Peripheral and bimanual reaching in a stroke survivor with left visual neglect and extinction.

Whether attentional deficits are accompanied by visuomotor impairments following posterior parietal lesions has been debated for quite some time. This single-case study investigated reaching in a stroke survivor (E.B.) with left visual neglect and visual extinction following right temporo-parietal-frontal strokes. Unlike most neglect patients, E.B. did not present left hemiparesis, homonymous hemianopia nor showed evidence of motor neglect or extinction allowing us to examine, for the first time, if lateralised attentional deficits co-occur with deficits in peripheral and bimanual reaching. First, we found a classic optic ataxia field effect: E.B.'s accuracy was impaired when reaching to peripheral targets in her neglected left visual field (regardless of the hand used). Second, we found a larger bimanual cost for movement time in E.B. than controls when both hands reached to incongruent locations. E.B.'s visuomotor profile is similar the one of patients with optic ataxia showing that attentional deficits are accompanied by visuomotor deficits in the affected field.

Is there a lower visual field advantage for object affordances? A registered report.

It's been repeatedly shown that pictures of graspable objects can facilitate visual processing, even in the absence of reach-to-grasp actions, an effect often attributed to the concept of affordances. A classic demonstration of this is the handle compatibility effect, characterised by faster reaction times when the orientation of a graspable object's handle is compatible with the hand used to respond, even when the handle orientation is task-irrelevant. Nevertheless, it is debated whether the speeded reaction times are a result of affordances or spatial compatibility. First, we investigated whether we could replicate the handle compatibility effect while controlling for spatial compatibility. Participants (N = 68) responded with left or right-handed keypresses to whether the object was upright or inverted and, in separate blocks, whether the object was red or green. We failed to replicate the handle compatibility effect, with no significant difference between compatible and incompatible conditions, in both tasks. Second, we investigated whether there is a lower visual field (VF) advantage for the handle compatibility effect in line with what has been found for hand actions. A further 68 participants responded to object orientation presented either in the upper or lower VF. A significant handle compatibility effect was observed in the lower VF, but not the upper VF. This suggests that there is a lower VF advantage for affordances, possibly as the lower VF is where our actions most frequently occur. However, future studies should explore the impact of eye movements on the handle compatibility effect and tool affordances.

Aging effects on extrapersonal (far-space) attention: cancellation and line bisection performance from 179 healthy adults.

Assessment of cognitive impairments is a vital part of clinical practice. Cancellation (visual search) and line bisection are commonly used tasks to assess visuospatial attention. Despite the fact visuospatial attention is engaged in both near (within reach) and far-space (out of reach), most studies have been conducted in near-space alone. Moreover, despite their use in clinical practice, it is unclear whether cancellation and bisection tasks are related. Here, we investigated the impact of aging on cancellation and line bisection performance in far-space in a large healthy sample. We provide preliminary age-graded norms for assessing visuospatial attention in far-space calculated from a sample of 179 healthy adults, between the ages of 18-94 (mean age = 49.29). Cancellation and line bisection were presented on a large screen in far-space and completed using a wireless remote. Aging was accompanied by longer task duration for both tasks, slower search speed and poorer quality of search. However, there was no significant effect of aging on line bisection error. There was a significant correlation between the two tasks in that longer task duration in line bisection was associated with slower search speed and poorer quality of search. Overall, participants presented a leftward bias during cancellation and line bisection akin to pseudoneglect. Moreover, we found that irrespective of age, search speed was faster in males than females. We offer novel evidence that performance on cancellation and line bisection tasks are related to one another in far-space, but are also sensitive to age-related decline, and even sex differences.

The role of the anterior temporal cortex in action: evidence from fMRI multivariate searchlight analysis during real object grasping.

