Cecilia Guariglia

Effect of optokinetic stimulation in patients with visual neglect

Three groups of subjects, normal controls, right brain damaged patients with and without heminattention, were required to bisect a line in presence of a fixed or a moving background. The stimulus moving horizontally toward the left or the right induced an optokinetic nystagmus with a slow phase coherent with the direction of the movement: together with the optokinetic nystagmus, a displacement of the subjective midpoint, as compared to the condition with a fixed background, was observed in all three groups of subjects. Within the right brain damaged with heminattention the displacement of the line bisection was great for stimuli moving toward the right, but a significant reduction of the left bias was present. In the same group of patients the effect of the optokinetic stimulation was present in a very large proportion of cases and proved to be relatively stable in a test-retest presentation. Theoretical relevance of these data and their potential importance for rehabilitation are discussed.

Retrosplenial and hippocampal brain regions in human navigation: complementary functional contributions to the formation and use of cognitive maps

The ability to orientate within familiar environments relies on the formation and use of a mental representation of the environment, namely a cognitive map. Neuropsychological and neuroimaging studies suggest that the retrosplenial and hippocampal brain regions are involved in topographical orientation. We combined functional magnetic resonance imaging with a virtual‐reality paradigm to investigate the functional interaction of the hippocampus and retrosplenial cortex during the formation and utilization of cognitive maps by human subjects. We found that the anterior hippocampus is involved during the formation of the cognitive map, while the posterior hippocampus is involved when using it. In conjunction with the hippocampus, the retrosplenial cortex was active during both the formation and the use of the cognitive map. In accordance with earlier studies in non‐human animals, these findings suggest that, while navigating within the environment, the retrosplenial cortex complements the hippocampal contribution to topographical orientation by updating the individuals location as the frame of reference changes.

Personal and extrapersonal space: A case of neglect dissociation

Dissociation between personal and extrapersonal neglect has rarely been observed in man. In this study we present a case of severe personal neglect in the absence of a deficit for extrapersonal space. An extensive neuropsychological assessment demonstrates the absence of cognitive impairments in visuo-spatial processing and confirms the selective presence of a severe representational deficit of the left side of the body.

Effectiveness of neglect rehabilitation in a randomized group study

The effectiveness of neglect rehabilitation training has been studied in two randomly selected groups of right brain-damaged patients. All patients proved heminattentive on a standard battery 2 months or more after the CVA. One group received 2 months of treatment immediately after admission to a clinic, and the other group received only general cognitive stimulation for the same amount of time. At the end of this period a comparison showed significant improvement in the first group, based on a standard test battery and a functional scale. The second group was then given rehabilitation training for neglect for the same amount of time and obtained similar improvement. It is concluded that the rehabilitation program produces significant results, which generalize to situations similar to those of everyday life. The importance of the duration of training on the generalization of learning is briefly discussed with reference to previous negative reports in the literature.

Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: a cross-over study.

A study of the effect of specific training for visual neglect on the recovery of motor and functional impairment in stroke patients is reported. Two groups of right hemisphere stroke patients with hemispatial neglect and one group without neglect were assessed by means of three functional and neurological scales (Rivermead Mobility Index, Barthel Index, Canadian Neurological Scale). Three evaluations were made at 0, 2 and 4 months from the beginning of physical rehabilitation. During the first 2 months of physical rehabilitation one of the two groups of neglect patients was randomly assigned to specific training for neglect, and the second group to a general cognitive intervention; during the final 2 months of rehabilitation the types of training were switched in the two groups. The non-neglect patients improved steadily during physical rehabilitation. In contrast, the functional recovery of the two neglect groups was time-locked to the period of the specific training for neglect. At the time of admission, the two neglect groups performed at the same level; after 2 months of rehabilitation, the group with neglect training showed higher functional recovery than the group with only general cognitive intervention. When the latter group received neglect training, there was no longer any difference between the two neglect groups. This pattern was present for both of the functional scales used but not for the neurological scale. Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect.

