Drawing perseveration in neglect: Effects of target density

In cancellation tasks, patients with unilateral spatial neglect typically fail to mark targets within the side of the sheet contralateral to the side of the lesion (contralesional). Moreover, they can show a perseverative behaviour, which consists in repeatedly cancelling stimuli, mainly in the side of the display ipsilateral to the side of the lesion (ipsilesional). We investigated in 13 right‐brain‐damaged patients with left spatial neglect and perseverative behaviour whether and how different densities of horizontal targets modulated omission and perseverative errors. We found that the density of targets modulated the patients’ distribution of neglect (area of omission), but not its extent, as indexed by the percentage of omissions. Specifically, the area of omissions tightened when target density increased leftwards. On the other hand, target density did not affect the distribution of perseverative behaviour (area of perseveration), as well as its extent, as indexed by the percentage of perseverations. Correlation analyses showed that both the extent and the distribution of omissions were positively correlated to clinical measures of spatial neglect. Conversely, perseverations did not show such a correlation. These findings support the view that two different pathological mechanisms might be involved in left spatial neglect and in ipsilesional perseverative behaviour.     

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.     

Asynchronous stimulus presentation in visual extinction: A psychophysical study

Patients showing visual extinction as a consequence of a unilateral brain lesion can correctly detect a single stimulus in either hemifield but fail to detect the contralesional stimulus (or at least process the stimulus less efficiently) when it is presented simultaneously with an ipsilesional stimulus. In an attempt to uncover the nature of the underlying deficit, some studies have manipulated the temporal characteristics of stimulus presentation. Contra- and ipsilesional stimuli with different stimulus onset asynchronies are typically used. In the present study, visual extinction was investigated in a group of left neglect patients (N=10) using a psychophysical paradigm with different stimulus onset asynchronies of target and distractor stimuli presented in different hemifields. Contrast thresholds for a target grating were determined with the target either in isolation or in the presence of an irrelevant distractor grating. When target and distractor gratings were presented simultaneously, neglect patients showed a significant extinction effect, i.e., a significant interference from the right hemifield distractor with left hemifield contrast sensitivity. When the right hemifield distractor preceded the left hemifield target stimulus by 250 ms, two different patterns of results were observed in the neglect patients. Five patients showed a significant improvement compared to the simultaneous presentation condition, five other patients showed a significant increase of the extinction effect. The results suggest that different underlying mechanisms, maybe due to different lesion locations, can cause extinction in neglect patients.     

Canceling out both the real and the spectral lines

Neglect patients typically show motor perseveration while canceling targets on the ipsilesional side. This behavior can be influenced by the presence vs. absence of targets on the (neglected) contralesional side (). As alternative explanations, the authors proposed (i) directional hypokinesia--the patient cannot perform reaching movements towards detected left-sided targets, and thus carries on canceling on the right side, and (ii) allochiria--the patient misperceives left-sided targets as located on the right side, and cancels them there. We report here data from a patient (EZ) that might confirm the second hypothesis. EZ was presented with 19 displays in which the number and position of cancellation targets on both sides were varied systematically. EZ showed motor perseveration while canceling, but this tendency did not vary across conditions. Interestingly though, EZ also drew cancellation marks in the empty space between the ipsilesional targets, and this phenomenon was significantly more intense when there were more targets on the neglected side. As EZ's comments suggested, such a behavior might reflect the attempt to cancel out delusional targets. Our speculation is that those objects were generated by allochiria.     

Relationship between hemispatial inattention and performance of activities of daily living in patients with schizophrenia

This study investigated the relation of hemispatial inattention to the performance of daily functions in 32 patients with schizophrenia or schizoaffective disorder and in 31 healthy controls. They were tested on the relationship between a target cancellation task and the Activities of Daily Living Rating Scale-II (ADLRS-II). According to the results of the hemispatial inattention test, the patients with schizophrenia made more omissions in the cancellation test than the controls. In addition, the results showed a significant correlation between number of omissions on the cancellation test and the ADLRS-II score in the study participants. A statistically significant relationship was observed between hemispatial inattention and the functional status of patients with schizophrenia, and suggests the need to incorporate measures of visual attention into psychiatric rehabilitation assessments.     

