Impact of macular scotoma and tubular vision on oculomotor behavior and performance in visuospatial comparison tasks.

Our aim in this study was to understand how we perform visuospatial comparison tasks by analyzing ocular behavior and to examine how restrictions in macular or peripheral vision disturb ocular behavior and task performance. Two groups of 18 healthy participants with normal or corrected visual acuity performed visuospatial comparison tasks (computerized version of the elementary visuospatial perception [EVSP] test) (Pisella et al., 2013) with a gaze-contingent mask simulating either tubular vision (first group) or macular scotoma (second group). After these simulations of pathological conditions, all participants also performed the EVSP test in full view, enabling direct comparison of their oculomotor behavior and performance. In terms of oculomotor behavior, compared with the full view condition, alternation saccades between the two objects to compare were less numerous in the absence of peripheral vision, whereas the number of within-object exploration saccades decreased in the absence of macular vision. The absence of peripheral vision did not affect accuracy except for midline judgments, but the absence of central vision impaired accuracy across all visuospatial subtests. Besides confirming the crucial role of the macula for visuospatial comparison tasks, these experiments provided important insights into how sensory disorder modifies oculomotor behavior with or without consequences on performance accuracy.

Reduced spatial attentional distribution in older adults.

Older adults show decline in visual search performance, but the underlying cause remains unclear. It has been suggested that older adults' altered performance may be related to reduced spatial attention to peripheral visual information compared with younger adults. In this study, 18 younger (M = 21.6 years) and 16 older (M = 69.1 years) participants performed pop-out and serial visual search tasks with variously sized gaze-contingent artificial central scotomas (3°, 5°, or 7° diameter). By occluding central vision, we measured how attention to the periphery was contributing to the search performance. We also tested the effect of target eccentricity on search times and eye movements. We hypothesized that, if attention is reduced primarily in the periphery in older adults, we would observe longer search times for more eccentric targets and with central occlusion. During the pop-out search, older adults showed a steeper decline in search performance with increasing eccentricity and central scotoma size compared with younger adults. In contrast, during the serial search, older adults had longer search times than younger adults overall, independent of target eccentricity and scotoma size. Longer search times were attributed to higher cost-per-item slopes, indicating increased difficulty in simultaneously processing complex symbols made up of separable features in aging, possibly stemming from challenges in spatially binding individual features. Altogether, our findings point to fewer attentional resources of simultaneous visual processing to distribute over space or separable features of objects, consistent with decreased dorsal visual stream functioning in aging.

Spatial bias in anti-saccade endpoints following bilateral dorsal posterior parietal lesions.

Anti-saccades are eye movements in which the saccade is executed in the opposite direction of a visual target and are often hypometric. Because the visual target and saccade goal are decoupled, it has been suggested that competition between the two locations occurs and needs to be resolved. It has been hypothesized that the hypometria of anti-saccades reflects this spatial competition by revealing a bias towards the visual target. To confirm that this hypometria is not simply due to reduced gain, we tested 10 healthy subjects on three different anti-saccade spatial configuration tasks: 90° away across hemifields, 90° away within the same hemifield and 180° away (classic, diagonally opposite). Specifically, we examined whether saccade endpoints showed evidence for the visual target location's interference with anti-saccade programming and execution processes. Among other neural substrates involved in anti-saccades production, the dorsal posterior parietal cortex (PPC) has been implicated in the spatial inhibition of contralateral visual target. To gain insight into the neural processes involved in spatial competition during anti-saccades, we also tested one patient with a bilateral dorsal PPC lesion. In all spatial configurations, we observed that anti-saccade endpoints demonstrated a spatial bias towards the visual target for all participants, likely due to an incomplete inhibition of the visual target location. This spatial bias was exacerbated in our patient, which suggests that the dorsal PPC contributes to the amalgamation of the two competing spatial representations.

Toward the characterization of a visual form of developmental dyslexia: Reduced visuo-attentional capacity for processing multiple stimuli made of separable features.

Some dyslexics cannot process multiple letters simultaneously. It has been argued that this reduced visuo-attentional (VA) letter span could result from poor reading ability and experience. Here, moving away from reading context, we showed that dyslexic group exhibited slower visual search than normal readers group for "symbols", defined as graphic stimuli made up of separable visual features, but not for filled objects. Slowness in symbol visual search was explained by reduced VA field and atypical ocular behaviour when processing those letter-like stimuli and was associated with reduced VA letter span and impaired elementary visuo-spatial perception. Such a basic visual search deficit can hardly be attributed to poor reading ability and experience. Moreover, because it is specific to letter-like stimuli (i.e., "symbols"), it can specifically hinder reading acquisition. Symbol visual search can easily be tested in the pre-reading phase, opening up prospects for early risk detection and prevention of VA dyslexia.

