Marco Pitteri

Optokinetic Stimulation Modulates Neglect for the Number Space: Evidence from Mental Number Interval Bisection

Behavioral, neuropsychological, and neuroimaging data support the idea that numbers are represented along a mental number line (MNL), an analogical, visuospatial representation of number magnitude. The MNL is left-to-right oriented in Western cultures, with small numbers on the left and larger numbers on the right. Left neglect patients are impaired in the mental bisection of numerical intervals, with a bias toward larger numbers that are relatively to the right on the MNL. In the present study we investigated the effects of optokinetic stimulation (OKS) – a technique inducing visuospatial attention shifts by means of activation of the optokinetic nystagmus – on number interval bisection. One patient with left neglect following right-hemisphere stroke (BG) and four control patients with right-hemisphere damage, but without neglect, performed the number interval bisection task in three conditions of OKS: static, leftward, and rightward. In the static condition, BG misbisected to the right of the true midpoint. BG misbisected to the left following leftward OKS, and again to the right of the midpoint following rightward OKS. Moreover, the variability of BG’s performance was smaller following both leftward and rightward OKS, suggesting that the attentional bias induced by OKS reduced the “indifference zone” that is thought to underlie the length effect reported in bisection tasks. We argue that shifts of visuospatial attention, induced by OKS, may affect number interval bisection, thereby revealing an interaction between the processing of the perceptual space and the processing of the number space.

Visual Scanning Training, Limb Activation Treatment, and Prism Adaptation for Rehabilitating Left Neglect: Who is the Winner?

We compared, for the first time, the overall and differential effects of three of the most widely used left neglect (LN) treatments: visual scanning training (VST), limb activation treatment (LAT), and prism adaptation (PA). Thirty-three LN patients were assigned in quasi-random order to the three groups (VST, LAT, or PA). Each patient received only one type of treatment. LN patients’ performance on everyday life tasks was assessed four times (over a period of 6u2009weeks): A1 and A2 (i.e., the two pre-treatment assessments); A3 and A4 (i.e., the two post-treatment assessments). LN patients in each of the three treatment conditions were treated for the same number of sessions (i.e., 20). The results showed that improvements were present in the majority of the tests assessing the peripersonal space in everyday life activities. Our findings were independent of unspecific factors and lasted for at least 2u2009weeks following the end of the treatments. There were no interactions, however, between LN treatments and assessments. We suggest that all three treatments can be considered as valid rehabilitation interventions for LN and could be employed for ameliorating LN signs.

Larger, smaller, odd or even? Task-specific effects of optokinetic stimulation on the mental number space

Previous studies have shown that number processing can induce spatial biases in perception and action and can trigger the orienting of visuospatial attention. Few studies, however, have investigated how spatial processing and visuospatial attention influences number processing. In the present study, we used the optokinetic stimulation (OKS) technique to trigger eye movements and thus overt orienting of visuospatial attention. Participants were asked to stare at OKS, while performing parity judgements (Experiment 1) or number comparison (Experiment 2), two numerical tasks that differ in terms of demands on magnitude processing. Numerical stimuli were acoustically presented, and participants responded orally. We examined the effects of OKS direction (leftward or rightward) on number processing. The results showed that rightward OKS abolished the classic number size effect (i.e., faster reaction times for small than large numbers) in the comparison task, whereas the parity task was unaffected by OKS direction. The effect of OKS highlights a link between visuospatial orienting and processing of number magnitude that is complementary to the more established link between numerical and visuospatial processing. We suggest that the bidirectional link between numbers and space is embodied in the mechanisms subserving sensorimotor transformations for the control of eye movements and spatial attention.

Is two better than one? Limb activation treatment combined with contralesional arm vibration to ameliorate signs of left neglect.

In the present study, we evaluated the effects of the Limb Activation Treatment (LAT) alone and in combination with the Contralateral Arm Vibration (CAV) on left neglect (LN) rehabilitation. We conceived them as techniques that both prompt the activation of the lesioned right hemisphere because of the activation (with the LAT as an active technique) and the stimulation (with the CAV as a passive technique) of the left hemibody. To test the effect of the simultaneous use of these two techniques (i.e., LAT and CAV) on visuo-spatial aspects of LN, we described the case of an LN patient (GR), who showed high intra-individual variability (IIV) in performance. Given the high IIV of GR, we used an ABAB repeated-measures design to better define the effectiveness of the combined application of LAT and CAV, as a function of time. The results showed an improvement of GR’s performance on the Bells test following the combined application of LAT and CAV, with respect to the application of LAT alone. We did not find, however, significant effects of treatment on two other LN tests (i.e., Line bisection and Picture scanning). We propose that the combined application of LAT and CAV can be beneficial for some aspects of LN.

Right-hemisphere (spatial?) acalculia and the influence of neglect

The present study aimed at exploring basic number and calculation abilities in right-hemisphere damaged patients (RHD), focusing primarily on one-digit orally presented tasks, which do not require explicit visuo-spatial abilities. Twenty-four non mentally-deteriorated RHD patients [12 with clinical neglect (RHDN+), 12 without clinical neglect (RHDN−)], and 12 healthy controls were included in the study. Participants were administered an ad hoc numerical battery assessing abilities such as counting, number magnitude comparison, writing and reading Arabic numerals and mental calculation, among others. Significant differences emerged among healthy controls and both the RHDN+ group and the RHDN− group, suggesting that the mathematical impairment of RHD patients does not necessarily correspond to the presence of left-neglect. A detailed analysis of the sub-tests of the battery evidenced expected differences among RHDN+ patients, RHDN− patients, and controls in writing and reading Arabic numerals. Crucially, differences between RHDN+ patients and controls were also found in tasks such as mental subtraction and mental multiplication, which do not require written visuo-spatial abilities. The present findings thus suggest that unilateral right hemisphere lesions may produce specific representational deficits that affect simple mental calculation, and not only the spatial arrangement of multi-digit written numbers as previously thought.

