Right Brain Damaged Patients Research Articles

Different constraints on grip selection in brain-damaged patients: Object use versus object transport

The present study discusses the presence of different constraints on action selection during object use versus object transport. Sixteen left brain-damaged (LBD) patients, 10 right brain-damaged (RBD) and 35 healthy controls were examined on a grip preference test consisting of a grasping-to-transport and a grasping-to-use condition. Assessment included a general praxis testing (pantomime production, object utilization gesture recognition and object use). We also reported the case of a close-head injury patient (DR) with an atypical behavioural pattern. Our results supported the different constraint hypothesis. While several LBD and RBD patients performed inappropriate grips in the grasping-to-transport condition, only two patients (L2 and DR) used inappropriate grips in the grasping-to-use condition. No correlation was found between the two conditions of the grip preference test and measures of the general praxis testing. The discussion focuses on the nature of constraints on grip selection during object use and object transport.

Local (focussed) and global (distributed) visual processing in hemispatial neglect

In the present study we set out to investigate deficits of focussed and distributed attention (and their interaction) in brain-damaged patients. To this purpose, four left brain damaged (LBD) patients without signs of hemispatial neglect and six right brain damaged (RBD) patients with variable signs of hemispatial neglect were tested by means of an experimental paradigm comprising two embedded tasks performed on the same visual array. The first task (i.e. counting the number of shapes, 1-4, briefly displayed) mainly involved distributed attention rather than focussed attention. The second task was a typical target detection task, which emphasized the detailed analysis of each element in the array, thus mainly tapping focussed attention. Results clearly showed that: (1) LBD patients are slightly impaired at directing focussed attention to the contralesional visual hemifield; (2) in comparison to LBD patients, RBD patients with mild neglect show an exaggerated difficulty in orienting focussed attention toward the contralesional side, while they are similarly unimpaired in the deployment of distributed attention, i.e. in global processing; (3) RBD patients with the most severe neglect suffer from a deficit of both local and global visual processing, i.e. of both focussed and distributed attention. Taken together, these observations indicate that focussed and distributed components of visual attentional processing may be differentially affected in left and right brain-damaged patients with and without neglect.

The influence of distracters, stimulus duration and hemianopia on first saccade in patients with unilateral neglect

The aim of the present study was to assess the influence of visual distracters, stimulus duration and the presence of contralesional hemianopia on direction of the first saccade in right brain damaged (RBD) patients affected by left unilateral neglect (UN). During a visual search task we recorded eye movements in five RBD patients with UN and hemianopia (N+H+), nine RBD patients with UN but no hemianopia (N+H−), four RBD patients with neither neglect nor hemianopia and four normal controls. Two task variables were orthogonally manipulated: (a) presence or absence of distracters and (b) short or long stimulus duration. A significant interaction was found between groups, presence of distracters, stimulus duration and the direction of the first saccade made in the search. Independently of the temporal duration of targets, in N+H+ patients the presence of distracters enhanced the frequency of saccades directed ipsilesionally (i.e., rightward). In N+H− patients, distracters biased the first saccade toward the right side only at short stimulus duration. These data show that bias of attentional orienting toward stimuli in the right half of space is specific of UN. This pathological mechanism (a) is enhanced and prolonged, over the period of exploration, by concomitant complete contralateral hemianopia and (b) is most evident, even in the absence of concomitant visual field defects, when voluntary planning of attention and eye movements are precluded by the short duration of stimuli to be inspected.