Pre-saccadic attention relies more on suppression than does covert attention.

During covert and pre-saccadic attentional shifts, it is unclear how facilitation and suppression processes interact for target selection. A recent countermanding task pointed to greater suppression at unattended locations during trials with saccades compared to trials without saccades (i.e., fixation and successful stop trials), whereas target facilitation did not differ. It is unknown whether this finding is restricted to countermanding paradigms that involve inhibitory processes. To test this, we adapted Gaspelin and colleagues (2015)'s attention capture task where, within the same block, one location was primed with frequent line discrimination trials, and all locations were occasionally probed using letters report trials. Participants also performed a baseline condition without priming. We tested 15 participants and examined how performance at non-primed locations was affected by covert versus pre-saccadic attention in blocks of four or six items, as well as by position from the primed location and timing from saccade onset. For both attention conditions, letter report at non-primed locations was worse compared to baseline, demonstrating suppression, and letter report at primed location was better, demonstrating facilitation. In saccades trials, letter report was better at primed locations and worse at non-primed locations compared to fixation trials. The timing of this additional pre-saccadic suppression differed from saccadic suppression. In both attention conditions, suppression was greater when primed and non-primed locations were within the same hemifield or in diagonal opposite quadrants. These results confirmed that attention preceding saccade execution suppressed non-primed locations to a larger extent than covert attention, with the same spatial quadrant effect.

Elementary visuospatial perception deficit in children with neurodevelopmental disorders.

AIM: To assess the prevalence of elementary visuospatial perception (EVSP) deficit in children with neurodevelopmental disorders. METHOD: Using a screening test designed and validated to measure dorsal EVSP ability, 168 children (122 males, 46 females; mean age 10y [SD 1y 10mo], range 4y 8mo-16y 4mo) diagnosed with developmental coordination disorder (DCD), specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), and/or oral language disorder were compared with a group of 184 typically developing children. We also tested 14 children with binocular vision dysfunction and no neurodevelopmental disorder. RESULTS: Children with SLD scored below the interquartile range of typically developing children as frequently (59%) as children with DCD, but only 5% were severely impaired (i.e. scored as outliers). Children with DCD were the most severely impaired (22% of outliers), even more so when they exhibited a co-occuring disorder. Children with language disorder and those with binocular vision dysfunction scored similarly to the group of typically developing children. INTERPRETATION: These results confirm the importance of assessing EVSP in the clinical evaluation of children with neurodevelopmental disorders, in particular those presenting with DCD or SLD. What this paper adds More than half of children with developmental coordination disorder (DCD) scored below the normal interquartile range on the elementary visuospatial perception (EVSP) test. More than half of children with specific learning disorder (SLD) scored below the normal interquartile range on the EVSP test. Twenty-two percent of children with DCD performed as outliers on the EVSP test. Children with language disorder and those with binocular vision dysfunction scored similarly to typically developing children.

Post-saccadic changes disrupt attended pre-saccadic object memory.

Trans-saccadic memory consists of keeping track of objects' locations and features across saccades; pre-saccadic information is remembered and compared with post-saccadic information. It has been shown to have limited resources and involve attention with respect to the selection of objects and features. In support, a previous study showed that recognition of distinct post-saccadic objects in the visual scene is impaired when pre-saccadic objects are relevant and thus already encoded in memory (Poth, Herwig, Schneider, 2015). Here, we investigated the inverse (i.e. how the memory of pre-saccadic objects is affected by abrupt but irrelevant changes in the post-saccadic visual scene). We also modulated the amount of attention to the relevant pre-saccadic object by having participants either make a saccade to it or elsewhere and observed that pre-saccadic attentional facilitation affected how much post-saccadic changes disrupted trans-saccadic memory of pre-saccadic objects. Participants identified a flashed symbol (d, b, p, or q, among distracters), at one of six placeholders (figures "8") arranged in circle around fixation while planning a saccade to one of them. They reported the identity of the symbol after the saccade. We changed the post-saccadic scene in Experiment one by removing the entire scene, only the placeholder where the pre-saccadic symbol was presented, or all other placeholders except this one. We observed reduced identification performance when only the saccade-target placeholder disappeared after the saccade. In Experiment two, we changed one placeholder location (inward/outward shift or rotation re. saccade vector) after the saccade and observed that identification performance decreased with increased shift/rotation of the saccade-target placeholder. We conclude that pre-saccadic memory is disrupted by abrupt attention-capturing post-saccadic changes of visual scene, particularly when these changes involve the object prioritized by being the goal of a saccade. These findings support the notion that limited trans-saccadic memory resources are disrupted when object correspondence at saccadic goal is broken through removal or location change.

