Arm position does not attenuate visual loss in patients with homonymous field deficits

Abstract

One of the most common and debilitating consequences of stroke is the loss of vision in the contralesional visual field. Clinicians typically regard this loss as irreversible and attempts at visual restoration have delivered only small and unreliable improvements. However, Schendel and Robertson [Schendel, K., & Robertson, L. C. (2004). Reaching out to see: Arm position can attenuate human visual loss. Journal of Cognitive Neuroscience, 16(6), 935–943] reported that the visual abilities of a hemianopic patient (WM) were significantly improved when the left arm was extended into the blind field. They suggest that visual stimuli near the arm recruited bimodal visual-tactile neurons, and this activity was sufficient to bring the stimulus into awareness. This result has enormous potential therapeutic value, but given that it is a single case study there are a number of reasons to be cautious about interpreting the data. Here, we investigate the effects of manipulating arm position on visual loss in a sample of five patients with homonymous field deficits. None of our patients showed any evidence of improved implicit or explicit visual ability in the blind field as a consequence of moving the arm. We suggest that WMs improvement was the consequence of a spatial bias towards the space containing his extended arm rather than the recruitment of bimodal neurons, and conclude that manipulating arm position is of little therapeutic value to patients with dense hemianopia.