No reversal of the Oppel–Kundt illusion with short stimuli: confutation of the space anisometry interpretation of neglect and ‘cross-over’ in line bisection

Right-brain damaged patients suffering neglect for the left side of space bisect long horizontal lines to the right of the true centre. This phenomenon is traditionally explained by pathological reduction of the attentional salience of the contralesional side of the line and enhancement of the attentional salience of its ipsilesional side due to brain damage (Pouget and Driver, 2000; Bartolomeo and Chokron, 2002). At variance with this largely accepted explanation, Bisiach and co-workers (Bisiach et al ., 1994; Bisiach, 1997; Bisiach et al ., 2002) conjectured that in neglect patients the representation of horizontal space is continuously and progressively ‘relaxed’ toward the left and ‘compressed’ toward the right, in a logarithmic manner. By consequence the left side of a symmetrical horizontal line immersed in this ‘anisometrical’ representational gradient will be perceived as being shorter than its physically equivalent right side, causing rightward shift of the subjective line midpoint. It is clear that this hypothesis predicts that at any point in the gradient and for any length of a line set within this gradient, the line's left side will always be perceived as being shorter than its identical right counterpart and the subjective line midpoint will always be shifted rightward. Thus, we previously concluded (Doricchi et al ., 2005) that the space anisometry hypothesis cannot account for the paradoxical leftward shift that can be observed when neglect patients are asked to mark the centre of very short horizontal lines, i.e. the cross-over effect. Bisiach (1997) also originally suggested that the anisometrical distortion of space suffered by neglect patients is adequately represented by horizontal Oppel–Kundt (O–K) illusions with vertical segments progressively increasing in spatial frequency towards the right endpoint (see ‘Right Longer’ stimuli, Fig. 1). In their recent study Savazzi et al . (2007) wished to determine whether while …

Rightward and leftward bisection biases in spatial neglect: two sides of the same coin?

Neglect patients, when asked to bisect a horizontal line, typically show large rightward errors with long lines and a decreased error with medium length lines. With very short lines the bisection bias reverses from the right to left side of the line physical centre (the so-called crossover effect). It is commonly pointed out that such a leftward bias is difficult to explain by traditional theories of neglect. Several accounts propose two distinct mechanisms, one that works for short lines and one that works for long. In the present study we demonstrated that the crossover effect can be explained by means of a unitary mechanism that derives from the space anisometry hypothesis. This hypothesis postulates that in neglect patients representational space is progressively 'relaxed' contralesionally and progressively 'compressed' ipsilesionally. In a series of five experiments, we investigated the crossover effect in 26 right-brain damaged patients: 17 with neglect without hemianopia, 4 with neglect and hemianopia and 6 without neglect or hemianopia. Patients were to bisect or extend lines of objectively and subjectively different lengths. The modulation of subjective length was created by an Oppel-Kundt illusion that is thought to resemble the distortion of representational space that occurs with neglect. All groups, except for the patients with neglect and hemianopia, were prone to the illusion. The rightward bias was reduced when the illusion induced a perceptual distortion opposite to that thought to underlie neglect. Importantly, the strength of the illusion decreased with reducing the physical line length and reversed with very short lines. These results argue for a simple and unitary explanation of the crossover effect in spatial neglect within the framework of the space anisometry hypothesis.

Association between auditory and visual symptoms of unilateral spatial neglect

Unilateral spatial neglect due to right brain damage (RBD) can occur in several different sensory modalities in the same patient. Previous studies of the association between auditory and visual neglect have yielded conflicting outcomes. Most such studies have compared performance on relatively simple clinical measures of visual neglect, such as target cancellation, with that on more sophisticated measures of auditory perception. This is problematic because such tasks are typically not matched for the cognitive processes they exercise. We overcame this limitation by using equivalent visual and auditory versions of extinction and temporal-order judgment (TOJ) tasks. RBD patients demonstrated lateralized deficits on both visual and auditory tasks when compared with same-aged, healthy controls. Critically, a significant association between the severity of visual and auditory deficits was apparent on the TOJ task but not the extinction task, suggesting that even when task demands are matched across modalities, dissociations between visual and auditory neglect can be apparent. Across the auditory tasks, patients showed more pronounced deficits for verbal stimuli than for non-verbal stimuli. These findings have implications for recent models proposed to explain the role of spatial attention in multimodal perception.