Intelligent manipulation of handheld tools marks a major discontinuity between humans and our closest ancestors. Here we identified neural representations about how tools are typically manipulated within left anterior temporal cortex, by shifting a searchlight classifier through whole-brain real action fMRI data when participants grasped 3D-printed tools in ways considered typical for use (i.e., by their handle). These neural representations were automatically evocated as task performance did not require semantic processing. In fact, findings from a behavioural motion-capture experiment confirmed that actions with tools (relative to non-tool) incurred additional processing costs, as would be suspected if semantic areas are being automatically engaged. These results substantiate theories of semantic cognition that claim the anterior temporal cortex combines sensorimotor and semantic content for advanced behaviours like tool manipulation.

Peripheral reaching in Alzheimer's disease and mild cognitive impairment.

Recent evidence has implicated areas within the posterior parietal cortex (PPC) as among the first to show pathophysiological changes in Alzheimer's disease (AD). Focal brain damage to the PPC can cause optic ataxia, a specific deficit in reaching to peripheral targets. The present study describes a novel investigation of peripheral reaching ability in AD and mild cognitive impairment (MCI), to assess whether this deficit is common among these patient groups. Individuals with a diagnosis of mild-to-moderate AD, or MCI, and healthy older adult controls were required to reach to targets presented in central vision or in peripheral vision using two reaching tasks; one in the lateral plane and another presented in radial depth. Pre-registered case-control comparisons identified 1/10 MCI and 3/17 AD patients with significant peripheral reaching deficits at the individual level, but group-level comparisons did not find significantly higher peripheral reaching error in either AD or MCI by comparison to controls. Exploratory analyses showed significantly increased reach duration in both AD and MCI groups relative to controls, accounted for by an extended Deceleration Time of the reach movement. These findings suggest that peripheral reaching deficits like those observed in optic ataxia are not a common feature of AD. However, we show that cognitive decline is associated with a generalised slowing of movement which may indicate a visuomotor deficit in reach planning or online guidance.

Reforms to improve reproducibility and quality must be coordinated across the research ecosystem: the view from the UKRN Local Network Leads.

Many disciplines are facing a "reproducibility crisis", which has precipitated much discussion about how to improve research integrity, reproducibility, and transparency. A unified effort across all sectors, levels, and stages of the research ecosystem is needed to coordinate goals and reforms that focus on open and transparent research practices. Promoting a more positive incentive culture for all ecosystem members is also paramount. In this commentary, we-the Local Network Leads of the UK Reproducibility Network-outline our response to the UK House of Commons Science and Technology Committee's inquiry on research integrity and reproducibility. We argue that coordinated change is needed to create (1) a positive research culture, (2) a unified stance on improving research quality, (3) common foundations for open and transparent research practice, and (4) the routinisation of this practice. For each of these areas, we outline the roles that individuals, institutions, funders, publishers, and Government can play in shaping the research ecosystem. Working together, these constituent members must also partner with sectoral and coordinating organisations to produce effective and long-lasting reforms that are fit-for-purpose and future-proof. These efforts will strengthen research quality and create research capable of generating far-reaching applications with a sustained impact on society.

Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke.

Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable therapies and remotely monitor adherence without the presence of a therapist at all times. Researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and, ultimately, optimize adherence and efficacy. This study aims to explore end-user perspectives on the use of self-administered VR for spatial neglect in a university environment to identify barriers and facilitators prior to extending its use remotely as a telerehabilitation tool. We used a mixed-method design including focus groups, self-administered questionnaires and interviews with stroke survivors (N = 7), their carers (N = 3) and stroke clinicians (N = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators were performance feedback, engagement and enjoyment, and psychological benefits associated with self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform development, enhance engagement and uptake of VR telerehabilitation and inform future studies.

Editorial for special issue on neglect rehabilitation.

It is clear already that in current and future years more people will suffer from stroke, whether related to COVID-19 or not, and given its prevalence, many more people's lives will be affected by neglect. Here we hope to have contributed to its possible amelioration with highlights of the latest thinking on neglect diagnosis, prevalence and treatment.

Hand-Selective Visual Regions Represent How to Grasp 3D Tools: Brain Decoding during Real Actions.

