Improving left spatial neglect through music scale playing

The study assessed whether the auditory reference provided by a music scale could improve spatial exploration of a standard musical instrument keyboard in right‐brain‐damaged patients with left spatial neglect. As performing music scales involves the production of predictable successive pitches, the expectation of the subsequent note may facilitate patients to explore a larger extension of space in the left affected side, during the production of music scales from right to left. Eleven right‐brain‐damaged stroke patients with left spatial neglect, 12 patients without neglect, and 12 age‐matched healthy participants played descending scales on a music keyboard. In a counterbalanced design, the participants' exploratory performance was assessed while producing scales in three feedback conditions: With congruent sound, no‐sound, or random sound feedback provided by the keyboard. The number of keys played and the timing of key press were recorded. Spatial exploration by patients with left neglect was superior with congruent sound feedback, compared to both Silence and Random sound conditions. Both the congruent and incongruent sound conditions were associated with a greater deceleration in all groups. The frame provided by the music scale improves exploration of the left side of space, contralateral to the right hemisphere, damaged in patients with left neglect. Performing a scale with congruent sounds may trigger at some extent preserved auditory and spatial multisensory representations of successive sounds, thus influencing the time course of space scanning, and ultimately resulting in a more extensive spatial exploration. These findings offer new perspectives also for the rehabilitation of the disorder.     

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.     

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.     

Improving neglect by TMS

Hemispatial neglect refers to the defective ability of patients to explore or act upon the side of space contralateral to the lesion and to attend to stimuli presented in that portion of space. Evidence from animal models suggests that many of the behavioural sequelae associated with visual neglect may result not solely from the size of the lesion, but also from a pathological state of increased inhibition exerted on the damaged hemisphere by the contralesional hemisphere. On the basis of these potential mechanisms underlying neglect, in this review we discuss therapeutic approaches, focusing particularly on recent research using transcranial magnetic stimulation (TMS). This technique, besides representing an ideal tool to investigate visuo-spatial attentive mechanisms in humans, has shown promising beneficial effects that might have an impact on clinical practice.     

Attentional modulation of electrophysiological activity in auditory cortex for unattended sounds within multistream auditory environments

In three experiments, we addressed the issue of attention effects on unattended sound processing when one auditory stream is selected from three potential streams, creating a simple model of the cocktail party situation. We recorded event-related brain potentials (ERPs) to determine the way in which unattended, task-irrelevant sounds were stored in auditory memory (i.e., as one integrated stream or as two distinct streams). Subjects were instructed to ignore all the sounds and attend to a visual task or to selectively attend to a subset of the sounds and perform a task with the sounds (Experiments 1 and 2). A third (behavioral) experiment was conducted to test whether global pattern violations (used in Experiments 1 and 2) were perceptible when the sounds were segregated. We found that the mismatch negativity ERP component, an index of auditory change detection, was evoked by infrequent pattern violations occurring in the unattended sounds when all the sounds were ignored, but not when attention was focused on a subset of the sounds. The results demonstrate that multiple unattended sound streams can segregate by frequency range but that selectively attending to a subset of the sounds can modify the extent to which the unattended sounds are processed. These results are consistent with models in animal and human studies showing that attentional control can limit the processing of unattended input in favor of attended sensory inputs, thereby facilitating the ability to achieve behavioral goals.     

Effects of attention and unilateral neglect on auditory stream segregation

Two pairs of experiments studied the effects of attention and of unilateral neglect on auditory streaming. The first pair showed that the build up of auditory streaming in normal participants is greatly reduced or absent when they attend to a competing task in the contralateral ear. It was concluded that the effective build up of streaming depends on attention. The second pair showed that patients with an attentional deficit toward the left side of space (unilateral neglect) show less stream segregation of tone sequences presented to their left than to their right ears. Streaming in their right ears was similar to that for stimuli presented to either ear of healthy and of brain-damaged controls, who showed no across-ear asymmetry. This result is consistent with an effect of attention on streaming, constrains the neural sites involved, and reveals a qualitative difference between the perception of left- and right-sided sounds by neglect patients.     

