Stephanie Rossit

fMRI reveals a lower visual field preference for hand actions in human superior parieto-occipital cortex (SPOC) and precuneus.

Humans are more efficient when performing actions towards objects presented in the lower visual field (VF) than in the upper VF. The present study used slow event-related functional magnetic resonance imaging (fMRI) to examine whether human brain areas implicated in action would show such VF preferences. Participants were asked to fixate one of four different positions allowing objects to be presented in the upper left, upper right, lower left or lower right VF. In some trials they reached to grasp the object with the right hand while in others they passively viewed the object. Crucially, by manipulating the fixation position, rather than the position of the objects, the biomechanics of the movements did not differ across conditions. The superior parieto-occipital cortex (SPOC) and the left precuneus, brain areas implicated in the control of reaching, were significantly more activated when participants grasped objects presented in the lower VF relative to the upper VF. Importantly, no such VF preferences were observed in these regions during passive viewing. This finding fits well with evidence from the macaque neurophysiology that neurons within visuomotor regions over-represent the lower VF relative to the upper VF and indicate that the neural responses within these regions may reflect a functional lower VF advantage during visually-guided actions.

A Thalamocortical Mechanism for the Absence of Overt Motor Behavior in Covertly Aware Patients

IMPORTANCE It is well accepted that a significant number of patients in a vegetative state are covertly aware and capable of following commands by modulating their neural responses in motor imagery tasks despite remaining nonresponsive behaviorally. To date, there have been few attempts to explain this dissociation between preserved covert motor behavior and absent overt motor behavior. OBJECTIVES To investigate the differential neural substrates of overt and covert motor behavior and assess the structural integrity of the underlying networks in behaviorally nonresponsive patients. DESIGN, SETTING, AND PARTICIPANTS A case-control study was conducted at an academic center between February 7, 2012, and November 6, 2014. Data analysis was performed between March 2014 and June 2015. Participants included a convenience sample of 2 patients with severe brain injury: a paradigmatic patient who fulfilled all clinical criteria for the vegetative state but produced repeated evidence of covert awareness (patient 1) and, as a control case, a patient with similar clinical variables but capable of behavioral command following (patient 2). Fifteen volunteers participated in the study as a healthy control group. MAIN OUTCOMES AND MEASURES We used dynamic causal modeling of functional magnetic resonance imaging to compare voluntary motor imagery and motor execution. We then used fiber tractography to assess the structural integrity of the fibers that our functional magnetic resonance imaging study revealed as essential for successful motor execution. RESULTS The functional magnetic resonance imaging study revealed that, in contrast to mental imagery, motor execution was associated with an excitatory coupling between the thalamus and primary motor cortex (Bayesian model selection; winning model Bayes factors >17). Moreover, we detected a selective structural disruption in the fibers connecting these 2 regions in patient 1 (fractional anisotropy, 0.294; P = .047) but not in patient 2 (fractional anisotropy, 0.413; P = .35). CONCLUSIONS AND RELEVANCE These results suggest a possible biomarker for the absence of intentional movement in covertly aware patients (ie, specific damage to motor thalamocortical fibers), highlight the importance of the thalamus for the execution of intentional movements, and may provide a target for restorative therapies in behaviorally nonresponsive patients.

Age-related differences in corrected and inhibited pointing movements

It has been widely reported that aging is accompanied by a decline in motor skill performance and in particular, it has been shown that older subjects take longer to adapt their ongoing reach in response to a target location shift. In the present experiment, we investigated the influence of aging on the ability to perform trajectory corrections in response to a target jump, but also assessed inhibition by asking a younger and an older group of participants to either adapt or stop their ongoing movement in response to a target location change. Results showed that although older subjects took longer to initiate, execute, correct and inhibit an ongoing reach, they performed both tasks with the same level of accuracy as the younger sample. Moreover, the slowing was also observed when older subjects were asked to point to stationary targets. Our findings thus indicate that aging does not specifically influence the ability to perform or inhibit fast online corrections to target location changes, but rather produces a general slowing and increased variability of movement planning, initiation and execution to both perturbed and stationary targets. For the first time, we demonstrate that aging is not accompanied by a decrease in the inhibition of motor control.

The neural basis of visuomotor deficits in hemispatial neglect

We have recently reported that patients with hemispatial neglect demonstrate increased terminal errors when performing delayed leftward reaches and that right-brain damaged patients (irrespective of neglect) take longer to complete their movements [Rossit, S., Muir, K., Reeves, I., Duncan, G., Birschel, P., & Harvey, M. (2009). Immediate and delayed reaching in hemispatial neglect. Neuropsychologiaa 47, 1563-1573]. Here we conducted an initial voxel-based lesion-symptom analysis to examine the neural basis of such deficits in 21 right-brain damaged subjects with 11 patients suffering from hemispatial neglect (2 more than in Rossit et al. [Rossit S., Muir K., Reeves I., Duncan, G., Birschel, P., & Harvey, M. (2009). Immediate and delayed reaching in hemispatial neglect. Neuropsychologia 47, 1563-1573] and 10 control patients without the condition. We found that the accuracy impairments in delayed leftward reaches were associated with damage to occipito-temporal areas. In contrast, the movement time slowing was related to more anterior lesions in the frontal lobe. These findings agree with the view that neglect affects actions thought to depend on the processing carried out by the ventral visual stream. In addition, we suggest that the timing impairments which are not neglect-specific maybe be driven by frontal structures.

