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.     

Developmental progression of clock face drawing in children.

The clock drawing test has been routinely administered by many neuropsychologists as part of their testing battery with the adult population. Our study investigated the development of clock face drawing in normal children ages 6 to 12 years. Conceptualization of time and construction of the clock face were assessed by an adapted scoring system developed as part of the investigation. As a group, the results indicated an upward progression with regard to the concept of time through age 8 and clock construction through age 12. Results further demonstrated that number reversals were more frequent among left-handers but were no longer evident by age 7 regardless of handedness. It also was determined that left visuospatial neglect specific to the upper quadrant was relatively common in 6- and 7-year olds but not evidenced by age 8. Given the pattern of the findings, it is likely that the neglect was secondary to poor planning and not a visuo-spatial deficit. In general, development of clock face drawing most closely paralleled that of frontal lobe maturation. Implications of these findings and the usefulness of clock face drawing with the pediatric population are presented.     

Spatial neglect, Balint-Homes' and Gerstmann's syndrome, and other spatial disorders

Brain-damaged patients with lesion or dysfunction involving the parietal cortex may show a variety of neuropsychological impairments involving spatial cognition. The more frequent and disabling deficit is the syndrome of unilateral spatial neglect that, in a nutshell, consists in a bias of spatial representation and attention ipsilateral to of extrapersonal, personal (ie, the body) space, or both, toward the side of the hemispheric lesion. The deficit is more frequent and severe after damage to the right hemisphere, involving particularly the posterior-inferior parietal cortex at the temporo-parietal junction. Damage to these posterior parietal regions may also impair visuospatial short-term memory, which may be associated with and worsen spatial neglect. The neural network supporting spatial representation, attention and short-term memory is, however, more extensive, including the right premotor cortex. Also disorders of drawing and building objects (traditionally termed constructional apraxia) are a frequent indicator of posterior parietal damage in the left and in the right hemispheres. Other less frequent deficits, which, however, have a relevant localizing value, include optic ataxia (namely, the defective reaching of visual objects, in the absence of elementary visuo-motor impairments), which is typically brought about by damage to the superior parietal lobule. Optic ataxia, together with deficits of visual attention, of estimating distances and depth, and with apraxia of gaze, constitutes the severely disabling Balint-Holmes' syndrome, which is typically associated with bilateral posterior parietal and occipital damage. Finally, lesions of the posterior parietal lobule (angular gyrus) in the left hemisphere may bring about a tetrad of symptoms (left-right disorientation, acalculia, finger agnosia, and agraphia) termed Gerstmann's syndrome, that also exists in a developmental form.     

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.     

Different patterns of dissociation in unilateral spatial neglect

The aim of this paper is to discuss the issue of dissociations found in unilateral spatial neglect according to the modality of space exploration and the nature of the task. For this purpose we present a reanalysis of the data from a recent paper of Gentilini et al. (1989) comparing visual and blindfolded exploration of a computer keyboard and discuss the performance of a left-brain-damaged patient with right visuospatial neglect and left-sided neglect dyslexia. We conclude that unilateral spatial neglect cannot be interpreted as a disruption of a single attentional mechanism, but rather it reflects impaired attentional mechanisms at several levels of cognitive processing.     

Early neuropsychological correlates of later clock drawing and clock copying abilities among school aged children.

Although widely used in empirical study and bedside neuropsychological evaluation of geriatric populations, there is little literature on clock copying and drawing among children. However, existing research suggests that clock drawing tests (CDTs) may be effective and efficient tools for assessing neurocognitive development in children. This paper reports data on clock drawing on demand (CDT-D) and clock drawing to copy (CDT-C) among a non-clinical sample of elementary school aged children and identifies predictive relationships between earlier measures of executive function, visuo-construction, and visual-motor coordination and CDT performance 3 years later. Similar to findings with adult samples, analyses revealed better performance on copying than on drawing. Longitudinal analyses indicate that general intelligence significantly predicted performance on both tasks. Visual-motor coordination only predicted performance on the drawing on demand subtest of the CDT.     