Most neuroimaging experiments that investigate how tools and their actions are represented in the brain use visual paradigms where tools or hands are displayed as 2D images and no real movements are performed. These studies discovered selective visual responses in occipitotemporal and parietal cortices for viewing pictures of hands or tools, which are assumed to reflect action processing, but this has rarely been directly investigated. Here, we examined the responses of independently visually defined category-selective brain areas when participants grasped 3D tools (N = 20; 9 females). Using real-action fMRI and multivoxel pattern analysis, we found that grasp typicality representations (i.e., whether a tool is grasped appropriately for use) were decodable from hand-selective areas in occipitotemporal and parietal cortices, but not from tool-, object-, or body-selective areas, even if partially overlapping. Importantly, these effects were exclusive for actions with tools, but not for biomechanically matched actions with control nontools. In addition, grasp typicality decoding was significantly higher in hand than tool-selective parietal regions. Notably, grasp typicality representations were automatically evoked even when there was no requirement for tool use and participants were naive to object category (tool vs nontools). Finding a specificity for typical tool grasping in hand-selective, rather than tool-selective, regions challenges the long-standing assumption that activation for viewing tool images reflects sensorimotor processing linked to tool manipulation. Instead, our results show that typicality representations for tool grasping are automatically evoked in visual regions specialized for representing the human hand, the primary tool of the brain for interacting with the world.

Assessment of visually guided reaching in prodromal Alzheimer's disease: a cross-sectional study protocol.

INTRODUCTION: Recent evidence has implicated the precuneus of the medial parietal lobe as one of the first brain areas to show pathological changes in Alzheimer's disease (AD). Damage to the precuneus through focal brain injury is associated with impaired visually guided reaching, particularly for objects in peripheral vision. This raises the hypothesis that peripheral misreaching may be detectable in patients with prodromal AD. The aim of this study is to assess the frequency and severity of peripheral misreaching in patients with mild cognitive impairment (MCI) and AD. METHODS AND ANALYSIS: Patients presenting with amnestic MCI, mild-to-moderate AD and healthy older-adult controls will be tested (target N=24 per group). Peripheral misreaching will be assessed using two set-ups: a tablet-based task of lateral reaching and motion-tracked radial reaching (in depth). There are two versions of each task, one where participants can look directly at targets (free reaching), another wheren they must maintain central fixation (peripheral reaching). All tasks will be conducted first on their dominant, and then their non-dominant side. For each combination of task and side, a Peripheral Misreaching Index (PMI) will be calculated as the increase in absolute reaching error between free and peripheral reaching. Each patient will be classified as showing peripheral misreaching if their PMI is significantly abnormal, by comparison to control performance, on either side of space. We will then test whether the frequency of peripheral misreaching exceeds the chance level in each patient group and compare the overall severity of misreaching between groups. ETHICS AND DISSEMINATION: Ethical approval was provided by the National Health Service (NHS) East of England, Cambridge Central Research Ethics Committee (REC 19/EE/0170). The results of this study will be published in a peer-reviewed journal and presented at academic conferences.

Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect.

Hemispatial neglect is a severe cognitive condition frequently observed after a stroke, associated with unawareness of one side of space, disability and poor long-term outcome. Visuomotor feedback training (VFT) is a neglect rehabilitation technique that involves a simple, inexpensive and feasible training of grasping-to-lift rods at the centre. We compared the immediate and long-term effects of VFT vs. a control training when delivered in a home-based setting. Twenty participants were randomly allocated to an intervention (who received VFT) or a control group (n = 10 each). Training was delivered for two sessions by an experimenter and then patients self-administered it for 10 sessions over two weeks. Outcome measures included the Behavioural Inattention Test (BIT), line bisection, Balloons Test, Landmark task, room description task, subjective straight-ahead pointing task and the Stroke Impact Scale. The measures were obtained before, immediately after the training sessions and after four-months post-training. Significantly greater short and long-term improvements were obtained after VFT when compared to control training in line bisection, BIT and spatial bias in cancellation. VFT also produced improvements on activities of daily living. We conclude that VFT is a feasible, effective, home-based rehabilitation method for neglect patients that warrants further investigation with well-designed randomised controlled trials on a large sample of patients.

