 5 degrees and 15 degrees were made to (a) a single target (one-target), (b) one target and immediately to another target without a change in direction (two-target-extension), and (c) one target and immediately back to the start location (two-target-reversal). Unlike manual movements, the movement times for the initial saccade in the two-target-extension condition were not prolonged compared to either of the other two conditions. Moreover, this pattern of results was found for both the shorter and longer amplitude saccades. The results indicate that the OTA does not occur in the oculomotor system and therefore is not a general motor control phenomenon.     

Perceptual grouping operates independently of attentional selection: Evidence from hemispatial neglect

To what extent can human observers process visual information that is not currently the focus of attention? We evaluated the extent to which unattended visual information (i.e., that which appears on the neglected side of space in individuals with hemispatial neglect) is perceptually organized and influences the perceptual processing of information on the attended side. To examine this, patients (and matched controls) judged whether successive, complex checkerboard stimuli (targets), presented entirely to their intact side of space, were the same or different. Concurrent with this demanding task, irrelevant distractor elements appeared on the unattended side and either changed or retained their perceptual grouping on successive displays, independently of changes in the ipsilesional task-relevant target. Changes in the grouping of the unattended task-irrelevant distractor elements produced congruency effects on the attended target-change judgment to the same extent in the neglect patients as in the control participants, and this was true even in those patients with severe attentional deficits. These results suggest that some perceptual processes, such as grouping, can operate in the absence of attention.     

Representational bias does not affect bisection of lines with a pictorially or semantically defined top by patients with left hemispatial neglect

Normal subjects may have both representational and visual-based components determining bias in bisection of horizontal, vertical, and radial lines. The influence of these components is less clear in patients with neglect. We asked 25 patients with right hemisphere stroke and clinical features of neglect to bisect lines oriented horizontally, vertically, and radially above and below eye level. Objects including human silhouette figures, arrowheads, and the words 'TOP' and 'BOTTOM' were placed at either end of each line. These figures were presented either upright or upside down in some orientations, and presented rightward and leftward in other orientations, to pictorially or semantically define a "top" to each line independent of the actual top of the visual field. Patients demonstrated a rightward bias on all horizontal line bisections, with similar bias and greater magnitude than normal subjects. Patients also demonstrated visual-based biases on some of the vertical, radial down, and radial up lines presented. However, patients did not demonstrate a significant representational bias with any of the visual cues presented on any of the line orientations. Patients with acute right hemisphere stroke demonstrate a rightward bias when asked to perform line bisection in the horizontal line orientation, as well as an upward bias in vertical line bisection. The lack of representational bias in patients with neglect may be due to a greater degree of visual-based neglect as compared to representational neglect, or it may be due to an absence of representational bias in patients with right hemisphere stroke.     

Transcranial alternating brain stimulation at alpha frequency reduces hemispatial neglect symptoms in stroke patients

Background/ObjectiveNon-invasive brain stimulation techniques such as transcranial alternating current stimulation (tACS) may help alleviate attention deficits in stroke patients with hemispatial neglect by modulating oscillatory brain activity. We applied high-definition (HD)-tACS at alpha frequency over the contralesional hemisphere to support unilateral oscillatory alpha activity and correct for the pathologically altered attention bias in neglect patients.MethodsWe performed a within-subject, placebo-controlled study in which sixteen stroke patients with hemispatial neglect underwent 10 Hz (alpha) as well as sham (placebo) stimulation targeting the contralesional posterior parietal cortex. Attentional bias was measured with a computerized visual detection paradigm and two standard paper-and-pencil neglect tests.ResultsWe revealed a significant shift of attentional resources after alpha-HD-tACS, but not sham tACS, toward the ipsilateral and thus contralesional hemifield leading to a reduction in neglect symptoms, measured with a computerized visual detection paradigm and a widely used standard paper and pencil neglect tests.ConclusionsWe showed a significant alpha-HD-tACS-induced shift of attentional resources toward the contralesional hemifield, thus leading to a reduction in neglect symptoms. Importantly, HD-tACS effects persisted after the stimulation itself had ended. This tACS protocol, based on intrinsic oscillatory processes, may be an effective and well-tolerated treatment option for neglect.     

