Rightward Errors Research Articles

Unilateral spatial neglect in AD

Unilateral spatial neglect has been rarely reported in patients with AD, although they often have right and left asymmetry of temporoparietal dysfunction. To investigate if patients with AD would show unilateral spatial neglect in the line bisection test, and to reveal the relationship between their neglect and the area of cerebral dysfunction. Thirty-two patients with mild to moderate AD and 32 age-matched healthy control subjects underwent an extensive line bisection test. SPECT was also obtained for the patients. Rightward bisection errors exceeded the normal range in 25% of patients with AD. They exhibited greater rightward errors for the longer lines in the left hemispace than in the right hemispace, and with the right hand than with the left hand; this corresponds to the characteristics of neglect seen after right hemisphere lesions. All patients who bisected 200 mm lines with errors over 10 mm showed disproportionate lowering of performance IQ and asymmetric right hemisphere hypoperfusion, especially in the temporoparietal region. Seventy-five percent of the patients performed normally in the center presentation but erred slightly toward the body midline in the right and left hemispaces. Left unilateral spatial neglect in mild to moderate AD may be rather common if tested with the line bisection test. Rightward errors over 10 mm suggest right temporoparietal dysfunction. In AD, three or more bisections of 200 mm lines in the center presentation are recommended for detection of neglect. Patients with AD but without neglect may have difficulty in shifting attention into the peripheral sector of the egocentric space.

Pseudoneglect: a review and meta-analysis of performance factors in line bisection tasks

An exhaustive qualitative (vote-counting) review is conducted of the literature concerning visual and non-visual line bisection in neurologically normal subject populations. Although most of these studies report a leftward bisection error (i.e., pseudoneglect), considerable between-study variability and inconsistency characterize this literature. A meta-analysis of this same literature is performed in which the total quantitative data set, comprising 73 studies (or sub-studies) and 2191 subjects, is analyzed with respect to 26 performance factors. The meta-analytic results indicate a significant leftward bisection error in neurologically normal subjects, with an overall effect size of between −0.37 and −0.44 (depending on integration method), which is significantly modulated to varying degrees by a number of additional task or subject variables. For example, visual bisection tasks, midsagittal-pointing tasks and tactile bisection tasks all lead to leftward errors, while kinesthetic tasks result in rightward errors. Tachistoscopic forced-choice testing methods reveal much greater estimates of bisection error (effect size=−1.32) than do manual method-of-adjustment procedures (effect size=−0.40). Subject age significantly modulates line bisection performance such that older subjects err significantly rightward compared to younger subjects, and to veridical line midpoint. Male subjects make slightly larger leftward errors than do female subjects. Handedness has a small effect on bisection errors, with dextrals erring slightly further to the left than sinistral subjects. The hand used to perform manual bisection tasks modulated performance, where use of the left hand lead to greater leftward errors than those obtained using the right hand. One of the most significant factors modulating bisection error is the direction in which subjects initiate motor scanning (with either eye or hand), where a left-to-right scan pattern leads to large leftward errors while a right-to-left scan pattern leads to rightward errors.

Two-dimensional distortion of space representation in unilateral neglect: perceptual and response-related factors

The paper reports the results of an experiment in which left-neglect patients were required to point at the location they judged vertically to correspond (within the frame of the visual stimulus display they were given) with a cue that was variably located along a left–right axis lying proximally or distally with respect to the left–right axis over which they had to give their response. Patients were found to make rightward errors as in a similar, single-case study. The significant positive correlation between those errors and the degree of response bias on a manual-response version of the Milner Landmark Task suggests that rightward pointing errors made by left-neglect patients in conditions such as those set in the present experiment are due to a dysfunction selectively affecting an output-related component of space representation.

Residual perceptual distortion in recovered hemispatial neglect

In most neglect patients, line bisection errors become smaller on repeated tests over the months following the lesion. We have tried to determine in two typical patients whether this is because of a real reduction in the perceptual distortions that appear to underlie line bisection errors in neglect, or whether it reflects a learned behavioural strategy to counteract those perceptual biases. We tested the patients on two occasions (2 and 12 months post-stroke), on line bisection and also on the Landmark task. The data indicated that at the first testing session both patients showed strong perceptual neglect, making large rightward errors in the standard bisection task and uniformly leftward pointing in the Landmark task. On the second occasion, as expected, both patients showed a marked recovery when tested with the line bisection task, making only very small errors. In contrast, their landmark performance was still markedly biased in the same direction as before. These findings suggest that despite their apparent recovery on the bisection task, both patients still experience some form of perceptual distortion of horizontal lines. It is suggested that the Landmark task may provide a sensitive means for identifying real recovery of the underlying perceptual deficit.