Spatial analysis after perinatal stroke: patterns of neglect and exploration in extra-personal space

This study was conducted to determine whether school-aged children who had experienced a perinatal stroke demonstrate evidence of persistent spatial neglect, and if such neglect was specific to the visual domain or was more generalized. Two studies were carried out. In the first, 38 children with either left hemisphere (LH) or right hemisphere (RH) damage and 50 age-matched controls were given visual cancellation tasks varying in two factors: target stimuli and stimulus array. In the second study, tactile neglect was evaluated in 41 children with LH or RH damage and 72 age-matched controls using a blindfolded manual exploration task. On the visual cancellation task, LH subjects omitted more target stimuli on the right, but also on the left, compared with controls. Children with RH lesions also produced a larger number of omissions on both the left and right sides than controls, but with poorer performance on the left. On the manual exploration task, LH children required significantly longer times to locate the target on both sides of the board than did controls. RH children had significantly prolonged search times on the left side, but not on the right, compared with controls. In both tasks, LH subjects employed unsystematic search strategies more often than both control and RH children. The search strategy of RH children also tended to be erratic when compared to controls, but only in the random arrays of the visual cancellation tasks; structure of the target stimuli improved their organization. These results demonstrate that children with early LH brain damage display bilateral difficulties in visual and tactile modalities; a pattern that is in contrast to that seen in adults with LH damage. This may result from disorganized search strategies or other subtle spatial or attentional deficits. Results of performance of RH children suggests the presence of contralateral neglect in both the visual and tactile modalities; a finding that is similar to the neglect in adult stroke patients with RH lesions. The fact that deficits in spatial attention and organizational strategies are present after very early focal damage to either the LH or the RH broadens our understanding of the differences in functional lateralization between the immature and mature brain. These results also add to evidence for limitations to plasticity in the developing brain. Our findings may have therapeutic and rehabilitative implications for the management of children with early focal brain lesions.     

The imbalance of oculomotor capture in unilateral visual neglect

Visual neglect has been associated with an imbalance in the level of activity in the saccadic system: activity in the contralesional field is suppressed, which makes target selection unlikely. We recorded eye movements of a patient with hemispatial neglect and a group of healthy participants during an oculomotor distractor paradigm. Results showed that the interfering effects of a distractor were very strong when presented in her ipsilesional visual field. However, when the distractor was presented in her contralesional field, there were no interfering effects when the target was presented in her ipsilesional field. These findings could not be explained by the presence of a visual field defect as revealed by the results of two hemianopic patients. Our results are in line with an imbalance in the level of activity in the saccadic system in visual neglect because visual elements presented in the contralesional field did not compete for saccadic selection.     

Influence of Stimulus Salience and Attentional Demands on Visual Search Patterns in Hemispatial Neglect

Seventy-five left and right brain-damaged patients, with or without hemispatial neglect, and 40 age-matched control subjects were tested on cancellation tasks with two different visual textures modeled after Julesz (1981). In one condition (“preattentive”), target elements segregated easily from background elements and were perceived effortlessly. In the other (“attentive”), target elements did not segregate easily and could be detected only after prolonged focal scrutiny. Both controls and patients were more accurate and faster on the preattentive than attentive texture. However, only neglect patients were disproportionately impaired on the attentive texture, thus suggesting that unilateral neglect is exacerbated by the low visual salience of the stimuli and a higher engagement of focal attention. Thus, a simple bedside test may help to tell apart the level of visual information processing maximally impaired in neglect patients.     

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.     

Visuospatial Neglect: The Ultimate Deconstruction?

Unilateral visuospatial neglect is now widely acknowledged to be a highly heterogeneous condition: The overt manifestations of visual neglect can vary as a function of task, spatial domain, and mode of response (at least). Double dissociations (sometimes of the strong form) have already been reported between most of the components of what was originally thought to be a relatively stable construct within the visual modality. Nonetheless, throughout successive fractionations of neglect, reported cases of bidirectional task-specific neglect after unilateral brain damage are rare. We now report two such cases. After right hemisphere stroke, the first patient reliably showed severe left neglect on cancellation but right neglect on line bisection. After left hemisphere stroke, the second case showed right neglect on cancellation but left neglect on line bisection. Extensive investigation of case 1 confirmed our previous conjecture that the crucial distinction between these tasks lies in the presence or the absence of an overt target. In contrast to cancellation, line bisection demands the internal computation of the location of the “target” (the midpoint), followed by executing a motor response toward the precise location of that “imaginary” midpoint. The relative attentional and premotor contributions of the intact and damaged hemispheres to these forms of bidirectional neglect are also assessed.     

