Igor Schindler

The fusiform face area is not sufficient for face recognition: evidence from a patient with dense prosopagnosia and no occipital face area.

We tested functional activation for faces in patient D.F., who following acquired brain damage has a profound deficit in object recognition based on form (visual form agnosia) and also prosopagnosia that is undocumented to date. Functional imaging demonstrated that like our control observers, D.F. shows significantly more activation when passively viewing face compared to scene images in an area that is consistent with the fusiform face area (FFA) (p < 0.01). Control observers also show occipital face area (OFA) activation; however, whereas D.F.s lesions appear to overlap the OFA bilaterally. We asked, given that D.F. shows FFA activation for faces, to what extent is she able to recognize faces? D.F. demonstrated a severe impairment in higher level face processing--she could not recognize face identity, gender or emotional expression. In contrast, she performed relatively normally on many face categorization tasks. D.F. can differentiate faces from non-faces given sufficient texture information and processing time, and she can do this is independent of color and illumination information. D.F. can use configural information for categorizing faces when they are presented in an upright but not a sideways orientation and given that she also cannot discriminate half-faces she may rely on a spatially symmetric feature arrangement. Faces appear to be a unique category, which she can classify even when she has no advance knowledge that she will be shown face images. Together, these imaging and behavioral data support the importance of the integrity of a complex network of regions for face identification, including more than just the FFA--in particular the OFA, a region believed to be associated with low-level processing.

Neck muscle vibration induces lasting recovery in spatial neglect

Objectives: To evaluate whether neck muscle vibration is an effective technique for neglect rehabilitation, with lasting beneficial effects. Methods: The effects of differential treatment of visual exploration training alone or in combination with neck muscle vibration were evaluated in a crossover study of two matched groups of 10 patients suffering from left sided neglect. Each group received a sequence of 15 consecutive sessions of exploration training and combined treatment. The effects of treatment were assessed with respect to different aspects of the neglect disorder such as impaired perception of the egocentric midline, exploration deficits in visual and tactile modes, and visual size distortion. The transfer of treatment effects to activities of daily living was examined by a reading test and a questionnaire of neglect related everyday problems. All variables were measured six times: three baseline measurements, two post-treatment measurements, and one follow up after two months. Results: The results showed superior effects of combination treatment. A specific and lasting reduction in the symptoms of neglect was achieved in the visual mode, which transferred to the tactile mode with a concomitant improvement in activities of daily living. The improvement was evident two months after the completion of treatment. In contrast, isolated exploration training resulted in only minor therapeutic benefits in visual exploration without any significant transfer effects to other tasks. Conclusions: Neck muscle vibration is a decisive factor in the rehabilitation of spatial neglect and induces lasting recovery when given as a supplement to conventional exploration training.

Intact automatic avoidance of obstacles in patients with visual form agnosia

In everyday life our reaching behaviour has to be guided not only by the location and properties of the target object, but also by the presence of potential obstacles in the workspace. Recent evidence from neglect and optic ataxia patients has suggested that this automatic obstacle avoidance is mediated by the dorsal, rather than the ventral, stream of visual processing. We tested this idea in two studies involving patients with visual form agnosia resulting from bilateral ventral-stream damage. In the first study, we asked patient DF to reach out and pick up a target object in the presence of obstacles placed at varying distances to the left or right of the target. We found that both DF and controls shifted their trajectories away from the potential obstacles and adjusted their grip aperture in such a way as to minimize risk of collision. In a second study, we asked DF and a second patient, SB, to either reach between, or to bisect the space between, two cylinders presented at varying locations. We found that both patients adjusted their reach trajectories to account for shifts in cylinder location in the reaching task, despite showing significantly worse performance than control subjects when asked to make a bisection judgement. Taken together, these data indicate that automatic obstacle avoidance behaviour is spared in our patients with visual form agnosia. We attribute their ability to the functional intactness of the dorsal stream of visual processing, and argue that the ventral stream plays no important role in automatic obstacle avoidance.

Avoidance of obstacles in the absence of visual awareness.

The spatial character of our reaching movements is extremely sensitive to potential obstacles in the workspace. We recently found that this sensitivity was retained by most patients with left visual neglect when reaching between two objects, despite the fact that they tended to ignore the leftward object when asked to bisect the space between them. This raises the possibility that obstacle avoidance does not require a conscious awareness of the obstacle avoided. We have now tested this hypothesis in a patient with visual extinction following right temporoparietal damage. Extinction is an attentional disorder in which patients fail to report stimuli on the side of space opposite a brain lesion under conditions of bilateral stimulation. Our patient avoided obstacles during reaching, to exactly the same degree, regardless of whether he was able to report their presence. This implicit processing of object location, which may depend on spared superior parietal‐lobe pathways, demonstrates that conscious awareness is not necessary for normal obstacle avoidance.

Head and trunk orientation modulate visual neglect

FIVE patients with left visual neglect after right hemisphere lesions were examined with a line bisection and a reading task under five different conditions: head and trunk straight ahead, head or trunk oriented 20° to the left and head or trunk oriented 20° to the right. Fixation was always straight ahead. Five patients with right hemisphere lesions but without neglect and five normal subjects served as controls. In all neglect patients, turning the head or trunk to the left reduced line bisection and reading errors significantly as compared with the other three conditions and with the control groups. The modulation of neglect behaviour by trunk as well as head position supports the hypothesis of a disturbed egocentric coordinate system leading to neglect.

