Subliminal galvanic-vestibular stimulation influences ego- and object-centred components of visual neglect

Neglect patients show contralesional deficits in egocentric and object-centred visuospatial tasks. The extent to which these different phenomena are modulated by sensory stimulation remains to be clarified. Subliminal galvanic vestibular stimulation (GVS) induces imperceptible, polarity-specific changes in the cortical vestibular systems without the unpleasant side effects (nystagmus, vertigo) induced by caloric vestibular stimulation. While previous studies showed vestibular stimulation effects on egocentric spatial neglect phenomena, such effects were rarely demonstrated in object-centred neglect. Here, we applied bipolar subsensory GVS over the mastoids (mean intensity: 0.7. mA) to investigate its influence on egocentric (digit cancellation, text copying), object-centred (copy of symmetrical figures), or both (line bisection) components of visual neglect in 24 patients with unilateral right hemisphere stroke. Patients were assigned to two patient groups (impaired vs. normal in the respective task) on the basis of cut-off scores derived from the literature or from normal controls. Both groups performed all tasks under three experimental conditions carried out on three separate days: (a) sham/baseline GVS where no electric current was applied, (b) left cathodal/right anodal (CL/AR) GVS and (c) left anodal/right cathodal (AL/CR) GVS, for a period of 20. min per session. CL/AR GVS significantly improved line bisection and text copying whereas AL/CR GVS significantly ameliorated figure copying and digit cancellation. These GVS effects were selectively observed in the impaired- but not in the unimpaired patient group. In conclusion, subliminal GVS modulates ego- and object-centred components of visual neglect rapidly. Implications for neurorehabilitation are discussed

Reflexive Orienting in Spatial Neglect Is Biased towards Behaviourally Salient Stimuli

Patients with spatial neglect are impaired when detecting contralesional targets presented shortly after an ipsilesional cue. This ‘disengagement' deficit is believed to reflect reflexive orienting towards ipsilesional stimuli that is independent of behavioural goals. Here, we show that the extent of this spatial bias depends on the behavioural salience of ipsilesional stimuli. Healthy participants, brain-injured patients without neglect and neglect patients reacted to ipsilesional and contralesional visual targets. Prior to target presentation, a visual cue similar or dissimilar to the target was presented at target position or opposite the target. Although participants did not react to the similar cue, it had high behavioural salience since it shared features with the target stimulus. Neglect patients showed dramatically increased reaction times to contralesional targets, but only when these followed behaviourally relevant ipsilesional cues. No decrease of performance was observed with irrelevant cues. This performance pattern was not due to perceptual similarity, since the same effect was found when cue and target were semantically related but differed perceptually. Importantly, semantically related cues ceased to attract attention when they were defined as behaviourally irrelevant. These results show that neglect patients only orient attention reflexively towards ipsilesional stimuli with high behavioural salienc

Visual search in spatial neglect studied with a preview paradigm

Impaired visual search is a hallmark of spatial neglect. When searching for an unique feature (e.g., color) neglect patients often show only slight visual field asymmetries. In contrast, when the target is defined by a combination of features (e.g., color and form) they exhibit a severe deficit of contralesional search. This finding suggests a selective impairment of the serial deployment of spatial attention. Here, we examined this deficit with a preview paradigm. Neglect patients searched for a target defined by the conjunction of shape and color, presented together with varying numbers of distracters. The presentation time was varied such that on some trials participants previewed the target together with same-shape/different-color distracters, for 300 or 600 ms prior to the appearance of additional different-shape/same-color distracters. On the remaining trials the target and all distracters were shown simultaneously. Healthy participants exhibited a serial search strategy only when all items were presented simultaneously, whereas in both preview conditions a pop-out effect was observed. Neglect patients showed a similar pattern when the target was presented in the right hemifield. In contrast, when searching for a target in the left hemifield they showed serial search in the no-preview condition, as well as with a preview of 300 ms, and partly even at 600 ms. A control experiment suggested that the failure to fully benefit from item preview was probably independent of accurate perception of time. Our results, when viewed in the context of existing literature, lead us to conclude that the visual search deficit in neglect reflects two additive factors: a biased representation of attentional priority in favor of ipsilesional information and exaggerated capture of attention by ipsilesional abrupt onsets

Cognitive and anatomical correlates of neglect for peripersonal and extrapersonal space

Spatial neglect is a neurological disorder where patients typically fail to orient or respond to events on their left side. Moreover, recent studies suggest that the severity of neglect may depend specifically on whether stimuli are presented within or beyond arm's reach. However, the evidence for such a general functional dissociation between near and far space processing in the brain remains conflicting: The majority of research has been focussed on line bisection errors which reflect only one small aspect of neglect behaviour. In addition, some behavioural findings suggest a functional dissociation only if a motor response is required. Finally, to date, the critical areas involved in distance related space processing have not been identified.Thus, it remains not only unclear whether neglect in near and far space is a task- and response independent phenomenon but also which damaged brain areas impair distance related space processing. In order to answer these questions the present study compared line bisection and visual search performance and its anatomical correlates in near and far space by using a combined single case- and group study approach.The results showed that neglect restricted to near or far space can vary not only depending on the type of task but also on the type of response required. Visual search tasks were particularly sensitive in detecting the dissociation between those two space sectors. Anatomically, neglect for near space was mainly associated with occipito-parietal lesions and medio-temporal structures, including the posterior cingulate. Neglect for far space was found to result from focal damage of medial, ventro-temporal structures and the prefrontal cortex. In conclusion, neglect for near and far space does not seem to result from a general impairment in distance related processing but from a combination of factors related to specific task demands as well as the location and extent of the brain damage