Maria Luisa Rusconi

Perceptual and premotor factors of unilateral neglect.

Right-brain-damaged patients showing unilateral neglect underwent a specifically devised line-bisection task that allowed uncoupling of the direction of visual attention from that of hand movement. This made it possible to isolate and separately assess perceptual and premotor factors of the disorder. Comparison of experimental and radiologic data suggested that premotor factors were more pronounced in patients with lesions involving the frontal lobes than in patients with lesions confined to postrolandic areas. The technique employed is compatible with bedside examination and provides data useful for standard assessment of neglect symptomatology for both clinical and experimental purposes.

Remission of somatoparaphrenic delusion through vestibular stimulation

The effects of vestibular stimulation on somatoparaphrenic delusion were investigated in a patient suffering from a fronto-temporo-parietal infarction located in the right hemisphere. Transitory remission of the patients delusional belief was consistently observed during unilateral vestibular activation obtained by means of cold-water irrigation of the left (contralesional) ear.

EXPLORING SOMATOSENSORY HEMINEGLECT BY VESTIBULAR STIMULATION

The effects of vestibular stimulation upon somatosensory deficits or tactile extinction contralateral to a hemispheric lesion were investigated in 20 right brain-damaged patients and 11 left brain-damaged patients. After stimulation, right brain-damaged patients showed a temporary partial recovery from left hemianaesthesia or extinction. Conversely, right somatosensory deficits associated with left brain damage were virtually unaffected by vestibular stimulation. Temporary recovery from somatosensory deficits was independent of the presence of visuo-spatial hemineglect. The suggestion is made that somatosensory deficits and extinction produced by right brain damage have an important non-sensory or perceptual component, that may be positively affected by vestibular stimulation. The mechanisms whereby this treatment may ameliorate somatosensory deficits may involve the restoration of the normal correspondence between somatotopic and egocentric representations of the body.

Improvement of left visuo-spatial hemineglect by left-sided transcutaneous electrical stimulation.

The effects of transcutaneous electrical stimulation on left visuo-spatial hemineglect, assessed by a visuo-motor exploratory task (letter cancellation), were investigated in patients with right hemisphere lesions. In Experiment 1 left neck stimulation temporarily improved the deficit in 13 out of 14 patients (93%), while stimulation of the right neck had no positive effects, worsening exploratory performance in nine patients (64%). Experiment 2 showed that left neck stimulation temporarily improved neglect also when head movements were prevented by a chin-rest. In Experiment 3, stimulation of both the left hand and left neck had comparable positive effects on visuo-spatial hemineglect. These results are interpreted in terms of: (1) non-specific activation of the right hemisphere, contralateral to the stimulation side; (2) specific directional effects of left somatosensory stimulation on the egocentric co-ordinates of extra-personal space, which in neglect patients are distorted towards the side of the brain lesion.

Challenging current accounts of unilateral neglect

Two left-neglect patients were asked (i) to bisect a 15 cm line, (ii) to bisect the empty space between the endpoints of a 15 cm virtual line, and (iii) to set the endpoints of a 15 cm virtual line, given its midpoint. With one patient, the subjective midpoint of the virtual line was found to be displaced leftwards with respect to the subjective midpoint of the real line, whereas with the other it was found to be displaced rightwards. However, in condition (iii) both patients significantly underestimated the distance from the centre of the rightmost point of the virtual line while relatively overestimating that from the centre to the left endpoint. This latter result challenges current accounts of unilateral neglect.

Break-down of perceptual awareness in unilateral neglect.

Four neglect patients are reported who where unable to detect left-side differences in pairs of drawings though being sometimes influenced by such differences in making preference judgements. In most instances, tracing the silhouette of the drawings did not help patients to find the difference despite the fact that tracing implied crossing the altered detail or following its contour with the fingertip. This finding cannot easily be accommodated by current theories of unilateral neglect.

Hemianopia, hemianesthesia, and spatial neglect A study with evoked potentials

We recorded somatosensory or visual evoked potentials (SEPs, VEPs) to stimuli contralateral and ipsilateral to the lesion in three right-brain-damaged patients with left spatial hemineglect and in three left-brain-damaged patients without evidence of neglect, as assessed by visual exploratory tasks. All patients had contralateral homonymous hemianopia or hemianesthesia. The three neglect patients showed normal SEPs or VEPs to stimuli delivered to the left half-field or to the left hand, without conscious perception and verbal report of the stimulation. By contrast, the three left-brain-damaged patients without neglect showed no recognizable cortical evoked response to contralateral visual or somatosensory stimuli. In all patients, the cortical evoked responses to ipsilateral stimulation were normal. In patients with spatial hemineglect, hemianopia and hemianesthesia may be manifestations of the neglect syndrome (visual and somatosensory hemi-inattention), rather than representing primary sensory deficit. Visual and somatosensory hemi-inattention may be due to defective access to the neural processes subserving conscious perception by information that has undergone early sensory processing.

Vestibular stimulation, spatial hemineglect and dysphasia, selective effects.

The selectivity of the effects of vestibular stimulation was investigated in a left brain-damaged patient suffering from right visuo-spatial hemineglect and severe dysplasia. Vestibular stimulation temporarily improved the former but not the latter disorder. These results support the view that this treatment improves hemineglect by a specific effect, running counter the rightward distortion of egocentric co-ordinates, rather than by a general hemispheric activation.

Unilateral neglect in route description

Route description was investigated in two patients suffering from left unilateral neglect. Both had evident difficulty with left turns. This finding suggests that the topological correspondence between represented environment and representational mechanisms in the brain is not confined to frozen (picture-like) perspectives.

ANALOGICAL REPRESENTATION AND LANGUAGE STRUCTURE

Severe impairment of the analogue of mental representation is not compensated for by putative language-based cognitive processes in non-dysphasic brain-damaged patients. This undermines the hypothesis of an independent role for language in the generation of thought. Against this view it may be contended that there seems to be no obvious way in which analogical mental representation can decide between alternative syntactical structures available for the expression of thought. We performed a visual imagery experiment in which we asked 40 subjects to imagine visual scenes representing the meanings of simple utterances presented to them. The subjects then had to indicate the relative position, in each visual image, of two objects mentioned in each utterance. Series of utterances were presented differing syntactically (active or passive phrase) and semantically (specifying in different ways the spatial and temporal relations between the objects mentioned). The results of this mental imagery experiment indirectly support the hypothesis that syntactical structures can be represented in a nonlinguistic analogue medium.