Visual size processing in spatial neglect.

Evidence from the use of the landmark task and from two size-matching tasks shows that many patients with left-sided neglect systematically under-perceive visual extent in leftward parts of space. This perceptual distortion of size serves to explain the occurrence of rightward line-bisection errors in most neglect patients. One possibility is that attentional biases of a chronic nature might underlie these perceptual changes seen in neglect patients. But contrary to this idea, we have found that attentional cueing in the landmark task causes changes in neglect patients exactly opposite to those seen in healthy subjects. The distortions of size perception seen in neglect could instead be caused by a high-level alteration of visual processing rather than by an attentional bias. In order to explore which visual stream of cortical processing might be compromised in such a disorder, we have begun to examine neglect patients on visuomotor as well as perceptual tasks. We have found clear evidence in one patient for intact grip scaling for object size in the neglected half of space, despite gross perceptual underestimations of the same objects. This result suggests that neglect can occur without major disruption of the dorsal stream, and may result instead from damage to a cortical system whose predominant visual input comes from the ventral stream.

What Is Line Bisection in Unilateral Spatial Neglect?: Analysis of Perceptual and Motor Aspects in Line Bisection Tasks

Three patients with unilateral spatial neglect could detect the difference of length between the right and left segments when a line had a transection mark. To examine the effect of response mode, the manual line bisection task and a new “line bisection task by fixation” were given to the patients. In tasks that used lines with no landmark, they showed apparent rightward errors. The results suggest that line bisection is not a task that examines the ability of patients with neglect to compare the right and left extents of a line. Where to fixate as the subjective midpoint may determine the rightward errors of bisection, whether manual response is used or not.

Near and far visual space in unilateral neglect

A 24-year-old right-handed woman with a right temporal hematoma showed marked left visual neglect for far but not near space in a variety of tasks systematically given in near and far distance conditions. This case thus provides the dissociation opposite to Halligan and Marshall's patient, who had neglect for near but not far space after a right parietal stroke. Furthermore, although she made rightward errors in bisecting far-distant lines, our patient made smaller opposite leftward errors for near-distant lines. The evidence that unilateral neglect of far and near visual space may exist independently supports a division in the neural systems subserving attention to different compartments of the extrapersonal space in humans.

Differential Effects of Line Length on Bisection Judgements in Hemispatial Neglect

Recent studies have shown that certain symptoms of spatial neglect are co-determined by two major factors: one whose general nature is perceptual, the other whose nature is directional and/or motor. In the present study, Patients whose neglect was classified as predominantly ‘perceptual’ or ‘directional’ through use of the Landmark task (Milner, Brechmann and Pagliarini 1992) were asked to bisect lines ranging in length from 20 to only 2.5 cm. It was found that the one patient with predominantly directional neglect showed large rightward errors at all line lengths. In contrast, those with perceptual neglect made very small (usually leftward) errors on short lines. It is argued that it is essential to separate these different subtypes of neglect patient if we are to understand the causation of their behaviour in tasks such as line bisection.

The effects of unilateral visuospatial neglect on perception of Müller-Lyer illusory figures.

Left visuospatial neglect after right hemisphere damage is a lateralised disorder of spatial perception and cognition. A study is reported of the extent to which patients with left visuospatial neglect are susceptible to the illusory effects normally elicited by Müller-Lyer figures, in which inducing fins are located on one end or on both ends of a horizontal line. Seven patients with left visuospatial neglect and seven normal controls were tested on a task of horizontal-line bisection in which stimuli consisted of plain lines of three lengths (100, 150, and 200 mm), randomly interleaved with lines with unilateral or bilateral fins. As a group, normals made accurate bisection judgments in the baseline (no-fins) condition, and exhibited significant illusory effects in both the unilateral-fin and the bilateral-fin conditions. In contrast, patients made substantial rightward errors in the baseline condition, consistent with their neglect of the left end of the line. However, as a group, patients still exhibited significant illusory effects with left-sided outward-projecting fins on 100 mm lines and with left-sided inward-projecting fins on 150 mm lines. Moreover, at least one patient exhibited consistent illusory effects both for inward-projecting and for outward-projecting left-sided fins at all line lengths. Normal illusory effects in patients were also obtained with stimuli containing unilateral right-sided and bilateral fins. The existence of such effects with inducing elements on the contralesional extremity of horizontal line stimuli suggests preservation of low-level, perhaps preattentive, perceptual mechanisms responsible for coding elementary visual features. The results may be relevant for an understanding of the influence of attentional factors on illusory perception.