Perceptual, premotor and motor factors in the performance of a delayed-reaching task by subjects with unilateral spatial neglect

We used a computerized delayed-reaching task with a simple reaction time (RT) to investigate the visuo-motor and spatio-temporal performance of right brain-damaged (RBD) patients with unilateral spatial neglect (USN). Fifty-three RBD patients (22 with and 31 without USN) and 25 controls performed the tasks. We recorded the following data: the first RT (RT-1), which is thought to reflect the detection of the target position (the perceptual factor); the second RT (RT-2), which represents the initiation of reaching (the motor initiation aspect of premotor factors); the movement time (MT), which is hypothesized to reflect the “pure” motor component of the task. RBD patients with both USN and hemianopia demonstrated significantly longer RTs towards the left than towards the right for both the RT-1 and the RT-2. Among the RBD patients without hemianopia, the laterality index (left side/right side) of the RT-1 in those with USN was significantly greater than in those without USN or the controls. Among the three groups, there were no significant differences between the laterality indices of either the RT-2s or the MTs. These results suggest that the impairment of leftward movement in RBD patients with USN might be caused primarily by a perceptual impairment rather than an impairment in motor initiation, and is certainly not a “pure” motor impairment.

Efficacy of Visuo-Spatial Training in Right-Brain Damaged Patients with Spatial Hemineglect and Attention Disorders

Several rehabilitative approaches have been used to reduce neglect disorders. Some studies tried to demonstrate that hemineglect can be ameliorated by using tasks promoting attentional activation towards the neglected hemispace (Robertson et al., 1995, 2001). As a consequence, a functional link between level of attention and disorders of space exploration has been proposed. For this reason we tried to explore the possible role of attentional deficits on the efficacy of a standard neglect treatment based on visuo spatial rehabilitation. In this study we then examined the performances of a selected group of seven right brain damaged patients, suffering from both severe hemineglect and attentional deficits (of both phasic and tonic components of attention), to several tasks before and after a visuo-spatial training (VST) whose efficacy has been already demonstrated (Pizzamiglio et al., 1992). Results showed that VST induces a significant remission of hemineglect symptoms independently from disorders of attention. Moreover, after visuo-spatial rehabilitation, no improvement of attentional deficits is detectable.

Is the right hemisphere involved in idiom comprehension? A neuropsychological study.

Nonambiguous idiom comprehension was assessed in 15 right brain-damaged (RBD) and 12 left brain-damaged (LBD) aphasic patients by means of a string-to-picture matching task. Idiom comprehension was found to be severely impaired with a bias toward literal interpretation. The RBD patients, though impaired, performed significantly better than LBD patients; their performance was correlated with visuospatial abilities and was significantly affected by lesion site. The results of this study suggest that the performance of RBD patients in the comprehension of idiomatic sentences may be affected by (a) an involvement of the frontal lobe and/or (b) visuospatial deficits that may impair their performance on the picture-matching task.

Temporal and Spatio-Temporal Attention to Tactile Stimuli in Extinction Patients

The temporal deployment of attention to tactile stimuli delivered to the same or to a symmetrical position of the body was assessed in 6 Right-Brain Damaged (RBD) patients with left tactile extinction and 6 healthy controls. Two different tasks called Temporal (T) and Spatio-Temporal (ST) extinction were used. In the T task single or double electro tactile stimuli were delivered to the same point to the left or, in separate blocks, to the right index finger. Double stimuli were separated by different Stimulus Onset Asynchronies (SOAs). In the ST task, stimuli could be single (left or right) or double (left and right). Double stimuli were delivered to the index finger of both hands simultaneously or sequentially. In both tasks subjects were asked to report the number of the stimuli they perceived. In the ST task, subjects were also requested to report the stimuli location. Results show that in both tasks RBD patients' detection of left sided stimuli was significantly lower than of right sided stimuli detection, mainly at shortest SOAs. Moreover, detection of left sided stimuli was higher when two stimuli were delivered in sequence and in symmetrical body areas and in different sides of the space than when stimuli were delivered in sequence in the same body area. Results suggest that the interaction between spatial and temporal variables enhances the ability of tactile extinction patients to detect left sided stimuli.