Adaptation to Leftward Shifting Prisms Alters Motor Interhemispheric Inhibition.

Adaptation to rightward shifting prisms (rightward prism adaptation, RPA) ameliorates neglect symptoms in patients while adaptation to leftward shifting prisms (leftward prism adaptation, LPA) induces neglect-like behaviors in healthy subjects. It has been hypothesized that prism adaptation (PA) modulates interhemispheric balance between the parietal cortices by inhibiting the posterior parietal cortex (PPC) contralateral to the prismatic deviation, but PA's effects on interhemispheric inhibition (IHI) have not been directly investigated. Since there are hyper-excitable connections between the PPC and primary motor cortex (M1) in the left hemisphere of neglect patients, we reasoned that LPA might mimic right hemisphere lesions by reducing parietal IHI, hyper-exciting the left PPC and PPC-M1 connections, and in turn altering IHI at the motor level. Namely, we hypothesized that LPA would increase IHI from the left to the right M1. We examined changes in left-to-right and right-to-left IHI between the 2 M1s using the ipsilateral silent period (iSP) (Meyer et al. 1995) before and after either LPA or RPA. The iSP was significantly longer after LPA but only from left-to-right and it did not change at all after RPA. This is the first physiological demonstration that LPA alters IHI in the healthy brain.

Learned rather than online relative weighting of visual-proprioceptive sensory cues.

When reaching to an object, information about the target location as well as the initial hand position is required to program the motor plan for the arm. The initial hand position can be determined by proprioceptive information as well as visual information, if available. Bayes-optimal integration posits that we utilize all information available, with greater weighting on the sense that is more reliable, thus generally weighting visual information more than the usually less reliable proprioceptive information. The criterion by which information is weighted has not been explicitly investigated; it has been assumed that the weights are based on task- and effector-dependent sensory reliability requiring an explicit neuronal representation of variability. However, the weights could also be determined implicitly through learned modality-specific integration weights and not on effector-dependent reliability. While the former hypothesis predicts different proprioceptive weights for left and right hands, e.g., due to different reliabilities of dominant vs. nondominant hand proprioception, we would expect the same integration weights if the latter hypothesis was true. We found that the proprioceptive weights for the left and right hands were extremely consistent regardless of differences in sensory variability for the two hands as measured in two separate complementary tasks. Thus we propose that proprioceptive weights during reaching are learned across both hands, with high interindividual range but independent of each hand's specific proprioceptive variability. NEW & NOTEWORTHY How visual and proprioceptive information about the hand are integrated to plan a reaching movement is still debated. The goal of this study was to clarify how the weights assigned to vision and proprioception during multisensory integration are determined. We found evidence that the integration weights are modality specific rather than based on the sensory reliabilities of the effectors.

Paradoxical adaptation of successful movements: The crucial role of internal error signals.

Visuo-motor adaptation has been classically studied using movements aimed at visual targets with visual feedback. In this type of experimental design, the respective roles of the different error signals cannot be fully disentangled. Here, we show that visuo-motor adaptation occurs despite the terminal success of the action and the compensation of the external error by a jump of the visual target. By using three grasping task conditions we manipulated the retinal error signal between the seen hand and the target (external error) and the conflict between the hand's visual reafference and either the proprioceptive or the efference copy signal (internal error), in order to estimate their respective roles in prism adaptation. In all conditions, subjects were asked to rapidly grasp an object. In the classical 'Prism' condition the object was stationary, which provided both external and internal errors. In the 'Prism & Jump' condition, at movement onset the object was suddenly displaced (jump) toward its virtual image location (visually displaced by the prism) which also corresponded to the location where the movement was planned to and executed through prisms. This jump therefore cancelled the external error (between the seen target and the seen hand), whereas the internal error (between the seen hand and the expected visual reafference of the hand, or between the seen hand and the hand felt by proprioception) was unchanged (because it is independent of the presence of the goal). In the 'Jump' condition, the movement was planned and executed without prismatic goggles and consequently with no internal error (no difference between where the hand visual reafference is expected to be and where it actually is), but the object was suddenly displaced at movement onset by a displacement equivalent to a prism shift which provided an external error. The 'Prism' and 'Prism & Jump' conditions exhibited similar aftereffects, whereas no aftereffect was observed in the 'Jump' condition. These results suggest that successful actions can be subjected to adaptation and that internal error is the only signal necessary to elicit true visuomotor adaptation characterized by context-independent generalization.

