Susanne Ferber

Spatial awareness is a function of the temporal not the posterior parietal lobe

Our current understanding of spatial behaviour and parietal lobe function is largely based on the belief that spatial neglect in humans (a lack of awareness of space on the side of the body contralateral to a brain injury) is typically associated with lesions of the posterior parietal lobe. However, in monkeys, this disorder is observed after lesions of the superior temporal cortex, a puzzling discrepancy between the species. Here we show that, contrary to the widely accepted view, the superior temporal cortex is the neural substrate of spatial neglect in humans, as it is in monkeys. Unlike the monkey brain, spatial awareness in humans is a function largely confined to the right superior temporal cortex, a location topographically reminiscent of that for language on the left. Hence, the decisive phylogenetic transition from monkey to human brain seems to be a restriction of a formerly bilateral function to the right side, rather than a shift from the temporal to the parietal lobe. One may speculate that this lateralization of spatial awareness parallels the emergence of an elaborate representation for language on the left side.

How to Assess Spatial Neglect - Line Bisection or Cancellation Tasks?

Spatial neglect is usually assessed using cancellation tests or line bisection. A recent comparison of these tests has revealed a double dissociation, in which one neglect patient was impaired in line bisection but not in star cancellation whereas another showed the reverse deficit. This dissociation has prompted the question whether neglect is still a meaningful theoretical entity. We compared line bisection and cancellation tasks regarding their accuracy in detecting spatial neglect. We tested 35 patients with well-defined spatial neglect using a line bisection task and four different cancellation tasks. The line bisection test missed 40% of our neglect patients. Far superior were the letter cancellation and bells tests, each of which missed only 6% of the cases. A deviation in line bisection is not fundamentally related to spatial neglect, but may also arise from other causes (e.g., hemianopia, or which hand is used), and therefore, should be treated with caution in clinical diagnosis. Cancellation tests, such as the bells test and letter cancellation, are more helpful tools to detect spatial neglect.

The origin of contraversive pushing: Evidence for a second graviceptive system in humans

Background: Stroke patients may exhibit the peculiar behavior of actively pushing away from the nonhemiparetic side, leading to lateral postural imbalance and a tendency to fall toward the paralyzed side. This phenomenon has been called the “pusher syndrome.” Objective: The current study analyzes the mechanism leading to contraversive pushing. Methods: The subjective postural vertical (SPV) and subjective visual vertical (SVV) were determined in five consecutively admitted patients with severe contraversive pushing and in controls. Whereas adjustment of the SPV reflects the perceived upright orientation of the body, the SVV provides a sensitive and direction-specific measurement of peripheral and central vestibular dysfunction. Results: The deficit leading to contraversive pushing is an altered perception of the body’s orientation in relation to gravity. Pusher patients experience their body as oriented “upright” when it is tilted 18° to the nonhemiparetic, ipsilesional side. In contrast, perception of the SVV was undisturbed. Conclusions: A separate pathway seems to be present in humans for sensing the orientation of gravity apart from the one for orientation perception of the visual world. This second graviceptive system decisively contributes to humans’ control of upright body posture. Contraversive pushing occurring after stroke lesions may represent the behavioral correlate of a disturbed neural representation of this system.

Revisiting unilateral neglect.

Unilateral neglect, a neurological disorder in which patients fail to detect or respond to contralesional stimuli, has long been considered a failure of attentional orienting mechanisms. This review provides a selective overview of the prominent biases in spatial orienting and exploratory motor behaviour observed in these patients before considering the impact of other factors on the presentation of the disorder and how those factors might inform current neurological models of neglect. In the latter part of the review, we intend to suggest that neglect is likely to be a combination of distinct but interacting impairments including biases in attentional orienting, exploratory motor behaviours and a deficit of spatial working memory. That is, we suggest that the cardinal symptom of neglect - a loss of awareness for contralesional stimuli and events - arises as a result of a combination of these impairments rather than being associated solely with the more dramatic and immediately evident biases in spatial attention.

Eye movements tell only half the story

The dramatic improvements of neglect symptoms after prism adaptation (PA) have been interpreted as evidence that PA reorganizes higher levels of spatial representation. Here the authors demonstrate that while the exploratory eye movements of a patient with neglect were clearly shifted toward the left after PA, he still showed no awareness for the left side of the stimuli he was now actively exploring. PA modulates functions of the parietal lobe, such as eye movement control, but fails to influence the underlying mechanisms of neglect.