Poor hand-pointing to sounds in right brain-damaged patients: Not just a problem of spatial-hearing

We asked 22 right brain-damaged (RBD) patients and 11 elderly healthy controls to perform hand-pointing movements to free-field unseen sounds, while modulating two non-auditory variables: the initial position of the responding hand (left, centre or right) and the presence or absence of task-irrelevant ambient vision. RBD patients suffering from visual neglect, unlike RBD patients without neglect and healthy controls, showed a systematic rightward error in sound localisation, which was modulated by the non-auditory variables. Localisation errors were exacerbated by initial hand-position to the right of the body-midline, and reduced by the leftwards initial hand-position. Moreover, for the visual neglect patients, mere presence of ambient vision worsened localisation errors. These results demonstrate that although hand-pointing to sounds has often been considered a straightforward approach to investigate sound-localisation abilities in brain-damaged patients, in some patients it may actually reveal localisation deficits that reflect a combination of impaired spatial-hearing and spatial biases from other sensory modalities (i.e., vision and proprioception).

The visual vertical in the pusher syndrome

The subjective visual vertical (SVV) was investigated in right brain-damaged (RBD) patients with pusher syndrome (PS) which is thought to stem from an erroneous perception of body orientation. The participants, sitting or lying, had to align a luminous rod with gravity. The task was performed in darkness with the rod centred to the body, or placed in the left (neglected) or in the right hemispace. The error, negligible in the control group (+0.3 degrees; n = 6) and mild in the nonneglect non-pusher patients (-1.8 degrees; n = 6), was clearly clockwise in the pusher neglect patients (N+P+; +7.2 degrees; n = 4), but anticlockwise in the non-pusher neglect patients (-6.6 degrees; n = 6). In both neglect groups, error was greater when the rod was in the left space. In N+P+ patients, the performance was strongly affected by posture (lying: +5.2 degrees ; sitting: +9.2 degrees ). Intra-individual variability was also much greater in this group. This study confirms the contralesional deviation of SVV in RBD patients without PS and suggests the presence of an opposite bias in RBD patients affected by PS.

Emotion recognition in stroke patients with left and right hemispheric lesion: Results with a new instrument—the FEEL Test

The aim of this study was to investigate the effect of a stroke event on people’s ability to recognize basic emotions. In particular, the hypothesis that right brain-damaged (RBD) patients would show less of emotion recognition ability compared with left brain-damaged (LBD) patients and healthy controls, was tested. To investigate this the FEEL Test (Facially Expressed Emotion Labeling) was used, a computer based psychometric test that assesses one’s ability to recognize facially displayed basic emotions via a forced-choice paradigm. We examined 24 patients after a stroke event (13 RBD, 11 LBD) and compared them with a matched group of healthy controls (HC, n = 29). Results showed that the stroke patients performed significantly worse in the FEEL Test than did HC ( p < .001). This deficit was especially evident for negative emotions (fear, anger, sadness, and disgust). In contrast to other studies we did not find any significant differences between RBD and LBD patients in their ability to recognize emotions. These results indicate that a stroke event has a negative effect on the recognition of facially displayed emotions but suggest that this effect is apparently not dependent on the side of the brain damage.