Spatial and temporal dynamics of presaccadic attentional facilitation before pro- and antisaccades.

The premotor theory of attention and the visual attention model make different predictions about the temporal and spatial allocation of presaccadic attentional facilitation. The current experiment investigated the spatial and temporal dynamics of presaccadic attentional facilitation during pro- and antisaccade planning; we investigated whether attention shifts only to the saccade goal location or to the target location or elsewhere, and when. Participants performed a dual-task paradigm with blocks of either anti- or prosaccades and also discriminated symbols appearing at different locations before saccade onset (measure of attentional allocation). In prosaccades blocks, correct prosaccade discrimination was best at the target location, while during errors, discrimination was best at the location opposite to the target location. This pattern was inversed in antisaccades blocks, although discrimination remained high opposite to the target location. In addition, we took the benefit of a large range of saccadic landing positions and showed that performance across both types of saccades was best at the actual saccade goal location (where the eye will actually land) rather than at the instructed position. Finally, temporal analyses showed that discrimination remained highest at the saccade goal location, from long before to closer to saccade onset, increasing slightly for antisaccades closer to saccade onset. These findings are in line with the premises of the premotor theory of attention, showing that attentional allocation is primarily linked both temporally and spatially to the saccade goal location.

Prism Adaptation Alters Electrophysiological Markers of Attentional Processes in the Healthy Brain.

Neglect patients typically show a rightward attentional orienting bias and a strong disengagement deficit, such that they are especially slow in responding to left-sided targets after right-sided cues (Posner et al., 1984). Prism adaptation (PA) can reduce diverse debilitating neglect symptoms and it has been hypothesized that PA's effects are so generalized that they might be mediated by attentional mechanisms (Pisella et al., 2006; Redding and Wallace, 2006). In neglect patients, performance on spatial attention tasks improves after rightward-deviating PA (Jacquin-Courtois et al., 2013). In contrast, in healthy subjects, although there is evidence that leftward-deviating PA induces neglect-like performance on some visuospatial tasks, behavioral studies of spatial attention tasks have mostly yielded negative results (Morris et al., 2004; Bultitude et al., 2013). We hypothesized that these negative behavioral findings might reflect the limitations of behavioral measures in healthy subjects. Here we exploited the sensitivity of event-related potentials to test the hypothesis that electrophysiological markers of attentional processes in the healthy human brain are affected by PA. Leftward-deviating PA generated asymmetries in attentional orienting (reflected in the cue-locked N1) and in attentional disengagement for invalidly cued left targets (reflected in the target-locked P1). This is the first electrophysiological demonstration that leftward-deviating PA in healthy subjects mimics attentional patterns typically seen in neglect patients. Significance statement: Prism adaptation (PA) is a promising tool for ameliorating many deficits in neglect patients and inducing neglect-like behavior in healthy subjects. The mechanisms underlying PA's effects are poorly understood but one hypothesis suggests that it acts by modulating attention. To date, however, there has been no successful demonstration of attentional modulation in healthy subjects. We provide the first electrophysiological evidence that PA acts on attention in healthy subjects by mimicking the attentional pattern typically reported in neglect patients: both a rightward attentional orienting bias (reflected in the cue-locked N1) and a deficit in attentional disengagement from the right hemispace (reflected in the target-locked P1). This study makes an important contribution to refining current models of the mechanisms underlying PA's cognitive effects.

Paired-Pulse Parietal-Motor Stimulation Differentially Modulates Corticospinal Excitability across Hemispheres When Combined with Prism Adaptation.