Parietal and occipital lobe contributions to perception of straight ahead orientation

OBJECTIVES Several studies have investigated how peripheral stimulation affects the perception of body orientation in healthy subjects. The studies showed that opposing stimulation of two different input modalities can cancel out, leaving perception of body orientation unchanged. It was ascertained whether a comparable phenomenon could be found in brain damaged patients with two distinct disorders which individually lead to opposing shifts of the perceived midline. METHODS The visual subjective straight ahead was measured in patients with pure neglect, pure hemianopia, or a combination of neglect and hemianopia. RESULTS As in previous studies, patients with pure neglect displayed an ipsilesional displacement of the perceived straight ahead. Patients with pure hemianopia showed a contralesional shift. By contrast, no significant midline shift occurred in the patients with both neglect and hemianopia. CONCLUSIONS Neglect and hemianopia interact so that opposing biases in the perception of body orientation neutralise each other. Both parietal and occipital areas seem to contribute to the perception of straight ahead body orientation and seem to have counteracting effects when lesioned in the same hemisphere.

Neglected Time: Impaired Temporal Perception of Multisecond Intervals in Unilateral Neglect

Recent neuroimaging and neuropsychological studies have suggested that the right hemisphere, particularly frontal regions, is important for the perception of the passage of time. We examined the ability to estimate durations of up to 60 sec in a group of eight patients with unilateral neglect. When estimating multisecond intervals, neglect patients grossly underestimated all durations. On average, healthy controls (HC) demonstrated reasonably accurate estimates of all durations tested. Although the right hemisphere lesioned control patients without neglect also tended to underestimate durations, these underestimations were significantly better than the performance of the neglect group. These findings suggest a pivotal role for a right hemisphere fronto-parietal network in the accurate perception of multisecond durations. Furthermore, these findings add to a growing body of literature suggesting that neglect cannot be understood simply in terms of a bias in orienting attention to one side of space. Additional deficits of the kind demonstrated here are likely to be crucial in determining the nature and extent of the loss of conscious awareness for contralesional events.

Direct effects of prismatic lenses on visuomotor control: an event-related functional MRI study

Exposure to prisms has long been used to explore the control of visually guided actions primarily because adaptation requires the recalibration of misaligned reference frames due to perturbed visual input (i.e. eye‐in‐head and hand‐centered reference frames must be realigned). To date, the only neuroimaging study to explore the direct effects of prisms on pointing used positron emission tomography and found increased activation only in right parietal cortex. We used event‐related functional MRI to examine the effects of prisms on visuomanual pointing. Results demonstrated changes in activity in the anterior cingulate, the anterior intraparietal region and in a medial region of the right cerebellum. Specifically, activity in these regions was higher for the first few pointing trials made while viewing targets through prisms when directly contrasted to the last few trials. These results highlight that a more extensive network of cortical and cerebellar regions is involved in recalibrating visuomotor commands in the face of perturbed visual input.

Selective, Non-lateralized Impairment of Motor Imagery Following Right Parietal Damage

Using variants of a visually guided pointing task, in which subjects make pointing movements towards targets of varying sizes, we explored motor imagery in a patient with visual neglect. When this patient actually pointed towards targets of different sizes he showed the normal correlation between movement duration (MD) and target size, such that MD increased as target size decreased. In contrast, his imagined movements did not show the same speed-accuracy trade-off observed for actual movements. This was true regardless of the hand used or the initial direction of movement (left versus right). The patient performed normally on several tasks of visual imagery, including size estimation, perceptual discrimination and localization of cities on an imagined map. This patient’s performance suggests that the networks in the right parietal lobe play an important role in the generation of internal models of motor movements regardless of the hand used to perform the task.

Segregation and persistence of form in the lateral occipital complex

While the lateral occipital complex (LOC) has been shown to be implicated in object recognition, it is unclear whether this brain area is responsive to low-level stimulus-driven features or high-level representational processes. We used scrambled shape-from-motion displays to disambiguate the presence of contours from figure-ground segregation and to measure the strength of the binding process for shapes without contours. We found persisting brain activation in the LOC for scrambled displays after the motion stopped indicating that this brain area subserves and maintains figure-ground segregation processes, a low-level function in the object processing hierarchy. In our second experiment, we found that the figure-ground segregation process has some form of spatial constancy indicating top-down influences. The persisting activation after the motion stops suggests an intermediate role in object recognition processes for this brain area and might provide further evidence for the idea that the lateral occipital complex subserves mnemonic functions mediating between iconic and short-term memory.