Look little, look often: the influence of gaze frequency on drawing accuracy

The present article attempts to determine what those who draw accurately do differently than those who do not. Four experiments explore the relation between drawing accuracy and the rate at which artists glance between their drawing and the stimulus (termed gaze frequency). Experiment 1 revealed a positive relation between gaze frequency and drawing accuracy (r2 = .33). Experiments 2, 3, and 4 demonstrated that gaze frequency directly influences drawing accuracy. High gaze frequencies may facilitate drawing accuracy by (1) allowing the artist to hold less information in working memory, (2) reducing memory distortion, and (3) facilitating the reduction of context effects through inattentional blindness.     

Lateral specialization in unilateral spatial neglect: a cognitive robotics model

In this paper, we present the experimental results of an embodied cognitive robotic approach for modelling the human cognitive deficit known as unilateral spatial neglect (USN). To this end, we introduce an artificial neural network architecture designed and trained to control the spatial attentional focus of the iCub robotic platform. Like the human brain, the architecture is divided into two hemispheres and it incorporates bio-inspired plasticity mechanisms, which allow the development of the phenomenon of the specialization of the right hemisphere for spatial attention. In this study, we validate the model by replicating a previous experiment with human patients affected by the USN and numerical results show that the robot mimics the behaviours previously exhibited by humans. We also simulated recovery after the damage to compare the performance of each of the two hemispheres as additional validation of the model. Finally, we highlight some possible advantages of modelling cognitive dysfunctions of the human brain by means of robotic platforms, which can supplement traditional approaches for studying spatial impairments in humans.     

Clock drawing performance and brain morphology in mild cognitive impairment and Alzheimer's disease

The Clock Drawing Test (CDT) is a widely used instrument in the neuropsychological assessment of Alzheimer's disease (AD). As CDT performance necessitates several cognitive functions (e.g., visuospatial and constructional abilities, executive functioning), an interaction of multiple brain regions is likely. Fifty-one subjects with mild cognitive impairment, 23 with AD and 15 healthy controls underwent high-resolution magnetic resonance imaging. Optimized voxel-based morphometry (VBM) was performed to investigate the putative association between CDT performance and gray matter (GM) density throughout the entire brain. In the first step of analysis (p<.001, uncorrected), VBM revealed a reduced GM density in numerous cortical (temporal lobe, frontal lobe, parietal lobe, cerebellum) and subcortical (thalamus, basal ganglia) brain regions to be associated with poorer CDT performance. When corrected for multiple comparisons (p<.01), the associations remained significant predominantly in the left temporal and--less pronounced--the right temporal lobe. VBM demonstrated CDT performance to depend on the integrity of widely distributed cortical and subcortical areas in both brain hemispheres with accentuation in the left-sided temporal lobe region.     

Attention,spatial representation,and visual neglect: simulating emergent attention and spatial memory in the selective attention for identification model (SAIM)

The selective attention for identification model (SAIM) is presented. This uses a spatial window to select visual information for recognition, binding parts to objects and generating translation-invariant recognition. The model provides a qualitative account of both normal and disordered attention. Simulations of normal attention demonstrate 2-object costs and effects of object familiarity on selection, global precedence, spatial cueing, and inhibition of return. When lesioned, SAIM demonstrated either view- or object-centered neglect or spatial extinction, depending on the type and extent of lesion. The model provides a framework to unify (a) object- and space-based theories of normal selection, (b) dissociations within the syndrome of unilateral neglect, and (c) attentional and representational accounts of neglect.     

Breakdown of spatial parallel coding in children's drawing

When drawing real scenes or copying simple geometric figures young children are highly sensitive to parallel cues and use them effectively. However, this sensitivity can break down in surprisingly simple tasks such as copying a single line where robust directional errors occur despite the presence of parallel cues. Before we can conclude that this directional bias is a limiting case it needs to be shown that any given parallel cues are indeed being processed. We achieved this by using a texture-defined contour where parallel cues are integral to the stimulus and thus cannot be ignored. Here we report that even when prolific parallel cues must have been processed, young children make robust directional errors when copying single lines. This finding demonstrates a major constraint on young children's spatial parallel coding.     