Rightward prism adaptation ameliorates neglect symptoms while leftward prism adaptation (LPA) induces neglect-like biases in healthy individuals. Similarly, inhibitory repetitive transcranial magnetic stimulation (rTMS) on the right posterior parietal cortex (PPC) induces neglect-like behavior, whereas on the left PPC it ameliorates neglect symptoms and normalizes hyperexcitability of left hemisphere parietal-motor (PPC-M1) connectivity. Based on this analogy we hypothesized that LPA increases PPC-M1 excitability in the left hemisphere and decreases it in the right one. In an attempt to shed some light on the mechanisms underlying LPA's effects on cognition, we investigated this hypothesis in healthy individuals measuring PPC-M1 excitability with dual-site paired-pulse TMS (ppTMS). We found a left hemisphere increase and a right hemisphere decrease in the amplitude of motor evoked potentials elicited by paired as well as single pulses on M1. While this could indicate that LPA biases interhemispheric connectivity, it contradicts previous evidence that M1-only MEPs are unchanged after LPA. A control experiment showed that input-output curves were not affected by LPA per se. We conclude that LPA combined with ppTMS on PPC-M1 differentially alters the excitability of the left and right M1.

Saccade execution suppresses discrimination at distractor locations rather than enhancing the saccade goal location.

As we have limited processing abilities with respect to the plethora of visual information entering our brain, spatial selection mechanisms are crucial. These mechanisms result in both enhancing processing at a location of interest and in suppressing processing at other locations; together, they enable successful further processing of locations of interest. It has been suggested that saccade planning modulates these spatial selection mechanisms; however, the precise influence of saccades on the distribution of spatial resources underlying selection remains unclear. To this end, we compared discrimination performance at different locations (six) within a work space during different saccade tasks. We used visual discrimination performance as a behavioral measure of enhancement and suppression at the different locations. A total of 14 participants performed a dual discrimination/saccade countermanding task, which allowed us to specifically isolate the consequences of saccade execution. When a saccade was executed, discrimination performance at the cued location was never better than when fixation was maintained, suggesting that saccade execution did not enhance processing at a location more than knowing the likelihood of its appearance. However, discrimination was consistently lower at distractor (uncued) locations in all cases where a saccade was executed compared with when fixation was maintained. Based on these results, we suggest that saccade execution specifically suppresses distractor locations, whereas attention shifts (with or without an accompanying saccade) are involved in enhancing perceptual processing at the goal location.

Plastic modification of anti-saccades: adaptation of saccadic eye movements aimed at a virtual target.

Saccades allow us to visually explore our environment. Like other goal-directed movements, their accuracy is permanently controlled by adaptation mechanisms that, in the laboratory, can be induced by systematic displacement of the "real" visual target during the saccade. However, in an anti-saccade (AS) task, the target is "virtual" because gaze has to be shifted away from the "real" visual target toward its mentally defined mirror position. Here, we investigated whether the brain can adapt movements aimed at a virtual target by trying, for the first time, to adapt AS. Healthy human volunteers produced leftward AS during three different exposure phases in which a visual target provided feedback after the AS. In the adaptation condition, the feedback target appeared after completion of the AS response at a location shifted outward from final eye position (immediate non-veridical feedback). In the two control conditions, adaptation was prevented by delaying (800 ms) the shifted feedback target (delayed-shift) or by providing an immediate but veridical feedback at the mirror position of the visual target (no-shift). Results revealed a significant increase of AS gain only in the adaptation condition. Moreover, testing pro-saccades (PS) before and after exposure revealed a significant increase of leftward PS gain in the adaptation condition. This transfer of adaptation supports the hypotheses of a motor level of AS adaptation and of a visual level of AS vector inversion. Together with data from the literature, these results also provide new insights into adaptation and planning mechanisms for AS and for other subtypes of voluntary saccades.

Adaptation of scanning saccades co-occurs in different coordinate systems.

Plastic changes of saccades (i.e., following saccadic adaptation) do not transfer between oppositely directed saccades, except when multiple directions are trained simultaneously, suggesting a saccadic planning in retinotopic coordinates. Interestingly, a recent study in human healthy subjects revealed that after an adaptive increase of rightward-scanning saccades, both leftward and rightward double-step, memory-guided saccades, triggered toward the adapted endpoint, were modified, revealing that target location was coded in spatial coordinates (Zimmermann et al. 2011). However, as the computer screen provided a visual frame, one alternative hypothesis could be a coding in allocentric coordinates. Here, we questioned whether adaptive modifications of saccadic planning occur in multiple coordinate systems. We reproduced the paradigm of Zimmermann et al. (2011) using target light-emitting diodes in the dark, with and without a visual frame, and tested different saccades before and after adaptation. With double-step, memory-guided saccades, we reproduced the transfer of adaptation to leftward saccades with the visual frame but not without, suggesting that the coordinate system used for saccade planning, when the frame is visible, is allocentric rather than spatiotopic. With single-step, memory-guided saccades, adaptation transferred to leftward saccades, both with and without the visual frame, revealing a target localization in a coordinate system that is neither retinotopic nor allocentric. Finally, with single-step, visually guided saccades, the classical, unidirectional pattern of amplitude change was reproduced, revealing retinotopic coordinate coding. These experiments indicate that the same procedure of adaptation modifies saccadic planning in multiple coordinate systems in parallel-each of them revealed by the use of different saccade tasks in postadaptation.

