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International audience; Recent years have been marked by the fulgurant expansion of non-invasive Brain-Computer Interface (BCI) devices and applications in various contexts (medical, industrial etc.). This technology allows agents “to directly act with thoughts,” bypassing the peripheral motor system. Interestingly, it is worth noting that typical non-invasive BCI paradigms remain distant from neuroscientific models of human voluntary action. Notably, bidirectional links between action and perception are constantly ignored in BCI experiments. In the current perspective article, we proposed an innovative BCI paradigm that is directly inspired by the ideomotor principle, which postulates that voluntary actions are driven by the anticipated representation of forthcoming perceptual effects. We believe that (1) adapting BCI paradigms could allow simple action-effect bindings and consequently action-effect predictions and (2) using neural underpinnings of those action-effect predictions as features of interest in AI methods, could lead to more accurate and naturalistic BCI-mediated actions.

Aims Patients with homonymous hemianopia may present a subtle ipsilesional deficit, recently referred to as ‘sightblindness’ in addition to the contralesional visual field defect. We recently demonstrated that this deficit could be worse in right brain-damaged patients with left hemianopia than in left brain-damaged patients with right hemianopia, confirming right hemisphere dominance for visuo-spatial and attentional capacities. In the present study we investigate whether this ipsilesional deficit could be attentional in nature and to what extent it is comparable in right brain-damaged (RBD) patients with left hemianopia and in RBD patients with left neglect. The study was also conducted in RBD patients with neither left hemianopia nor left neglect signs in order to test if a right hemisphere lesion per se could be responsible for subtle ipsilesional attentional deficit. To reach this aim, we tested selective attentional capacities in both visual fields of 10 right brain-damaged patients with left neglect (LN), 8 right brain-damaged patients with left homonymous hemianopia (LHH), 8 right brain-damaged patients with no signs of left neglect or left hemianopia (RBD controls), and 17 healthy age-matched participants (Normal controls). Method A lateralized letter-detection task was used to test if right-brain damaged patients with LN or LH may present a deficit of selective attention in their right, ipsilesional visual field, in comparison to Normal and RBD controls. Participants were asked to detect a target letter in either a single large stimulus (low attentional load) or a small stimulus surrounded by flankers (high attentional load). Stimuli were displayed either in the left or in the right visual field. Accuracy and reaction times were recorded. Results Results on accuracy showed that both LN and LH patients exhibited lower correct responses than Normal controls in their ipsilesional right visual field, suggesting an attentional deficit in their ipsilesional, supposed healthy visual field. More specifically, LH patients exhibited a specific deficit for processing single large stimuli, but not for processing flanked stimuli, relative to normal controls. LN patients exhibited lower correct responses for processing all types of stimulus than normal controls, but also than right brain damaged controls, in both visual fields suggesting a non-lateralized deficit not only due to the right hemisphere lesion. Furthermore, this deficit is more pronounced for flanked small stimuli, requiring higher attentional load. Conclusions The present results bring further evidence that patients with left homonymous hemianopia or left unilateral neglect both present a weaker but significant ipsilesional deficit in addition to their well-known massive contralesional deficit. The presence of a specific attentional deficit in the right ipsilesional visual field of left hemianopic and left neglect patients is discussed regarding the hypothesis of hemispheric specialization for selective spatial attention and may have clinical implications for both conditions.

The most common visual defect to follow a lesion of the retrochiasmal pathways is homonymous hemianopia (HH), whereby patients are blind to the contralesional visual field of each eye. Homonymous hemianopia has been studied in terms of its deleterious consequences on perceptual, cognitive and motor tasks as well as because it represents an interesting model of vision loss after a unilateral lesion of the occipital lobe. From a behavioral perspective, in addition to exhibiting a severe deficit in their contralesional visual field, HH patients can also exhibit dissociations between perception and awareness. Firstly, HH patients suffering from anosognosia may be unaware of their visual field defect. Secondly, HH patients can present with unconscious visual abilities in the blind hemifield, a phenomenon referred to as blindsight. Thirdly, recent reports demonstrate that HH patients can suffer from a subtle deficit in their ipsilesional visual field that they are unaware of, a condition called sightblindness (i.e. the reverse case of 'blindsight'). Finally, HH patients may also exhibit visual hallucinations in their blind field; however, such patients are not systematically aware that their perceptions are unreal. In this review, we provide an overview of the visual-field losses in HH patients after a left or right unilateral occipital lesion. Furthermore, we explore the implications of these four phenomena for models of visual processing and rehabilitation of visual field defects in HH patients. Finally, in contrast to the traditional view that HH is solely a visual-field defect, we discuss why this deficit is an interesting model for studying the dissociation between perception and awareness.