Modulation of the Directional Attention Deficit in Visual Neglect by Hemispatial Factors

Using a visuo-spatial cuing paradigm, Posner and collaborators (Posner, Cohen, & Rafal, 1982; Posner, Walker, Friedrich, & Rafal, 1984) reported that subjects with a parietal lobe lesion have difficulty in disengaging their visual attention from an invalidly precued location in the ipsilesional hemifield when the target they have to respond to is presented in the contralesional field. Later, these authors (Posner, Walker, Friedrich, & Rafal, 1987) proposed that this disengagement deficit is one involving spatial shifts of attention in a contralesional direction, irrespective of the visual hemifield in which the target is presented. This proposal of a directional disengagement deficit along the horizontal axis, present in either hemifield, contrasts with a report by Baynes, Holtzman, & Volpe (1986) showing, in right parietal subjects, a disengagement deficit for shifts of attention along the vertical axis that is only manifest in the contralesional hemifield. In the present report, we assessed the disengagement deficit of a neglect subject along the horizontal and vertical axes. Results show a disengagement deficit restricted to shifts of attention in the contralesional direction (horizontal axis), which is significant only in the contralesional visual hemifield. However, there is a clear trend for a directional disengagement deficit in the ipsilateral field. These observations indicate that the attention deficit present in neglect is directional and is modulated either by hemispatial factors or by the lateral target location in the visual field. On the basis of the present results, it is proposed that the deficit of parietal subjects may best be conceptualized as one of attentional capture for stimuli located on the contralesional side of the current focus of attention rather than one of disengagement.     

Behavioral distraction by auditory novelty is not only about novelty: The role of the distracter’s informational value

Unexpected events often distract us. In the laboratory, novel auditory stimuli have been shown to capture attention away from a focal visual task and yield specific electrophysiological responses as well as a behavioral cost to performance. Distraction is thought to follow ineluctably from the sound’s low probability of occurrence or, put more simply, its unexpected occurrence. Our study challenges this view with respect to behavioral distraction and argues that past research failed to identify the informational value of sound as a mediator of novelty distraction. We report an experiment showing that (1) behavioral novelty distraction is only observed when the sound announces the occurrence and timing of an upcoming visual target (as is the case in all past research); (2) that no such distraction is observed for deviant sounds conveying no such information; and that (3) deviant sounds can actually facilitate performance when these, but not the standards, convey information. We conclude that behavioral novelty distraction, as observed in oddball tasks, is observed in the presence of novel sounds but only when the cognitive system can take advantage of the auditory distracters to optimize performance.     

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.     

Visual dominance and attention: the Colavita effect revisited

Under many conditions, humans display a robust tendency to rely more on visual information than on other forms of sensory information. Colavita (1974) illustrated this visual dominance effect by showing that naive observers typically fail to respond to clearly suprathreshold tones if these are presented simultaneously with a visual target flash. In the present study, we demonstrate that visual dominance influences performance under more complex stimulation conditions and address the role played by attention in mediating this effect. In Experiment 1, we show the Colavita effect in the simple speeded detection of line drawings and naturalistic sounds, whereas in Experiment 2 we demonstrate visual dominance when the task targets (auditory, visual, or bimodal combinations) are embedded among continuous streams of irrelevant distractors. In Experiments 3-5, we address the consequences of varying the probability of occurrence of targets in each sensory modality. In Experiment 6, we further investigate the role played by attention on visual dominance by manipulating perceptual load in either the visual or the auditory modality. Our results demonstrate that selective attention to a particular sensory modality can modulate--although not completely reverse--visual dominance as illustrated by the Colavita effect.     