Effect of juggling expertise on pointing performance in peripheral vision.

Juggling is a very complex activity requiring motor, visual and coordination skills. Expert jugglers experience a "third eye" monitoring leftward and rightward ball zenith positions alternately, in the upper visual fields, while maintaining their gaze straight-ahead. This "third eye" reduces their motor noise (improved body stability and decrease in hand movement variability) as it avoids the numerous head and eye movements that add noise into the system and make trajectories more uncertain. Neuroimaging studies have shown that learning to juggle induces white and grey matter hypertrophy at the posterior intraparietal sulcus. Damage to this brain region leads to optic ataxia, a clinical condition characterised by peripheral pointing bias toward gaze position. We predicted that expert jugglers would, conversely, present better accuracy in a peripheral pointing task. The mean pointing accuracy of expert jugglers was better for peripheral pointing within the upper visual field, compatible with their subjective experience of the "third eye". Further analyses showed that experts exhibited much less between-subject variability than beginners, reinforcing the interpretation of a vertically asymmetrical calibration of peripheral space, characteristic of juggling and homogenous in the expert group. On the contrary, individual pointing variability did not differ between groups neither globally nor in any sector of space, showing that the reduced motor noise of experts in juggling did not transfer to pointing. It is concluded that the plasticity of the posterior intraparietal sulcus related to juggling expertise does not consist of globally improved visual-to-motor ability. It rather consists of peripheral space calibration by practicing horizontal covert shifts of the attentional spotlight within the upper visual field, between left and right ball zenith positions.

Visuospatial Perception in Prematurely Born Children Without Cerebral Palsy or Retinopathy but With Scholar Complaints.

In the absence of any complaints in early childhood, preterm children remain more at risk of encountering academic difficulties, but their clinical picture remains not well characterized. We screened visuospatial perception in 70 children born preterm consulting for scholar complaints. Developmental Coordination Disorder (with or without comorbidities) was associated with high prevalence (27%) of impaired perception of spatial relationship. Prematurely born children who obtained no diagnosis of Neuro-Developmental Disorder exhibited a high prevalence (31%) of impaired perception of object magnitude. Regression revealed that low gestational age and fetal growth restriction significantly predicted the magnitude but not the spatial relationship perception.

Striking the Balance: Embracing Technology While Upholding Humanistic Principles in Neurorehabilitation.

BACKGROUND: The rapid advancement of technology-focused strategies in neurorehabilitation has brought optimism to individuals with neurological disorders, caregivers, and physicians while reshaping medical practice and training. OBJECTIVES: We critically examine the implications of technology in neurorehabilitation, drawing on discussions from the 2021 and 2024 World Congress for NeuroRehabilitation. While acknowledging the value of technology, it highlights inherent limitations and ethical concerns, particularly regarding the potential overshadowing of humanistic approaches. The integration of technologies such as robotics, artificial intelligence, neuromodulation, and brain-computer interfaces enriches neurorehabilitation by offering interdisciplinary solutions. However, ethical considerations arise regarding the balance between compensation for deficits, accessibility of technologies, and their alignment with fundamental principles of care. Additionally, the pitfalls of relying solely on neuroimaging data are discussed, stressing the necessity for a more comprehensive understanding of individual variability and clinical skills in rehabilitation. RESULTS: From a clinical perspective, the article advocates for realistic solutions that prioritize individual needs, quality of life, and social inclusion over technological allure. It underscores the importance of modesty and honesty in responding to expectations while emphasizing the uniqueness of each individual's experience. Moreover, it argues for the preservation of human-centric approaches alongside technological advancements, recognizing the invaluable role of clinical observation and human interaction in rehabilitation. CONCLUSION: Ultimately, the article calls for a balanced attitude that integrates both scientific and humanistic perspectives in neurorehabilitation. It highlights the symbiotic relationship between the sciences and humanities, advocating for philosophical questioning to guide the ethical implementation of new technologies and foster interdisciplinary dialogue.