ObjectivesHomonymous hemianopia (HH) is the most frequent visual-field defect after a stroke. Some of these patients also have visual hallucinations, the origin and frequency of which remain largely unknown. The aims of this work were to determine the occurrence of visual hallucinations among poststroke hemianopic patients in function of the location (Brodmann areas) of the brain lesion, as determined by MRI, and to study the neuroanatomic correlates of these hallucinations by nature, frequency, and type.MethodsOne hundred sixteen patients with HH who had had a stroke in the posterior region, including the occipital lobe, participated in the study. We evaluated the frequency and nature of visual hallucinations with the Questionnaire for Hallucinations in Homonymous Hemianopia. The volume of each patient's brain lesion was modeled in 3 dimensions.ResultsOf 116 patients with an HH from a cortical infarction, 85 were excluded due to confounding factors associated with hallucinations. In the final cohort of 31 patients matched for lesion location and etiology, 58% had experienced hallucinations. A significant inverse correlation between lesion size and the frequency of visual hallucinations emerged. The presence of visual hallucinations in poststroke hemianopic patients requires a relatively small lesion that includes, at the very least, loss of the striate cortex but that spares Brodmann area 19, 20, and 37.ConclusionOur results suggest that visual hallucinations might be due to complex interactions between damaged areas and intact areas of the visual cortex. We discuss these findings regarding models of perception and of visual recognition. Our results also have implications for the clinical care of patients with HH who have had a stroke.

We recently published the results of a study on the occurrence of blindsight among eight, post-stroke homonymous hemianopic (HH) patients (Garric et al., 2019), in whom we measured blindsight through forced-choice tasks and assessed perceptual experiences by a new awareness scale, the Sensation Awareness Scale (SAS). Within the cohort, we found different profiles of dissociation between objective and subjective performance. Importantly, we were able to describe several cases of a dissociation phenomenon that we named blindsense, whereby patients exhibited marked subjective sensitivity in their blind hemifield despite being unable to discriminate the different stimuli. Following publication of our article (Garric et al., 2019), Prof. Ian Phillips (Phillips, 2019) wrote a Commentary in which he questioned the methodology we used to measure and analyze objective and subjective perception in our HH patients. As opposed to our original interpretation of our results to describe the new profile of blindsense, based on a non-visual experience hypothesis (Kentridge, 2015), Prof. Phillips re-evaluated the different blindsight profiles that we identified in our study through the lens of a degraded conscious vision hypothesis (Overgaard, Fehl, Mouridsen, Bergholt, & Cleeremans, 2008). In the present response, we explain that, although we agree that dichotomous visual scales lead to highly conservative responses and mask conscious perceptual experience of patients, we still support the notion that nuanced report protocols can enable more-sensitive measurements of perceptual experiences in the hemianopic, so-called blind visual field. Furthermore, we affirm that the additional awareness-scale phenomenal levels that such protocols enable are more consistent with patients' experiences and lead patients to provide more liberal responses when describing their subjective perceptions.

International audience; Cerebral (cortical) visual impairment (CVI) is the primary cause of visual impairment in children in high-income countries. It is increasing globally due to improved life-saving measures for premature and full-term infants. Yet the consequences of this condition are only beginning to be understood and addressed. In contrast to visual impairment due to refractive error and disorders of the eye, there is limited public awareness of CVI, and the consequent impairment of a variety of visual capabilities may go unidentified, adversely affecting cognitive, motor, and social development. CVI refers to visual perception deficits not related to the peripheral (i.e., prechiasmatic) system disorder, but rather, to injury to brain areas serving assimilation, integration, and interpretation of visual information. According to the topography, site, and the extent of the pathology, the deficit may variably concern central visual functions, the visual field, perception of movement, visual analysis, visual exploration and attention, or visual memory, as well as visual guidance of movement. Each affected child has a unique clinical picture, which needs to be identified and individually profiled. This is probably the underlying reason that CVI is commonly underdiagnosed, especially in children, and, as a consequence, the full range of potential behavioral outcomes are not identified and adequately addressed. The present paper shows how the use of multiple methods of assessment can improve the understanding of children with CVI.