Extra-powerful on the visuo-perceptual space, but variable on the number space: Different effects of optokinetic stimulation in neglect patients

We studied the effects of optokinetic stimulation (OKS; leftward, rightward, control) on the visuo-perceptual and number space, in the same sample, during line bisection and mental number interval bisection tasks. To this end, we tested six patients with right-hemisphere damage and neglect, six patients with right-hemisphere damage but without neglect, and six neurologically healthy participants. In patients with neglect, we found a strong effect of leftward OKS on line bisection, but not on mental number interval bisection. We suggest that OKS influences the number space only under specific conditions.

Pure left neglect for Arabic numerals

Arabic numerals are diffused and language-free representations of number magnitude. To be effectively processed, the digits composing Arabic numerals must be spatially arranged along a left-to-right axis. We studied one patient (AK) to show that left neglect, after right hemisphere damage, can selectively impair the computation of the spatial frames underpinning recognition and understanding of Arabic numerals, without impairing the spatial frames for coding alphabetic strings or for coding environmental spatial information. The presence in our brain of these specific and precise spatial frames must be rooted in the paramount importance of Arabic numerals processing in our everyday activities.

Mental time line distortion in right-brain-damaged patients: Evidence from a dynamic spatiotemporal task.

OBJECTIVEnTime is an elusive phenomenon that is difficult to grasp with our senses. Recent work has shown how spatial representations often lie beneath temporal ones, as shown by a family of spatiotemporal congruency effects. For instance, individuals who have been exposed to left-to-right orthographic systems are better at judging short durations with their left effector and long durations with their right effector than vice versa, a phenomenon known as the spatial-temporal association of response codes (STEARC) effect. In the present neuropsychological study, we aimed to provide evidence that spatial attention mechanisms play a crucial role in generating this spatially organized mental time line.nnnMETHODnA group of 13 patients suffering from right hemisphere lesions with different degrees of spatial neglect signs and a control group of 15 age- and education-matched neurologically healthy participants were administered a unimanual version of a spatiotemporal compatibility task (STEARC task).nnnRESULTSnThe main results showed that the more a patient suffered from spatial neglect signs, the smaller the accuracy difference was between the left and right side responses for short durations.nnnCONCLUSIONSnThese findings corroborate the hypothesis that the presence of disorders in spatial attention affects the left-to-right mental time line representation, especially in its leftward segment, proportionally with the amount of deficit. This study therefore suggests the critical role of spatial attention for the emergence of a spatial representation of time durations.

How to differentiate hemianesthesia from left tactile neglect: a preliminary case report.

When assessing for the presence of hemianesthesia, the examiner touches the body of the patients, and requests that they report verbally the location of the delivered tactile stimulus. Contralesional omissions of single tactile stimuli, however, might be due to either primary somatosensory deficits or to spatial attention impairment (i.e., neglect). In this preliminary study, we tested whether clinical assessment can be improved to differentiate between these two types of deficit by modifying the assessment procedure. K.L., a patient with left unilateral neglect, was asked to detect tactile stimuli delivered in two conditions: spatial attention distributed either to his left or to his right hand, and spatial attention focused only on his left hand. Note that K.L. did not receive double simultaneous tactile stimuli. In the distributed spatial attention condition, K.L. omitted most of the single tactile stimuli delivered to his left hand. In the focused attention condition, K.L. was asked to focus his spatial attention only on his left hand. Under this latter condition, his performance increased dramatically, suggesting that his omissions were not due to hemianesthesia, but rather reflected left tactile neglect. In line with the neuropsychological findings, voxel based analysis of his grey and white matter damage confirmed significant loss in areas associated with left-sided neglect, but sparing of the primary somatosensory cortex. This result suggests that standard somatosensory assessment and differential diagnosis between hemianesthesia and tactile neglect may be more accurate when neuropsychology-based procedures are incorporated in the standard neurological examination.

Conventional and functional assessment of spatial neglect: Clinical practice suggestions.

Objective: Spatial neglect (SN) constitutes a substantial barrier to functional recovery after acquired brain injury. However, because of its multimodal nature, no single test can capture all the signs of SN. To provide a clinically feasible solution, we used conventional neuropsychological tests as well as the Catherine Bergego Scale (CBS) via the Kessler Foundation Neglect Assessment Process (KF-NAP). The goal was to add evidence that a global approach should detect better even subtle signs of SN. Method: Fourteen individuals with lesions located in the right cerebral hemisphere participated in the study. Participants were assessed with a comprehensive battery of neuropsychological tests, comprising a set of visuospatial tests to evaluate several spatial domains. In addition, patients underwent functional assessment with the Barthel Index, the Functional Independence Measure (FIM), and the CBS via KF-NAP. Results: The CBS via KF-NAP was associated with the visuospatial paper-based tests (p = .004) as well as the Motor FIM (p = .003), and was more sensitive than the Behavioral Inattention Test-Conventional in detecting SN (p = .014). Conclusions: We showed that the CBS via KF-NAP was able: (a) to detect functional impairment, especially motor, related to SN; (b) to selectively measures spatial rather than nonspatial dysfunctions; and (c) to be highly sensitive in detecting SN signs especially in those patients with mild severity, covering several aspects of SN manifestations. The patient’s SN diagnosis based on the CBS via KF-NAP is clinically important and directly relevant to care planning and goal setting.