Social priming of hemispatial neglect affects spatial coding: Evidence from the Simon task

In the Simon effect (SE), choice reactions are fast if the location of the stimulus and the response correspond when stimulus location is task-irrelevant; therefore, the SE reflects the automatic processing of space. Priming of social concepts was found to affect automatic processing in the Stroop effect. We investigated whether spatial coding measured by the SE can be affected by the observer’s mental state. We used two social priming manipulations of impairments: one involving spatial processing - hemispatial neglect (HN) and another involving color perception - achromatopsia (ACHM). In two experiments the SE was reduced in the “neglected” visual field (VF) under the HN, but not under the ACHM manipulation. Our results show that spatial coding is sensitive to spatial representations that are not derived from task-relevant parameters, but from the observer’s cognitive state. These findings dispute stimulus-response interference models grounded on the idea of the automaticity of spatial processing.     

The control of stimulus-driven saccades is subject not to central, but to visual attention limitations

In three experiments, we investigated whether the control of reflexive saccades is subject to central attention limitations. In a dual-task procedure, Task 1 required either unspeeded reporting or ignoring of briefly presented masked stimuli, whereas Task 2 required a speeded saccade toward a visual target. The stimulus onset asynchrony (SOA) between the two tasks was varied. In Experiments 1 and 2, the Task 1 stimulus was one or three letters, and we asked how saccade target selection is influenced by the number of items. We found (1) longer saccade latencies at short than at long SOAs in the report condition, (2) a substantially larger latency increase for three letters than for one letter, and (3) a latency difference between SOAs in the ignore condition. Broadly, these results match the central interference theory. However, in Experiment 3, an auditory stimulus was used as the Task 1 stimulus, to test whether the interference effects in Experiments 1 and 2 were due to visual instead of central interference. Although there was a small saccade latency increase from short to long SOAs, this difference did not increase from the ignore to the report condition. To explain visual interference effects between letter encoding and stimulus-driven saccade control, we propose an extended theory of visual attention.     

Suppressing where but not what: the effect of saccades on dorsal- and ventral-stream visual processing

Some cognitive processes are suppressed during saccadic eye movements, whereas others are not. In two experiments, we investigated the locus of this interference effect. In one experiment, subjects decided whether pictured items were objects or nonobjects while making saccades of different lengths. Saccade distance had no effect on response time, indicating that saccades do not interfere with object recognition. However, in a second experiment, in which subjects decided whether pictured items faced to the left or to the right, response time increased with saccade distance, indicating that processing was suppressed during the saccade. These results (along with others) suggest that dorsal-stream (where) processes are suppressed during saccades, whereas ventral-stream (what) processes are not. Because the dorsal stream is instrumental in generating saccades, we propose that cognitive saccadic suppression results from dual-task interference within this visual subsystem.     

Bilateral saccades increase intrahemispheric processing but not interhemispheric interaction: Implications for saccade-induced retrieval enhancement

Retrieval of memories is enhanced when bilateral saccades are made immediately before attempting retrieval. One hypothesis is that saccades enhance retrieval by increasing interaction of the brain hemispheres. To test this, subjects viewed arrays of lateralized letters and indicated whether target letters matched either of two probe letters. Matching targets and probes were presented to either the same hemisphere (within-hemisphere trials) or separate hemispheres (across-hemisphere trials). Match detection requires interhemispheric interaction on across-hemisphere trials but primarily intrahemispheric processing on within-hemisphere trials. Subjects performed letter matching following saccades and a fixation control condition. Saccades increased match-detection accuracy on within-hemisphere trials only, suggesting that, counter to the hypothesis, saccades enhance intrahemispheric processing but not interhemispheric interaction. Across-hemisphere accuracy was higher, however, for subjects who were not strongly right-handed, versus those who were, and the absence of strong right-handedness may reflect greater interhemispheric interaction. We discuss implications for accounts of saccade-induced retrieval enhancement.     