Manual and hemispheric asymmetries in the execution of actual and pantomimed prehension

Impairments of the ipsilesional hand after brain damage have been reported in goal-directed motor acts and in pantomimes; the relationship between both movement conditions is largely unknown. In the presented study, pantomimed and actual prehension was examined in 29 stroke patients with left brain damage (LBD) or right brain damage (RBD) as well as in 21 control subjects. Kinematic analyses revealed various performance differences between the conditions of movement execution and the subject groups. The differences depended on the hand tested and on the side of the brain lesion. During actual prehension deviations from normal performance were obvious in the peak velocity of the transport component of the movement, which was reduced in RBD patients, and in the duration of the final adjustment phase, which was prolonged in both patient groups. Pantomime changed various features of movement execution. The transport component was particularly altered in the groups performing with the right hand. Hand aperture was significantly smaller during pantomime than during actual movement execution in all groups. However, this effect was particularly obvious in LBD patients, in whom the hand aperture was even completely absent during many of their pantomimes. Actual movement execution immediately preceding the pantomimes did not change the characteristic features of pantomimes. Thus, the cerebral processes for actually executed and pantomimed motor acts differ. Actual movements seem to be governed by external affordances and constraints; whereas, pantomimes may represent a symbolic act. During prehension, differences in grip formation reveal most directly this dichotomy. We argue that the left hemisphere plays a special role in the generation of the symbolic act; a lesion may abolish grip formation and causes the clinical symptom of apraxia.

Visuospatial neglect in near and far space: dissociation between line bisection and letter cancellation

The differential performance on a line bisection and a cancellation task in near and far space was studied. A group of 10 patients with severe left-sided visuospatial neglect and a group of 10 right-brain damaged patients without neglect were examined. The stimuli were presented at a distance of 60 cm (near space) and 160 cm (far space), respectively, and corrected for visual angle. In the line bisection task, patients were asked to point to the estimated line centre with a pencil (near space) or a stick (far space). In the cancellation task, patients pointed to all target stimuli they could detect using either a pencil (near space) or a stick (far space). Most patients with left hemineglect showed a more prominent neglect in far space as compared to near space for the line bisection task, whereas no difference of performance between near and far space was found in the control patients. In contrast, no group showed a distance effect in the cancellation task. The observation that only line bisection is influenced by the distance of the stimulus suggests that line bisection and cancellation are processed differentially. It is proposed that line bisection requires an allocentric reference system focusing attention on objects, whereas cancellation tasks are based on an egocentric reference system responsible for visuospatial attention. Our results indicate that distance changes perception within the allocentric but not within the egocentric system.

Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients

Objectives: The evolutionary pattern of spontaneous recovery from acute neglect was studied by assessing cognitive deficits and motor impairments. Detailed lesion reconstruction was also performed to correlate the presence of...

Dissociation between taste and tactile extinction on the tongue after right brain damage

In patients with right brain damage (RBD) or left brain damage (LBD) and healthy subjects, tactile and three basic gustatory stimuli (sour, salty, bitter) were applied to the left or right hemitongues or to both hemitongues simultaneously. Tactile stimuli were detected and localized by verbal report, whereas gustatory stimuli were identified by pointing to the corresponding name on cards bearing the names of the three tastes. In the tactile test, 9 of 18 RBD patients showed extinction of left hemitongue stimuli, whereas the remaining RBD patients, 9 LBD patients and 14 healthy subjects detected virtually all stimuli in all conditions. In the gustatory test, healthy subjects outperformed the two brain damaged groups which nevertheless responded well above chance and did not differ from one another. Unexpectedly, the nine RBD patients with left hemitongue tactile extinction showed no gustatory extinction, since performance did not differ significantly between the two hemitongues on both unilateral and bilateral stimulations. To account for these findings, some evidence suggests that the tongue representation is bilateral in both modalities, but predominantly ipsilateral in the gustatory modality and predominantly contralateral in the tactile modality. The RBD patients with left hemitongue tactile extinction were those with more marked symptoms of left-sided extinction in the visual and auditory modalities, making it likely that their brain damage was also responsible for left lingual tactile extinction. The absence of left gustatory extinction in those patients can be attributed to the predominant channelling of left hemitongue taste inputs into the intact left hemisphere.

