Online research in philosophy

The extent to which visual information on the contralateral, unattended side influences the performance of patients with hemispatial neglect was studied in a visuomotor reaching task. We replicated the well-established finding that, relative to target-alone trials, normal subjects are slower to reach to targets in the presence of visual distractors which appear either ipsilateral or contralateral to the target, with greater interference in the former condition. Six patients with hemispatial neglect showed even greater interference than did the normal subjects when the distractor appeared ipsilaterally but showed no significant interference from contralateral distractors. This pattern of performance was qualitatively similar for patients with lesions restricted to posterior regions and for patients with more extensive lesions involving both posterior and anterior brain regions. These findings suggest that, in the visuomotor domain, information on the contralateral side is processed minimally, if at all, in patients with hemispatial neglect.

When left-neglect patients are required to extend horizontal segments to double their original length, relative left overextension is frequently observed. Less frequently, relative left underextension may also be found. It was hypothesized that this contrast could depend on the degree of horizontal anisometry of the medium for the representation of spatial properties. The present paper reports an experiment conducted in order to test that hypothesis, on the basis of which left overextension should be larger with shorter than with longer segments and with segments lying in the right rather than in the left hemispace. Although supportive, the results unveiled unexpected complications: the expected effect of line length was found only in neglect patients with frontal damage, while the expected effect of side of presentation was found only in neglect patients without frontal damage.

Patients may show a more-or-less complete deviation of the head and eyes towards the right (ipsilesional) side [that is, to the same side of egocentric space as the brain lesion responsible for their disorder]. If addressed by the examiner from the left (contralesional) side [the opposite side to their lesion], patients with severe extrapersonal neglect may fail to respond or may look for the speaker in the right side of the room, turning head and eyes more and more to the right. Frequently these patients will not pick up food from the left half of the plate. Given a crossword puzzle, they may complete only the squares to the right. If walking is not prevented by hemiparesis, neglect patients may lose their bearings, since they do not make use of left sided cues.

We describe some of the signs and symptoms of left visuo-spatial neglect. This common, severe and often long-lasting impairment is the most striking consequence of right hemisphere brain damage. Patients seem to (over-)attend to the right with subsequent inability to respond to stimuli in contralesional space. We draw particular attention to how patients themselves experience neglect. Furthermore, we show that the neglect patient's loss of awareness of left space is crucial to an understanding of the condition. Even after left space has been brought into the patient's consciousness (either by local cueing on the left or by an emphasis on global properties of the scene as a whole), this awareness of left space rapidly declines. We suggest that much of the symptomology of left neglect can be interpreted as a disconnection between brain mechanisms that are relatively specialized for local (detail) visual processing and global (panoramic) processing. This failure of communication between functional (subpersonal) mechanisms then has consequences for how perceptual and representational content enters into awareness. Failure of the local contents of left space to be consciously accessed is, in turn, an important aspect of why left neglect is so difficult to remediate. Patients can ''know'' that they have neglect but are cut off from the perceptual awareness that would enable them to overcome their attentional bias to the right.

Ninety-one right brain-damaged patients with left neglect and 43 right brain-damaged patients without neglect were asked to extend horizontal segments, either left- or rightward, starting from their right or left endpoints, respectively. Earlier experiments based on similar tasks had shown, in left neglect patients, a tendency to overextend segments toward the left side. This seemingly paradoxical phenomenon was held to undermine current explanations of unilateral neglect. The results of the present extensive research demonstrate that contralesional overextension is also evident in most right brain-damaged patients without contralesional neglect. Furthermore, they show that in a minority of left neglect patients, the opposite behavior, i.e., right overextension can be found. The paper also reports the results of correlational analyses comprising the parameters of line-extension, line-bisection, and cancellation tasks, as well as the parameters relative to the Milner Landmark Task, by which a distinction is drawn between perceptual and response biases in unilateral neglect. A working hypothesis is then advanced about the brain dysfunction underlying neglect and an attempt is made at finding an explanation of neglect and the links between the mechanisms of space representation and consciousness through the study of the changes induced by unilateral brain lesions in the characteristics of space-coding neurons. Abbreviations: C, control group;GN+91,full group of neglect patients;GN+27,group of neglect patients with relative left overextension;GN+14,group of neglect patients with relative right overextension;GN-43,full group of non-neglect patients;GN-9,group of non-neglect patients with relative left overextension; H canc, H cancellation task; LE, left extension; LE/RE, ratio of left-right extension; N+, neglect patients; N-, non-neglect patients; PB Land-M, perceptual bias on Landmark motor task; PB Land-V, perceptual bias on Landmark verbal task; RB Land-M, response bias on Landmark motor task; RB Land-V, response bias on Landmark verbal task; RE, right extension.

Unilateral neglect stems from a relatively selective impairment of exogenous, or stimulus-related, orienting of attention. This neuropsychological evidence parallels “change blindness” experiments, in which normal individuals lack awareness of salient details in the visual scene as a consequence of their attention being exogenously attracted by a competing event, suggesting that visual consciousness requires the integrity of exogenous orienting of attention.