No Vertical Visual Field Asymmetry in Online Control: Evidence from Reaching in Depth.

We sought to determine whether a putative lower-visual field (loVF) advantage for projections to the visuomotor networks of the dorsal visual pathway influences online reaching control. Participants reached to 3-dimensional depth targets presented in the loVF and upper-visual field (upVF) in binocular and monocular visual conditions, and when online vision was available (i.e., closed-loop) or unavailable (i.e., open-loop). To examine the degree to which responses were controlled online we computed the proportion of variance (R2) explained by the spatial position of the limb at distinct stages in the reaching trajectory relative to a response's ultimate movement endpoint. Results showed that binocular and closed-loop reaches exhibited shorter movement times and more online corrections (i.e., smaller R2 values) than their monocular and open-loop counterparts. Notably, however, loVF and upper-visual field reaches exhibited equivalent performance metrics across all experimental conditions. Accordingly, results provide no evidence of a loVF advantage for online reaching control to 3-dimensional targets.

Identifying and detecting facial expressions of emotion in peripheral vision.

Facial expressions of emotion are signals of high biological value. Whilst recognition of facial expressions has been much studied in central vision, the ability to perceive these signals in peripheral vision has only seen limited research to date, despite the potential adaptive advantages of such perception. In the present experiment, we investigate facial expression recognition and detection performance for each of the basic emotions (plus neutral) at up to 30 degrees of eccentricity. We demonstrate, as expected, a decrease in recognition and detection performance with increasing eccentricity, with happiness and surprised being the best recognized expressions in peripheral vision. In detection however, while happiness and surprised are still well detected, fear is also a well detected expression. We show that fear is a better detected than recognized expression. Our results demonstrate that task constraints shape the perception of expression in peripheral vision and provide novel evidence that detection and recognition rely on partially separate underlying mechanisms, with the latter more dependent on the higher spatial frequency content of the face stimulus.

Impaired peripheral reaching and on-line corrections in patient DF: Optic ataxia with visual form agnosia.

An influential model of vision suggests the presence of two visual streams within the brain: a dorsal occipito-parietal stream which mediates action and a ventral occipito-temporal stream which mediates perception. One of the cornerstones of this model is DF, a patient with visual form agnosia following bilateral ventral stream lesions. Despite her inability to identify and distinguish visual stimuli, DF can still use visual information to control her hand actions towards these stimuli. These observations have been widely interpreted as demonstrating a double dissociation from optic ataxia, a condition observed after bilateral dorsal stream damage in which patients are unable to act towards objects that they can recognize. In Experiment 1, we investigated how patient DF performed on the classical diagnostic task for optic ataxia, reaching in central and peripheral vision. We replicated recent findings that DF is remarkably inaccurate when reaching to peripheral targets, but not when reaching in free vision. In addition we present new evidence that her peripheral reaching errors follow the optic ataxia pattern increasing with target eccentricity and being biased towards fixation. In Experiments 2 and 3, for the first time we examined DF's on-line control of reaching using a double-step paradigm in fixation-controlled and free-vision versions of the task. DF was impaired when performing fast on-line corrections on all conditions tested, similarly to optic ataxia patients. Our findings question the long-standing assumption that DF's dorsal visual stream is functionally intact and that her on-line visuomotor control is spared. In contrast, in addition to visual form agnosia, DF also has visuomotor symptoms of optic ataxia which are most likely explained by bilateral damage to the superior parietal-occipital cortex (SPOC). We thus conclude that patient DF can no longer be considered as an appropriate single-case model for testing the neural basis of perception and action dissociations.

A selective impairment of perception of sound motion direction in peripheral space: A case study.