No Neglect-Specific Deficits in Reaching Tasks

It is well established that patients with hemispatial neglect present with severe visuospatial impairments, but studies that have directly investigated visuomotor control have revealed diverging results, with some studies showing that neglect patients perform relatively better on such tasks. The present study compared the visuomotor performance of patients with and without neglect after right-hemisphere stroke with those of age-matched controls. Participants were asked to point either directly towards targets or halfway between two stimuli, both with and without visual feedback during movement. Although we did not find any neglect-specific impairment, both patient groups showed increased reaction times to leftward stimuli as well as decreased accuracies for open loop leftward reaches. We argue that these findings agree with the view that neglect patients code spatial parameters for action veridically. Moreover, we suggest that lesions in the right hemisphere may cause motor deficits irrespective of the presence of neglect and we performed an initial voxel-lesion symptom analysis to assess this. Lesion-symptom analysis revealed that the reported deficits did not result from damage to neglect-associated areas alone, but were further associated with lesions to crucial nodes in the visuomotor control network (the basal ganglia as well as occipito-parietal and frontal areas).

The role of right temporal lobe structures in off-line action:Evidence from lesion-behavior mapping in stroke patients

Recent evidence suggests the possibility that not all action modes depend on dorsal visual stream processing but that off-line nontarget-directed actions, such as antipointing, require additional and even distinct neural networks when compared with target-directed online actions. Here, we explored this potential dissociation in a group of 11 patients with left visual neglect, a syndrome characterized by a loss of awareness of the contralesional side of space. Ten healthy participants and 10 right hemisphere-damaged patients without neglect served as controls. Participants had to point either directly toward targets presented on their left or right (i.e., propointing) or to the mirror position in the opposite hemispace (i.e., antipointing). Compared with both control groups, neglect patients showed reduced accuracy when antipointing but not propointing. Lesion-behavior mapping revealed that the areas critically associated with these deficits were located in the middle and superior temporal and parahippocampal gyri. We argue that neglect patients present specific deficits only when the visuomotor task taps into more perceptual representations thought to rely on ventral visual stream processing and that our results indicate that right temporal brain regions are implicated in these off-line actions.

Memory-guided saccade processing in visual form agnosia (patient DF)

According to Milner and Goodale’s model (The visual brain in action, Oxford University Press, Oxford, 2006) areas in the ventral visual stream mediate visual perception and off-line actions, whilst regions in the dorsal visual stream mediate the on-line visual control of action. Strong evidence for this model comes from a patient (DF), who suffers from visual form agnosia after bilateral damage to the ventro-lateral occipital region, sparing V1. It has been reported that she is normal in immediate reaching and grasping, yet severely impaired when asked to perform delayed actions. Here we investigated whether this dissociation would extend to saccade execution. Neurophysiological studies and TMS work in humans have shown that the posterior parietal cortex (PPC), on the right in particular (supposedly spared in DF), is involved in the control of memory-guided saccades. Surprisingly though, we found that, just as reported for reaching and grasping, DF’s saccadic accuracy was much reduced in the memory compared to the stimulus-guided condition. These data support the idea of a tight coupling of eye and hand movements and further suggest that dorsal stream structures may not be sufficient to drive memory-guided saccadic performance.

Impaired delayed but preserved immediate grasping in a neglect patient with parieto-occipital lesions

Patients with optic ataxia, a deficit in visually guided action, paradoxically improve when pantomiming an action towards memorized stimuli. Visual form agnosic patient D.F. shows the exact opposite pattern of results: although being able to grasp objects in real-time she loses grip scaling when grasping an object from memory. Here we explored the dissociation between immediate and delayed grasping in a patient (F.S.) who after a parietal-occipital stroke presented with severe left visual neglect, a loss of awareness of the contralesional side of space. Although F.S. had preserved grip scaling even in his neglected field, he was markedly impaired when asked to pretend to grasp a leftward object from memory. Critically, his deficit cannot be simply explained by the absence of continuous on-line visual feedback, as F.S. was also able to grasp leftward objects in real-time when vision was removed. We suggest that regions surrounding the parietal-occipital sulcus, typically damaged in patients with optic ataxia but spared in F.S., seem to be essential for real-time actions. On the other hand, our data indicates that regions in the ventral visual stream, damaged in D.F but intact in F.S., would appear to be necessary but not sufficient for memory-guided action.

Non-lateralised deficits in anti-saccade performance in patients with hemispatial neglect

We tested patients suffering from hemispatial neglect on the anti-saccade paradigm to assess voluntary control of saccades. In this task participants are required to saccade away from an abrupt onset target. As has been previously reported, in the pro-saccade condition neglect patients showed increased latencies towards targets presented on the left and their accuracy was reduced as a result of greater undershoot. To our surprise though, in the anti-saccade condition, we found strong bilateral effects: the neglect patients produced large numbers of erroneous pro-saccades to both left and right stimuli. This deficit in voluntary control was present even in patients whose lesions spared the frontal lobes. These results suggest that the voluntary control of action is supported by an integrated network of cortical regions, including more posterior areas. Damage to one or more components within this network may result in impaired voluntary control.

Long Term Improvements in Activities of Daily Living in Patients with Hemispatial Neglect

Monika Harvey, Keith Muir, Ian Reeves, George Duncan, Philip Birschel, Margaret Roberts, Katrina Livingstone, Hazel Jackson, Caroline Hogg , Pauline Castle , Gemma Learmonth and Stephanie Rossit School of Psychology, University of Glasgow, Glasgow, UK Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK Department of Medicine for the Elderly, Southern General Hospital, Glasgow, UK Stroke Discharge and Rehabilitation Team, Southern General Hospital, Glasgow, UK Stroke Unit, Southern General Hospital, Glasgow, UK Mansion House Unit, Glasgow, UK Victoria Infirmary, Glasgow, UK Department of Psychology, University of Western Ontario, London, Canada