Poor hand-pointing to sounds in right brain-damaged patients: Not just a problem of spatial-hearing

We asked 22 right brain-damaged (RBD) patients and 11 elderly healthy controls to perform hand-pointing movements to free-field unseen sounds, while modulating two non-auditory variables: the initial position of the responding hand (left, centre or right) and the presence or absence of task-irrelevant ambient vision. RBD patients suffering from visual neglect, unlike RBD patients without neglect and healthy controls, showed a systematic rightward error in sound localisation, which was modulated by the non-auditory variables. Localisation errors were exacerbated by initial hand-position to the right of the body-midline, and reduced by the leftwards initial hand-position. Moreover, for the visual neglect patients, mere presence of ambient vision worsened localisation errors. These results demonstrate that although hand-pointing to sounds has often been considered a straightforward approach to investigate sound-localisation abilities in brain-damaged patients, in some patients it may actually reveal localisation deficits that reflect a combination of impaired spatial-hearing and spatial biases from other sensory modalities (i.e., vision and proprioception).     

Poor hand-pointing to sounds in right brain-damaged patients: not just a problem of spatial-hearing

We asked 22 right brain-damaged (RBD) patients and 11 elderly healthy controls to perform hand-pointing movements to free-field unseen sounds, while modulating two non-auditory variables: the initial position of the responding hand (left, centre or right) and the presence or absence of task-irrelevant ambient vision. RBD patients suffering from visual neglect, unlike RBD patients without neglect and healthy controls, showed a systematic rightward error in sound localisation, which was modulated by the non-auditory variables. Localisation errors were exacerbated by initial hand-position to the right of the body-midline, and reduced by the leftwards initial hand-position. Moreover, for the visual neglect patients, mere presence of ambient vision worsened localisation errors. These results demonstrate that although hand-pointing to sounds has often been considered a straightforward approach to investigate sound-localisation abilities in brain-damaged patients, in some patients it may actually reveal localisation deficits that reflect a combination of impaired spatial-hearing and spatial biases from other sensory modalities (i.e., vision and proprioception).     

Does visual experience influence the spatial distribution of auditory attention?

Sighted individuals are less accurate and slower to localize sounds coming from the peripheral space than sounds coming from the frontal space. This specific bias in favour of the frontal auditory space seems reduced in early blind individuals, who are particularly better than sighted individuals at localizing sounds coming from the peripheral space. Currently, it is not clear to what extent this bias in the auditory space is a general phenomenon or if it applies only to spatial processing (i.e. sound localization). In our approach we compared the performance of early blind participants with that of sighted subjects during a frequency discrimination task with sounds originating either from frontal or peripheral locations. Results showed that early blind participants discriminated faster than sighted subjects both peripheral and frontal sounds. In addition, sighted subjects were faster at discriminating frontal sounds than peripheral ones, whereas early blind participants showed equal discrimination speed for frontal and peripheral sounds. We conclude that the spatial bias observed in sighted subjects reflects an unbalance in the spatial distribution of auditory attention resources that is induced by visual experience.     

Sounds exaggerate visual shape

While perceiving speech, people see mouth shapes that are systematically associated with sounds. In particular, a vertically stretched mouth produces a /woo/ sound, whereas a horizontally stretched mouth produces a /wee/ sound. We demonstrate that hearing these speech sounds alters how we see aspect ratio, a basic visual feature that contributes to perception of 3D space, objects and faces. Hearing a /woo/ sound increases the apparent vertical elongation of a shape, whereas hearing a /wee/ sound increases the apparent horizontal elongation. We further demonstrate that these sounds influence aspect ratio coding. Viewing and adapting to a tall (or flat) shape makes a subsequently presented symmetric shape appear flat (or tall). These aspect ratio aftereffects are enhanced when associated speech sounds are presented during the adaptation period, suggesting that the sounds influence visual population coding of aspect ratio. Taken together, these results extend previous demonstrations that visual information constrains auditory perception by showing the converse - speech sounds influence visual perception of a basic geometric feature.     