It is still an open question if the auditory system, similar to the visual system, processes auditory motion independently from other aspects of spatial hearing, such as static location. Here, we report psychophysical data from a patient (female, 42 and 44 years old at the time of two testing sessions), who suffered a bilateral occipital infarction over 12 years earlier, and who has extensive damage in the occipital lobe bilaterally, extending into inferior posterior temporal cortex bilaterally and into right parietal cortex. We measured the patient's spatial hearing ability to discriminate static location, detect motion and perceive motion direction in both central (straight ahead), and right and left peripheral auditory space (50° to the left and right of straight ahead). Compared to control subjects, the patient was impaired in her perception of direction of auditory motion in peripheral auditory space, and the deficit was more pronounced on the right side. However, there was no impairment in her perception of the direction of auditory motion in central space. Furthermore, detection of motion and discrimination of static location were normal in both central and peripheral space. The patient also performed normally in a wide battery of non-spatial audiological tests. Our data are consistent with previous neuropsychological and neuroimaging results that link posterior temporal cortex and parietal cortex with the processing of auditory motion. Most importantly, however, our data break new ground by suggesting a division of auditory motion processing in terms of speed and direction and in terms of central and peripheral space.

A Thalamocortical Mechanism for the Absence of Overt Motor Behavior in Covertly Aware Patients.

IMPORTANCE: It is well accepted that a significant number of patients in a vegetative state are covertly aware and capable of following commands by modulating their neural responses in motor imagery tasks despite remaining nonresponsive behaviorally. To date, there have been few attempts to explain this dissociation between preserved covert motor behavior and absent overt motor behavior. OBJECTIVES: To investigate the differential neural substrates of overt and covert motor behavior and assess the structural integrity of the underlying networks in behaviorally nonresponsive patients. DESIGN, SETTING, AND PARTICIPANTS: A case-control study was conducted at an academic center between February 7, 2012, and November 6, 2014. Data analysis was performed between March 2014 and June 2015. Participants included a convenience sample of 2 patients with severe brain injury: a paradigmatic patient who fulfilled all clinical criteria for the vegetative state but produced repeated evidence of covert awareness (patient 1) and, as a control case, a patient with similar clinical variables but capable of behavioral command following (patient 2). Fifteen volunteers participated in the study as a healthy control group. MAIN OUTCOMES AND MEASURES: We used dynamic causal modeling of functional magnetic resonance imaging to compare voluntary motor imagery and motor execution. We then used fiber tractography to assess the structural integrity of the fibers that our functional magnetic resonance imaging study revealed as essential for successful motor execution. RESULTS: The functional magnetic resonance imaging study revealed that, in contrast to mental imagery, motor execution was associated with an excitatory coupling between the thalamus and primary motor cortex (Bayesian model selection; winning model Bayes factors >17). Moreover, we detected a selective structural disruption in the fibers connecting these 2 regions in patient 1 (fractional anisotropy, 0.294; P = .047) but not in patient 2 (fractional anisotropy, 0.413; P = .35). CONCLUSIONS AND RELEVANCE: These results suggest a possible biomarker for the absence of intentional movement in covertly aware patients (ie, specific damage to motor thalamocortical fibers), highlight the importance of the thalamus for the execution of intentional movements, and may provide a target for restorative therapies in behaviorally nonresponsive patients.

fMRI reveals a lower visual field preference for hand actions in human superior parieto-occipital cortex (SPOC) and precuneus.

Humans are more efficient when performing actions towards objects presented in the lower visual field (VF) than in the upper VF. The present study used slow event-related functional magnetic resonance imaging (fMRI) to examine whether human brain areas implicated in action would show such VF preferences. Participants were asked to fixate one of four different positions allowing objects to be presented in the upper left, upper right, lower left or lower right VF. In some trials they reached to grasp the object with the right hand while in others they passively viewed the object. Crucially, by manipulating the fixation position, rather than the position of the objects, the biomechanics of the movements did not differ across conditions. The superior parieto-occipital cortex (SPOC) and the left precuneus, brain areas implicated in the control of reaching, were significantly more activated when participants grasped objects presented in the lower VF relative to the upper VF. Importantly, no such VF preferences were observed in these regions during passive viewing. This finding fits well with evidence from the macaque neurophysiology that neurons within visuomotor regions over-represent the lower VF relative to the upper VF and indicate that the neural responses within these regions may reflect a functional lower VF advantage during visually-guided actions.