You never know where you are going until you know where you have been: Disorganized search after stroke

Disorders in spatial exploration can be expressed in a disorganized fashion of target cancellation. There is debate regarding whether disorganized search is related to stroke in general, to right brain damage or to unilateral spatial neglect (USN) in particular. In this study, 280 stroke patients and 37 healthy control subjects performed a computerized shape cancellation test. We investigated the number of perseverations and several outcome measures regarding disorganized search: Consistency of search direction (best r), distance between consecutive cancelled targets and intersections with paths between previous cancelled targets. We compared performance between patients with left and right brain damage (L, R) and with and without USN (USN+, USN?), resulting in four subgroups: LUSN?, RUSN?, LUSN+, and RUSN+. Higher numbers of intersections were found for the left brain‐ and right brain‐damaged patients with USN and for the right brain‐damaged patients without USN, compared to healthy control subjects. Furthermore, right brain‐damaged patients with USN showed a higher number of intersections compared to right brain‐damaged patients without USN and compared to left brain‐damaged patients with USN. To conclude, disorganized search was most strongly related to the neglect syndrome, and patients with more severe USN were even more impaired.     

Ipsilesional arm reaching movements are not affected by the postural configuration adopted by individuals with stroke

Individuals with stroke present several impairments in the ipsilesional arm reaching movements that can limit the execution of daily living activities. These impairments depend on the side of the brain lesion. The present study aimed to compare the arm reaching movements performed in sitting and standing positions and to examine whether the effects of the adopted posture configuration depend on the side of the brain lesion. Twenty right-handed individuals with stroke (half with right hemiparesis and a half with left hemiparesis) and twenty healthy adults (half used the left arm) reached toward a target displayed on a monitor screen placed in one of three heights (i.e., upper, central, or lower targets). Participants performed the reaches in sitting and standing positions under conditions where the target location was either well-known in advance (certainty condition) or unknown until the movement onset (uncertainty condition). The values of movement onset time, movement time, and constant error were compared across conditions (posture configuration and uncertainty) and groups for each target height. Individuals with stroke were slower and spent more time to start to move than healthy participants, mainly when they reached the superior target in the upright position and under the uncertainty condition. Individuals who have suffered a right stroke were more affected by the task conditions and those who suffered a left stroke showed less accurate reaches. Overall, these results were observed regardless of the adopted posture. The current findings suggested that ipsilesional arm reaching movements are not affected by the postural configuration adopted by individuals with stroke. The central nervous system modulates the reaching movements according to the target position, adopted posture, and the uncertainty in the final target position to be reached.     

Solving the chicken-and-egg problem of letter detection and fixation duration in reading

When asked to detect target letters while reading a text, participants miss more letters in frequent function words than in less frequent content words. According to the truncation assumption that characterizes most models of this effect, misses occur when word-processing time is shorter than letter-processing time. Fixation durations for detections and omissions were compared with fixation durations from a baseline condition when participants were searching for a target letter embedded in different words. Although, as predicted by truncation, fixation durations were longer for detections than for omissions, fixation durations for detections were also longer than those for the same words in the baseline condition, demonstrating that longer fixation durations when targets are detected are more likely to be due to demands associated with producing a detection response than to truncation. Also, contrary to predictions from the truncation assumption, the standard deviation of fixation durations for detections was larger than that from the baseline condition.     

Multi-target visual search organisation across the lifespan: cancellation task performance in a large and demographically stratified sample of healthy adults

Accurate tests of cognition are vital in (neuro)psychology. Cancellation tasks are popular tests of attention and executive function, in which participants find and ‘cancel’ targets among distractors. Despite extensive use in neurological patients, it remains unclear whether demographic variables (that vary among patients) affect cancellation performance. Here, we describe performance in 523 healthy participants of a web-based cancellation task. Age, sex, and level of education did not affect cancellation performance in this sample. We provide norm scores for indices of spatial bias, perseverations, revisits, processing speed, and search organisation. Furthermore, a cluster analysis identified four cognitive profiles among participants, characterised by many omissions (N=18), many revisits (N=18), relatively poor search organisation (N=125), and relatively good search organisation (N=362). Thus, patient scores pertaining to search organisation should be interpreted cautiously: Given the large proportion of healthy individuals with poor search organisation, disorganised search in patients might be pre-existing rather than disorder-related.     

