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.