0 + 1 > 1: How adding noninformative sound improves performance on a visual task

It is well known that the nervous system combines information from different cues within and across sensory modalities to improve performance on perceptual tasks. In this article, we present results showing that in a visual motion-detection task, concurrent auditory motion stimuli improve accuracy even when they do not provide any useful information for the task. When participants judged which of two stimulus intervals contained visual coherent motion, the addition of identical moving sounds to both intervals improved accuracy. However, this enhancement occurred only with sounds that moved in the same direction as the visual motion. Therefore, it appears that the observed benefit of auditory stimulation is due to auditory-visual interactions at a sensory level. Thus, auditory and visual motion-processing pathways interact at a sensory-representation level in addition to the level at which perceptual estimates are combined.     

Eye movements in search in visual neglect

We report data on eye movements in a patient (MP) with unilateral visual neglect, in a task of searching a real-world scene. We demonstrate that MP missed some contralesional targets after fixating on them. On such “miss”; trials, MP's eye movements were similar to those on objects in target-absent trials trials, where MP was cued to search for a target that was not actually present. In addition, MP showed little evidence of memory for the locations of objects that remained across a trial, though poor memory fails to explain performance on trials where targets were fixated. We suggest that, in this case, neglect reflected the poor uptake of information from the contralesional side of space, so that even fixated targets sometimes failed to match a “template” held in his memory.     

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.     

Misprojection of landmarks onto the spatial map

It has been suggested that neglect patients misrepresent the metric spatial relations along the horizontal axis (anisometry). The "fabric" of their internal spatial medium would be distorted in such a way that physically equal distances appear relatively shorter on the contralesional side (canonical anisometry). The case of GL, a 76-year-old lady with left neglect on visual search tasks, is presented. GL showed severe relative overestimation on the left (contralesional) side on two independent tasks evaluating the metrics of her internal representation. A qualitatively similar pattern was found in two out of 10 other neglect patients who performed the second task. This behavior cannot be accounted for by the canonical anisometry hypothesis. Nevertheless, GL produced a relative left overextension (underestimation) when trying to set the endpoints of a virtual line given its midpoint (Endpoints Task). An interpretation of these results is offered in terms of a misprojection of relevant landmarks onto the internal representation without assuming distortion of its "fabric."     

Visual determinants of a cross-modal illusion

Contrary to the predictions of established theory, Schutz and Lipscomb (2007) have shown that visual information can influence the perceived duration of concurrent sounds. In the present study, we deconstruct the visual component of their illusion, showing that (1) cross-modal influence depends on visible cues signaling an impact event (namely, a sudden change of direction concurrent with tone onset) and (2) the illusion is controlled primarily by the duration of post-impact motion. Other aspects of the post-impact motion—distance traveled, velocity, acceleration, and the rate of its change (i.e., its derivative, jerk)—play a minor role, if any. Together, these results demonstrate that visual event duration can influence the perception of auditory event duration, but only when stimulus cues are sufficient to give rise to the perception of a causal cross-modal relationship. This refined understanding of the illusion’s visual aspects is helpful in comprehending why it contrasts so markedly with previous research on cross-modal integration, demonstrating that vision does not appreciably influence auditory judgments of event duration (Walker & Scott, 1981).     

High-intensity sound increases the size of visually perceived objects

The effect of audiovisual interactions on size perception has yet to be examined, despite its fundamental importance in daily life. Previous studies have reported that object length can be estimated solely on the basis of the sounds produced when an object is dropped. Moreover, it has been shown that people typically and easily perceive the correspondence between object sizes and sound intensities. It is therefore possible that auditory stimuli may act as cues for object size, thereby altering the visual perception of size. Thus, in the present study we examined the effects of auditory stimuli on the visual perception of size. Specifically, we investigated the effects of the sound intensity of auditory stimuli, the temporal window of audiovisual interactions, and the effects of the retinal eccentricity of visual stimuli. The results indicated that high-intensity auditory stimuli increased visually perceived object size, and that this effect was especially strong in the peripheral visual field. Additional consideration indicated that this effect on the visual perception of size is induced when the cue reliability is relatively higher for the auditory than for the visual stimuli. In addition, we further suggest that the cue reliabilities of visual and auditory stimuli relate to retinal eccentricity and sound intensity, respectively.