Contributions of the human pulvinar to linking vision and action

In 3 patients with unilateral pulvinar lesions, we tested the pulvinar’s role in selective attention processing. Each patient completed four variants of a flanker interference task in which they reported the color of a square of a specified size while ignoring an irrelevant flanker that appeared either contralesionally or ipsilesionally to the target. The main finding was that when target location was not known and target and flanker were associated with competing responses, reaction times to contralesional targets were longer than those to ipsilesional targets. Our findings suggest that pulvinar damage produces a contralesional deficit in response competition.     

Reducing neglect by introducing ipsilesional global cues

Halligan and Marshall (1994) have proposed that unilateral neglect (UN) can be reduced by ipsilesional global cues which induce processing of the whole object, including contralesional features. This hypothesis has the potential to distinguish difficulties with disengaging attention after ipsilesional capture from the failure of contralesional stimuli to capture attention. To test the role of global cues, seven individuals with unilateral right-hemispheric lesions copied and verbally identified drawings adapted from Seron, Coyette, and Bruyer (1989). The level of meaningful information presented in the ipsilesional hemispace was varied across three levels: symmetrical objects, objects with an identifying left-side feature, and objects that required processing of the left-side information for plausible identification. The results support the global processing hypothesis by demonstrating that the less the ipsilesional information, the less was the neglect of contralesional information.     

Does prism adaptation affect visual search in spatial neglect patients: A systematic review

Prism adaptation (PA) is a widely used intervention for (visuo‐)spatial neglect. PA‐induced improvements can be assessed by visual search tasks. It remains unclear which outcome measures are the most sensitive for the effects of PA in neglect. In this review, we aimed to evaluate PA effects on visual search measures. A systematic literature search was completed regarding PA intervention studies focusing on patients with neglect using visual search tasks. Information about study content and effectiveness was extracted. Out of 403 identified studies, 30 met the inclusion criteria. The quality of the studies was evaluated: Rankings were moderate‐to‐high for 7, and low for 23 studies. As feature search was only performed by five studies, low‐to‐moderate ranking, we were limited in drawing firm conclusions about the PA effect on feature search. All moderate‐to‐high‐ranking studies investigated cancellation by measuring only omissions or hits. These studies found an overall improvement after PA. Measuring perseverations and total task duration provides more specific information about visual search. The two (low ranking) studies that measured this found an improvement after PA on perseverations and duration (while accuracy improved for one study and remained the same for the other). This review suggests there is an overall effect of PA on visual search, although complex visual search tasks and specific visual search measures are lacking. Suggestions for search measures that give insight in subcomponents of visual search are provided for future studies, such as perseverations, search path intersections, search consistency and using a speed–accuracy trade‐off.     

Auditory and multisensory aspects of visuospatial neglect

Spatial neglect is a common neurological syndrome in which awareness of contralesional space is disrupted after unilateral (typically right) stroke. Although most research has focused on visual aspects of neglect, there is increasing evidence that neglect can often be multisensory. Here we focus on auditory disturbances that can co-occur with visual neglect. Patients selected for showing visual neglect often also show deficits in localization of single sounds; and also in the detection or identification of contralesional sounds, particularly in the presence of an ipsilesional competitor. Moreover, auditory and visual aspects of neglect often correlate in their severity across patients. These results are considered in relation to recent neuroimaging findings in the normal brain, showing that the brain regions typically damaged in neglect patients might contain multimodal representations of space.     

Response Channel Activation and the Temporoparietal Junction

When we learn to make one motor response to one visual stimulus and a different motor response to another, representations of these stimulus–response associations must be maintained to efficiently transduce perception into action. When an irrelevant distractor is presented adjacent to a target stimulus, interference is observed when the two stimuli are associated with conflicting responses, presumably due to response channel activation by the incompatible information. We have explored the neural bases of these interference effects. In a previous study, patients with hemispatial neglect showed normal interference from contralesional flankers. In another study, patients with lesions of the lateral prefrontal cortex were found not to show interference from distractors presented in the contralesional hemifield. The current study provided a more anatomically detailed investigation of the effects of posterior association cortex lesions on flanker interference. Patients with chronic, unilateral lesions involving the temporoparietal junction (TPJ), two of whom had hemispatial neglect, were compared with patients with lesions of the posterior association cortex not involving the TPJ. All patients performed a color discrimination task at fixation while a congruent or incongruent colored flanker was briefly presented (16.7 ms) in the adjacent contralesional or ipsilesional hemifield. Patients with TPJ lesions showed no interference effects from the contralesional flankers. These results suggest that the TPJ, in combination with the dorsolateral prefrontal cortex, is involved in transducing perception into action.