Distortion of size perception in visuospatial neglect.

A number of studies have shown that most patients with symptoms of unilateral (left-sided) visuospatial neglect make consistently rightward errors when attempting to bisect a horizontal line at its midpoint. One possible interpretation of this impairment is that such patients misperceive the left half of the line: that is, that they underestimate its extent relative to the right half. We have carried out direct tests for such a perceptual distortion in three neglect patients by asking them to make matching judgements on pairs of horizontal rectangles, vertical rectangles or nonsense shapes, of varying relative size, presented on a computer screen. We report here that all of the patients tested showed a significant and substantial relative underestimation of the horizontal extent or area of stimuli presented on the left side of their egocentric space. There was no such misperception of vertical extent. It is suggested that size perception may be partially determined by a representational system that is anatomically centred in the parieto-temporal region of the brain. The results are interpreted in terms of damage to this system in neglect patients.

Visual and Tactile Rod Bisection in Unilateral Neglect

A rod bisection task was performed by 16 RBD patients with visual neglect, 10 RBD and 10 LBD patients without visual neglect, and 10 normal controls. Three different conditions were used: tactile, where they explored the rod blindfolded; visuo-tactile, where they explored the rod manually without blindfold; and visual, where they pointed to the midpoint without prior manual exploration. Only within the RBD group with visual neglect was there a significant difference between the three conditions. These patients made large rightward errors under the visual condition but no significant deviations from actual midpoint under the visuo-tactile or the tactile condition. It is therefore possible that rod exploration, which is an integral part of tactile bisection, reduces neglect to such an extent that it is difficult to identify neglect in the tactile modality on this task.

Line bisection errors in visual neglect: Misguided action or size distortion?

The rightward line bisection errors made by patients with visuospatial neglect can be explained as due to a spatially misdirected response, which would be predicted on either of two accounts. An alternative view, however, is that such patients actually mispercieve the left half of a horizontal line as being shorter than the right half. We have tested this possibility directly in three neglect patients, by giving them prebisected lines: they were found to judge a central transection mark as lying nearer to the left end of the lines. We were also able to test one of the patients on a series of size comparisons using computer-generated patterns. She was found to judge horizontal lines as shorter in the left half of visual space than in the right. This was also true for comparisons of the areas of nonsense figures. However she did not make such constant errors when comparing the lengths of vertical lines. It is suggested that an attentional deficit in left hemispace may result in the underestimation of horizontal extent. This would act in combination with misdirected reaching to determine the magnitude of line bisection errors.

Darkness Improves Line Bisection in Unilateral Spatial Neglect

This study was performed to determine the influence of background illumination on the performance of patients with left visual neglect. We examined six RBD patients with unilateral visual neglect, and as controls six RBD patients and six LBD patients without neglect. A luminous line consisting of LEDs was used in a line bisection task under two conditions, normal illumination and darkness.As expected, neglect patients made large rightward errors under normal illumination. Their performance improved by about 43% in darkness. Our results are discussed with reference to earlier studies of space exploration without visual guidance.

The influence of stimulus properties on visual neglect.

Twenty five patients with right cerebral hemisphere damage and neglect participated in a series of bisection experiments. As expected, long lines were bisected to the right of true midpoint. By contrast, large circles and long white paper strips were bisected accurately, or with leftward errors. Small objects were less sensitive to stimulus properties: short lines and paper strips, and small circles, were bisected to the left of true midpoint, and these leftward errors were equally common as rightward errors with long lines. When asked to draw a perpendicular line of the same length as the presented horizontal line, patients overestimated the length of short lines but underestimated that of long lines. Presenting lines in near and far extrapersonal space selectively affected bisection of short lines. The results suggest that two opposing, independent mechanisms determine bisection performance in left neglect.