Selective spatial attention and length representation in normal subjects and in patients with unilateral spatial neglect

The aim of this study was to assess whether perceptual representation along the horizontal axis is affected by hemispace position of the stimulus or by orienting attention to one side. Ten control subjects and 10 right brain damaged patients with left unilateral spatial neglect (USN) were asked to bisect lines of five lengths in three space positions (left, center, right) and under three cueing conditions (no cue, left cue, right cue). Normal controls showed significant displacement of bisection opposite to the side of hemispace presentation and toward the side of cueing. USN patients showed a bisection error toward the right end which increased with lines placed in the left hemispace and decreased with lines placed in the right hemispace and when attention was oriented toward the left side. We conclude that (1) In absence of cues normal subjects tend to overestimate the portions of space closer to their body midline; (2) both normal and USN patients tend to overestimate portions of space that they direct their attention to; (3) USN patients' performance without cueing is consistent with an attentional shift toward the right hemispace implying a gradient of overestimation of the right-most portions of space. A common neural substratum for directing attention and space representation can explain these findings.     

A quantitative analysis of accuracy,reliability and bias in judgements of functional analyses

Functional analysis can be considered a diagnostic assessment that behavior analysts use to determine behavioral function. Such a diagnosis ultimately requires a yes or no decision (i.e., a variable maintains a behavior, or it does not) that is determined by both subjective (clinical judgement) and objective (data) variables. Accurate and reliable identification of function is essential for successful treatment, yet behavior analysts' interpretation of data relies on their ability to detect visual differences in graphed data. Some research indicates that behavior analysts have questionable reliability in their visual analysis. To further examine the reliability, accuracy, and bias in visual analysis of functional analysis graphs, we simulated functional analysis results and surveyed 121 BCBA-Ds experienced in visual analysis. We then examined reliability of responses and used a signal detection theory approach to analyze accuracy and bias. Findings suggest that reliability and accuracy of judgements are questionable, and exploration of decision aids is warranted.     

Eye movements and bisection behavior in spatial neglect syndrome: representational biases induced by the segment length and spatial dislocation of the stimulus

The present study explored behavioral and eye-movement measures in unilateral neglect patients in response to online bisection task (unfilled gap line). Two different tasks supported the bisection performance, a pointing and a grasping strategy. It was explored whether these different strategies may influence subjects' behavioral and eye-movement measures in response to different segment features: segment length (from shorter to longer) and segment spatial dislocation (from right to left spatial location). Consistent spatial biases were found for both bisection responses, fixation count, and duration, as well as for the first fixation count in case of pointing task. An "extreme-left" gradient effect was suggested and discussed, with patients' behavioral and eye measures more impaired. On the contrary, the patients' performance overlaps with the controls' one in case a grasping task. The direct link of visual pointing and grasping strategy, respectively, with the two cortical ventral and dorsal pathways was adduced to explain our results.     

Eye movements and bisection behavior in spatial neglect syndrome: representational biases induced by the segment length and spatial dislocation of the stimulus

The present study explored behavioral and eye-movement measures in unilateral neglect patients in response to online bisection task (unfilled gap line). Two different tasks supported the bisection performance, a pointing and a grasping strategy. It was explored whether these different strategies may influence subjects’ behavioral and eye-movement measures in response to different segment features: segment length (from shorter to longer) and segment spatial dislocation (from right to left spatial location). Consistent spatial biases were found for both bisection responses, fixation count, and duration, as well as for the first fixation count in case of pointing task. An “extreme-left” gradient effect was suggested and discussed, with patients’ behavioral and eye measures more impaired. On the contrary, the patients’ performance overlaps with the controls’ one in case a grasping task. The direct link of visual pointing and grasping strategy, respectively, with the two cortical ventral and dorsal pathways was adduced to explain our results.     

Gender differences in unilateral spatial neglect within 24 hours of ischemic stroke

Hemispatial neglect is a common and disabling consequence of stroke. Previous reports examining the relationship between gender and the incidence of unilateral spatial neglect (USN) have included either a large numbers of patients with few neglect tests or small numbers of patients with multiple tests. To determine if USN was more common and/or severe in men or women, we examined a large group of patients (312 right-handed) within 24 hours of acute right hemisphere ischemic stroke. Multiple spatial neglect tasks were used to increase the sensitivity of neglect detection. No differences based upon gender were observed for the prevalence, severity, or a combined task measure of USN.     

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.