Visual background motion reduces size distortion in spatial neglect

Patients with visual neglect show deficits in horizontal size perception in their neglected hemispace, as previously reported. The present study examined whether this size distortion can be modulated by visual background motion to the left or right while the patient performs a visual size judgment task. Six neglect patients and six normal subjects were investigated with a psychophysical size judgment task. All neglect patients showed a significant perceptual underestimation of horizontal bars in their left hemispace expressed as an overestimation of horizontal object size in the baseline (no motion) condition. Slow visual motion of background stimuli towards the right, ipsilesional side aggravated the deficit slightly, but not significantly, whereas leftward background motion completely normalized the size distortion (in four cases) or even led to an overcompensation (in two cases). This facilitatory effect was specific as it was obvious for the constant errors in the size judgments, but not in their accuracy as reflected by unchanged difference thresholds. These results suggest that coherent background motion restores temporarily the disturbed perception and representation of horizontal object size in spatial neglect.

Near and far space neglect: Task sensitivity and anatomical substrates

Most group studies which have investigated neglect for near and far space have found an increased severity of symptoms in far space compared to near space. However, the majority of these studies used relatively small samples and based their findings almost exclusively on line bisection performance. The aim of the present study was, therefore, to explore the occurrence of neglect for near and far space in a larger group of unselected right brain damaged patients and to evaluate whether neglect specific to near and far space is a task-related deficit or generalises across distance irrespective of task. In addition, a lesion overlap analysis was carried out to identify critical lesion sites associated with distance specific neglect deficits. Thirty-eight right hemisphere damaged patients carried out a line bisection and a cancellation task by using a pen in near space (40 cm) and a laser pointer in far space (320 cm). The results showed that both the number of left-sided omissions and rightward bisection errors were significantly increased in near compared to far space. Distance specific dissociations, albeit less common, were more frequently observed for cancellation than line bisection. These results suggest that space representation in neglect is more severely impaired in near than in far space. In addition, distance related dissociations in neglect may depend on task demands. Although the anatomical findings were broadly consistent with a dorsal and ventral stream dichotomy for near and far space processing, they also suggest the involvement of intermediate structures in distance related neglect phenomena.

Visuospatial neglect in near and far space: dissociation between line bisection and letter cancellation

The differential performance on a line bisection and a cancellation task in near and far space was studied. A group of 10 patients with severe left-sided visuospatial neglect and a group of 10 right-brain damaged patients without neglect were examined. The stimuli were presented at a distance of 60 cm (near space) and 160 cm (far space), respectively, and corrected for visual angle. In the line bisection task, patients were asked to point to the estimated line centre with a pencil (near space) or a stick (far space). In the cancellation task, patients pointed to all target stimuli they could detect using either a pencil (near space) or a stick (far space). Most patients with left hemineglect showed a more prominent neglect in far space as compared to near space for the line bisection task, whereas no difference of performance between near and far space was found in the control patients. In contrast, no group showed a distance effect in the cancellation task. The observation that only line bisection is influenced by the distance of the stimulus suggests that line bisection and cancellation are processed differentially. It is proposed that line bisection requires an allocentric reference system focusing attention on objects, whereas cancellation tasks are based on an egocentric reference system responsible for visuospatial attention. Our results indicate that distance changes perception within the allocentric but not within the egocentric system.

Convergent and divergent effects of neck proprioceptive and visual motion stimulation on visual space processing in neglect.

Visual motion stimulation as well as neck muscle vibration are known to effectively modulate the subjective body orientation in spatial neglect. However, so far only motion stimulation has been demonstrated to substantially influence size and space distortion in neglect patients. The present study aimed to compare the two stimulation methods with respect to their potentially differential impact on subjective body orientation and on space and size distortion, in five neglect patients showing perceptual distortions. We found comparable beneficial effects during left motion stimulation and left neck vibration for the subjective straight ahead. Additionally, left motion stimulation significantly ameliorated the leftward overextension in size matching, line bisection and distance estimation in all five patients. In contrast, during neck vibration only two patients showed an improvement for line bisection and size estimation and none did so for distance estimation. Since these two patients differed from the others as they had either no visual field defects or a major visual field sparing, we suggest--based on recent anatomical and neuropsychological findings--that neck vibration only tends to improve pure neglect-related visuo-perceptual distortions whereas motion stimulation can additionally improve perceptual distortions in neglect associated with hemianopia.

The disengage deficit in hemispatial neglect is restricted to between-object shifts and is abolished by prism adaptation

We sought to determine the effects of prism adaptation on peripherally cued visual attention shifting in patients with spatial neglect, using a task devised by Egly et al. (J Exp Psychol Gen 123:161–177, 1994) based on the classic Posner paradigm. This task allowed a comparison of “within-object” versus “between-object” attention shifts. A display was presented containing two parallel outline rectangles, and subjects were asked to make rapid responses to a target, which would appear at one end of one of the rectangles. The target location was pre-cued with 75% validity: on invalid trials attention was directed either to the other end of the same rectangle, or to the other rectangle. Healthy subjects and right-hemisphere patients without neglect showed a left-right symmetrical pattern, with a larger validity effect when required to shift attention between rectangles, thus indicating a greater difficulty of attention-shifting between than within the respective shapes. The neglect patients showed the typical leftward “disengage deficit” previously observed in neglect, but only for attention shifts between objects, indicating that the effect is object-based rather than purely spatial. A comparison of vertical and horizontal shift costs showed that this attention-shifting deficit for left-hemifield target stimuli was directional rather than hemifield-based: it was absent for vertical shifts of attention within the left hemifield. Finally, we found that prism adaptation abolished the disengage deficit. We found no effects of prism adaptation in the control subjects. We argue that prism adaptation has a powerful effect on one of the fundamental manifestations of the neglect syndrome.