Deficits of position sense, unilateral neglect and optokinetic stimulation

The effects of optokinetic stimulation on position sense disorders were investigated in a series of 30 patients with unilateral vascular lesions (10 right brain-damaged patients with visuospatial hemineglect, 10 right brain-damaged patients without visuo-spatial hemineglect, 10 left brain-damaged patients), and 10 control subjects. The position sense deficit was more severe in right brain-damaged patients with neglect, where both the contralateral and the ipsilateral arm were involved. Optokinetic stimulation was effective only in right brain-damaged patients with neglect: stimulation with a leftward movement (contralateral to the side of the hemispheric lesion) improved the position sense deficit, while stimulation with a rightward (ipsilateral) movement produced a worsening of the performance level. These findings suggest that in right brain-damaged patients with neglect the position sense deficit has a nonsensory component, related to neglect, which may be affected by optokinetic stimulation. The role of the derangement of sensory and perceptual-egocentric representations of the body and of extrapersonal space in producing position sense disorders is discussed.

Walking in the Corsi test: which type of memory do you need?

Sex differences are often reported in spatial abilities. However, some studies show conflicting results, which can be ascribed to the complexity of the variables involved in the visuo-spatial domain. Until a few years ago, it was widely accepted that men outperformed women on almost all spatial tasks. However, recently some studies [A. Postma, G. Jager, R.P.C. Kessels, H.P.F. Koppeschaar, J. van Honk, Sex differences for selective forms of spatial memory, Brain Cogn. 54 (2004) 24-34; D.H. McBurney, S.J.C. Gaulin, T. Devineni, C. Adams, Superior spatial memory of women: stronger evidence for the gathering hypothesis, Evol. Hum. Behav. 18 (1997) 165-174; Q. Rahman, G.D. Wilson, S. Abrahams, Sexual orientation related differences in spatial memory, J. Int. Neuropsychol. Soc. 9 (2003) 376-383] found sex differences for selective forms of spatial memory and described a female advantage in specific spatial abilities. In this paper, we studied sex differences by testing object locations and route memories with the Corsi Block-Tapping test (CBT), one of the non-verbal tasks most used in clinical settings, and its modified, large-scale version. Our results showed a performance advantage for males in both tests and a more homogeneous pattern of memory in females.

Optokinetic stimulation affects both vertical and horizontal deficits of position sense in unilateral neglect.

The effects of optokinetic stimulation on the disorders of position sense in the horizontal and vertical planes were assessed in 24 patients with unilateral cerebral lesions (eight right brain-damaged patients with visuo-spatial hemineglect, eight right brain-damaged patients without neglect, eight left brain-damaged patients without neglect). In neglect patients, the position sense disorder was more severe, and affected by optokinetic stimulation in a direction-specific fashion. In both the horizontal and the vertical plane, and in both arms, stimulation with a direction of the movement contralateral to the side of the lesion improved the disorder, whereas stimulation with an ipsilateral direction worsened the deficit. The suggestion is made that in patients with neglect the disorder of position sense is produced, at least in part, by an ipsilateral distortion of an egocentric co-ordinate system, comprising both the horizontal and the vertical dimension, which may be affected by direction-specific optokinetic stimuli.

Developmental topographical disorientation in a healthy subject.

We present the case of F.G., a healthy, normally developed 22-year-old male subject affected by a pervasive disorder in environmental orientation and navigation who presents no history of neurological or psychiatric disease. A neuro-radiological examination showed no evidence of anatomical or structural alterations to the brain. We submitted the subject for a comprehensive neuropsychological assessment of the different cognitive processes involved in topographical orientation to evaluate his ability to navigate the spatial environment. The results confirmed a severe developmental topographical disorder and deficits in a number of specific cognitive processes directly or indirectly involved in navigation. The results are discussed with reference to the sole previously described case of developmental topographical disorientation (Pt1; Iaria et al., 2009). F.G. differs from the former case due to the following: the greater severity of his disorder, his complete lack of navigational skills, the failure to develop compensatory strategies, and the presence of a specific deficit in processing the spatial relationships between the parts of a whole. The present case not only confirms the existence of developmental topographical-skill disorders, but also sheds light on the architecture of topographical processes and their development in human beings.

Motor deficits and optokinetic stimulation in patients with left hemineglect

Optokinetic stimulation with left direction of the movement of luminous dots temporarily improved motor weakness of the left hand in two right-brain-damaged patients with left spatial hemineglect. Stimulation to the right had no effect. In two left-brain-damaged patients, optokinetic stimulation did not affect the right motor weakness, regardless of direction of the movement of the optokinetic stimuli. We suggest that in patients with left hemineglect, contralesional motor deficits have a neglect-related component, which, as other aspects of the neglect syndrome, may be improved by optokinetic stimulation. The mechanisms may include a temporary restoration of the spatial coordinates of bodily representations, pathologically distorted towards the side of the lesion.