Visuospatial neglect in action.

It is well established that patients with hemispatial neglect present with severe visuospatial impairments, but studies that have investigated visuomotor control directly have revealed diverging results, with some investigations finding impairments mirroring the perceptual difficulties of these patients, while others have shown that such neglect patients perform relatively better in action tasks. In this review we attempt to reconcile these diverging findings, addressing differences in the type of visuomotor tasks studied but also highlighting the diverging neuroanatomy that seems to be driving the differences in performance. We argue that there are different types of actions and that these in turn depend on different cortical networks (Goodale, Westwood, & Milner, 2004; Milner & Goodale, 2006). Patients with visuospatial neglect, in contrast to patients with optic ataxia, are relatively unimpaired at performing target-directed tasks even towards stimuli located in their 'neglected' field. We relate these findings to the view that for the on-line guidance of action, spatial information is coded in egocentric coordinates and depends on the visuomotor networks of the visual dorsal stream. Furthermore, based on recent lesion-symptom mapping studies, we postulate that deficits in on-line actions that are observed after right-brain damage are associated with damage to the visuomotor control network, in particular with damage to the basal ganglia, frontal and parieto-occipital regions. On the other hand, clear neglect-specific deficits emerge when the action is off-line and not directly target-driven, thus requiring relational metrics or scene-based coordinates (as is the case for example in delayed and mirrored (anti-pointing) reaches). We review recent studies that support our argument that such deficits in off-line actions are associated with damage to occipito-temporal and parahippocampal cortex, perhaps as part of the ventral visual stream or areas where information from the two visual streams is combined.

Attention in action: evidence from on-line corrections in left visual neglect.

It is widely accepted that the posterior parietal cortex is critical for the on-line control of action and optic ataxia patients are unable to correct their movements in-flight to changes in target position. The current study investigated on-line correction in patients with left visual neglect, right brain damaged patients without neglect and healthy controls. Participants were asked to reach towards a central target that could jump unexpectedly, at movement onset, to the right or left sides of space. In response to the jump, participants were asked either to follow the target or to stop their movement. Neglect patients were able to correct their ongoing movements smoothly and accurately towards right and left target jumps. They did so even when told to stop their movement, indicating that these corrections occurred automatically (i.e., without instruction). However, the timing of corrections to the left was delayed in neglect patients and this produced a drastic increase in movement time. To our surprise, we also found that neglect patients were impaired at stopping their ongoing reaches, when compared to the control groups, in response to either left or right jump trials. We suggest that the 'automatic pilot' system for the hand is spared in neglect, but its processing speed is unilaterally slowed due to a deficit in orienting of attention to the contralesional side. We relate these findings to the breakdown of a system that combines information for attention, perception and action. Damage to this system may not only slow corrective movements to the contralesional side, but also produce non-lateralized deficits in interrupting an ongoing reach.

Impaired delayed but preserved immediate grasping in a neglect patient with parieto-occipital lesions.

Patients with optic ataxia, a deficit in visually guided action, paradoxically improve when pantomiming an action towards memorized stimuli. Visual form agnosic patient D.F. shows the exact opposite pattern of results: although being able to grasp objects in real-time she loses grip scaling when grasping an object from memory. Here we explored the dissociation between immediate and delayed grasping in a patient (F.S.) who after a parietal-occipital stroke presented with severe left visual neglect, a loss of awareness of the contralesional side of space. Although F.S. had preserved grip scaling even in his neglected field, he was markedly impaired when asked to pretend to grasp a leftward object from memory. Critically, his deficit cannot be simply explained by the absence of continuous on-line visual feedback, as F.S. was also able to grasp leftward objects in real-time when vision was removed. We suggest that regions surrounding the parietal-occipital sulcus, typically damaged in patients with optic ataxia but spared in F.S., seem to be essential for real-time actions. On the other hand, our data indicates that regions in the ventral visual stream, damaged in D.F but intact in F.S., would appear to be necessary but not sufficient for memory-guided action.