Motor initiation and execution in patients with conversion paralysis

Motor initiation and motor execution in four patients with conversion paralysis were investigated in a non-affected motor modality (speech). In line with the hypothesis of dissociated control in conversion disorder [Cognit. Neuropsychiatry 8 (1) (2001) 21] motor initiation, but not response duration, was expected to be impaired. The motor initiation times (reaction time: RT) and motor execution times (response duration: RD) were compared on four RT-tasks that required the production of a verbal response: a simple choice RT-task, a mental letter rotation task, and an implicit and an explicit mental hand rotation task. Because conversion disorder is expected to primarily involve an impairment in the initiation of movement, we expected the following task characteristics to uniquely affect RT and not RD: type of instruction (implicit versus explicit instructed imagery), angle of rotation, and target arm (affected versus non-affected arm). The results indeed showed the task characteristics to significantly affect the participants' RT and not their RD. It was concluded that conversion paralysis is associated with a specific impairment in the explicit initiation of processes with a spatial and motor component.     

Impaired task switching performance in children with dyslexia but not in children with autism

Problems with cognitive control in both autism and dyslexia have already been reported in different studies. The present study specifically examined task-switching performance in children with autism and dyslexia. For this purpose, a multiple-trial paradigm was used with cues for colour- and shape-matching tasks presented before a run of trials. The cue could imply a task switch (when the cue changed the task) or a task repetition (when the cue did not change the task). Both reaction times and error rates were measured for switching, restarting, and general task performance. Participants were children with autism (24) and with dyslexia (25) and healthy controls (27) with normal IQ and ages from 12 to 18 years. The main finding was that while similar switching performance was observed between children with autism and the healthy controls, children with dyslexia showed a significant switch-specific delay relative to both healthy controls and children with autism. Furthermore, no deficit in restarting performance was observed for any of the two patient groups. Finally, additional evidence is provided for a more general deficit in information processing in dyslexia. Our data suggest that children with autism are able to switch between tasks in a similar way as do normally developing children as long as the tasks are unambiguously specified. Furthermore, the data imply switch-specific deficits in dyslexia additionally to the deficits in general information processing already reported in the literature. The implications of our data are further discussed in relation to the interpretation of the Wisconsin Card Sorting Test.     

Impaired face detection may explain some but not all cases of developmental prosopagnosia

Developmental prosopagnosia (DP) is defined by severe face recognition difficulties due to the failure to develop the visual mechanisms for processing faces. The two‐process theory of face recognition (Morton & Johnson, 1991) implies that DP could result from a failure of an innate face detection system; this failure could prevent an individual from then tuning higher‐level processes for face recognition (Johnson, 2005). Work with adults indicates that some individuals with DP have normal face detection whereas others are impaired. However, face detection has not been addressed in children with DP, even though their results may be especially informative because they have had less opportunity to develop strategies that could mask detection deficits. We tested the face detection abilities of seven children with DP. Four were impaired at face detection to some degree (i.e. abnormally slow, or failed to find faces) while the remaining three children had normal face detection. Hence, the cases with impaired detection are consistent with the two‐process account suggesting that DP could result from a failure of face detection. However, the cases with normal detection implicate a higher‐level origin. The dissociation between normal face detection and impaired identity perception also indicates that these abilities depend on different neurocognitive processes.     

Impaired memory retrieval correlates with individual differences in cortisol response but not autonomic response

Stress can enhance or impair memory performance. Both cortisol release and sympathetic nervous system responses have been implicated in these differential effects. Here we investigated how memory retrieval might be affected by stress-induced cortisol release, independently of sympathetic nervous system stress responses. Thirty-two healthy participants (16 women) learned emotionally arousing and neutral words. One hour later, half of the participants underwent a stressor (cold pressor test) and the other half, a control warm water exposure, both followed by a delayed free recall task. The stressed participants were split into those who did (responders, N = 8) and those who did not (nonresponders, N = 6) show a cortisol response. Both responders and nonresponders showed comparable sympathetic nervous system activity (skin conductance level) during the cold pressor. The cortisol responders recalled significantly fewer words compared to nonresponders, and compared to control participants; this effect was most pronounced for moderately arousing words (compared to highly arousing and neutral words). These results suggest that individual differences in cortisol reactivity affect memory retrieval performance, and help to explain the differential effects of stress on memory.