Temporal Modulation of Spatial Tactile Extinction in Right-Brain-Damaged Patients

Unilateral and bilateral electrotactile stimuli were delivered to both hands of 11 right-brain-damaged (RBD) patients with left tactile extinction and 20 healthy subjects. Bimanual stimuli could be presented simultaneously or with varying stimulus onset asynchronies (SOAs). Subjects indicated their detection of unilateral or bilateral stimuli, their judgements of whether stimuli were simultaneous or successive, and, in the latter case, which side came first. In RBD patients, extinction was maximal with simultaneous presentations and decreased as SOA increased. With short SOAs, omissions of left-sided stimuli occurred with both right-side and left-side stimulus precedence, suggesting a forward and backward interference of the right stimulus on the processing of the left stimulus within a time window of at least 100 msec. In contrast, there was no interference of the left stimulus on the detection of the right stimulus. Unlike controls, extinction patients rarely expressed simultaneity judgements, but those that were produced tended to be veridical or nearly so, like in normal controls. Whereas controls expressed generally accurate judgements of right or left precedence, patients showed a bias toward a right precedence and a maximal uncertainty between left-first and right-first choices when the left stimulus had a lead between 100 and 200 msec. The results are consistent with the hypothesis that, as in other sensory modalities, tactile extinction is associated with an abnormal persistent bias of attention toward the ipsilesional side that delays the processing of contralesional stimuli. However, the finding that both extinction and explicit judgements of simultaneity tended to occur with simultaneous bilateral stimuli suggest the presence of some residual neural capacity to detect precise temporal coincidence.

Disturbed Sound Lateralization in Patients with Spatial Neglect

Abstract Previous studies on auditory space perception in patients with neglect have investigated localization of free-field-sound stimuli or lateralization of dichotic stimuli that are perceived intracranially. Since those studies in part revealed contradictory results, reporting either systematic errors to the left or systematic errors to the right, we reassessed the ability of auditory lateralization in patients with right hemispheric lesions with and without neglect. Unexpectedly, about half of the patients with neglect showed erratic judgments on sound position, that is, they were completely unable to lateralize sounds. The remaining neglect patients only showed a small deviation of the auditory median plane to the left side, indicating that they perceived the sounds as slightly shifted to the right side. The comparison between both groups revealed higher severity of neglect in the group of neglect patients who were unable to perform the task, suggesting that the inability of sound lateralization was associated with the strength of clinical neglect. However, we also observed 1 out of 9 patients with left brain damage who was not able to lateralize spatial sounds. This patient did not show any symptoms of spatial neglect. Thus, it may be that a spatial auditory deficit, such as that observed here in right-braindamaged patients, only co-occurs with spatial neglect if the right superior temporal cortex is lesioned.

Textpragmatic impairments of figure-ground distinction in right-brain damaged stroke patients compared with aphasics and healthy controls

Abstract Following previously published work on aphasic texts and unpublished pilot studies on textpragmatic impairments in right-brain damaged stroke patients (RBDs), we present an exploratory study on textpragmatic dimensions of several text classes produced by RBDs as compared with aphasics and healthy controls. In contrast to the main thrust of published research on (text)pragmatic impairments in RBDs, we assume for them the existence of a specific major impairment of figure-ground segregation, with consequences in defective textual organization, in inferencing, and in metalinguistic behavior. In this way we explain the RBDs’ deficits in producing (but not in comprehending) the essential textual core and emotional elements, and essential inferences. Difficulties in figure-ground distinction also result in RBDs’ insecurity about how well they solve discursive problems. These deficits appeared in the tests that we administered to 4 RBDs, 5 controls, 3 Broca and 2 Wernicke aphasics. Subjects had to carry out the following tasks: (a) oral production of a longer and a shorter picture story, (b) oral and written reproduction of a longer and a shorter oral narrative, (c) productions of telegraphic versions, of titles and of punch lines for (a) and (b). Differences in the RBDs’ performances in these distinct tasks are traced back to different cognitive demands on oral vs. written vs. reductive reproduction vs. picture story telling.