International audience; A review of the concepts of self-consciousness is presented, highlighting the important role of the body (particularly, body perception but also body action) and the social other in the construction of self-consciousness. More precisely, body perception, especially intermodal sensory perception including kinesthetic perception, is involved in the construction of a sense of self allowing self-nonself differentiation. Furthermore, the social other, through very early social and emotional interactions, provides meaning to the infant's perception and contributes to the development of his/her symbolization capacities. This is a necessary condition for body image representation and awareness of a permanent self in a time-space continuum (invariant over time and space). Self-image recognition impairments in the mirror are also discussed regarding a comprehensive developmental theory of self-consciousness. Then, a neuropsychological and neurophysiological approach to self-consciousness reviews the role of complex brain activation/integration pathways and the mirror neuron system in self-consciousness. Finally, this article offers new perspectives on self-consciousness evaluation using the mirror as an experimental paradigm to study self-and other-image and body recognition.

After a post-chiasmatic lesion, some patients may retain unconscious visual function, known as blindsight, in their contralesional visual field. Despite the importance of blindsight in the study of consciousness, little is known about the nature of patients' experience in their hemianopic field. To address this knowledge gap, we measured blindsight, and assessed the perceptual experience in the contralesional visual field, of seventeen homonymous hemianopic (HH) patients. To ensure that the stimuli were shown in a "blind" sector of the visual field, we selected a subgroup of eight complete-HH patients, as determined by automatic perimetry. Firstly, we measured blindsight through a forced-choice task in which the patients had to identify letters displayed on a screen. Secondly, we compared the patients' binary responses ("Something was presented" vs "Nothing was presented") to responses on a new, five-level scale, the Sensation Awareness Scale (SAS), which we designed to include visual as well as non-visual answers (e.g., "I felt something"). Interestingly, only one of the eight complete-HH patients met the criteria for blindsight. More importantly, our SAS enabled us to identify a previously unreported dissociation, which we have named blindsense, in four of the eight complete-HH patients. Specifically, these four patients exhibited better-than-chance sensitivity to the presence of a stimulus on the subjective scale, despite being unable to identify the stimulus during the forced-choice task. Our findings highlight the importance of awareness-assessment methods to investigate perceptual experiences in the contralesional visual field and suggest a low incidence of blindsight in post-stroke HH patients.

In age-related macular degeneration (AMD), the processing of fine details in a visual scene, based on a high spatial frequency processing, is impaired, while the processing of global shapes, based on a low spatial frequency processing, is relatively well preserved. The present fMRI study aimed to investigate the residual abilities and functional brain changes of spatial frequency processing in visual scenes in AMD patients. AMD patients and normally sighted elderly participants performed a categorization task using large black and white photographs of scenes (indoors vs. outdoors) filtered in low and high spatial frequencies, and nonfiltered. The study also explored the effect of luminance contrast on the processing of high spatial frequencies. The contrast across scenes was either unmodified or equalized using a root-mean-square contrast normalization in order to increase contrast in high-pass filtered scenes. Performance was lower for high-pass filtered scenes than for low-pass and nonfiltered scenes, for both AMD patients and controls. The deficit for processing high spatial frequencies was more pronounced in AMD patients than in controls and was associated with lower activity for patients than controls not only in the occipital areas dedicated to central and peripheral visual fields but also in a distant cerebral region specialized for scene perception, the parahippocampal place area. Increasing the contrast improved the processing of high spatial frequency content and spurred activation of the occipital cortex for AMD patients. These findings may lead to new perspectives for rehabilitation procedures for AMD patients.

L’hemianopsie laterale homonyme (HLH) est une amputation du meme hemichamp visuel, pour chacun des deux yeux, a la suite d’une atteinte retro-chiasmatique. La perte de champ visuel est controlaterale a la lesion (c’est-a-dire qu’une lesion droite engendre une amputation des deux hemichamps visuels gauches : HLHg et inversement). Une HLH bilaterale realise une cecite centrale ou cecite corticale. L’HLH est le trouble visuel le plus frequent a la suite d’une atteinte cerebrale. L’etiologie la plus frequente est l’accident vasculaire cerebral. Elle est souvent associee a des difficultes de lecture, de reperage dans l’espace, d’exploration visuo-spatiale, d’acces a l’information dans sa globalite et a l’impossibilite de conduire une automobile. Il existe, cependant, des capacites visuelles non conscientes au sein du champ visuel dit « aveugle ». Ces capacites, decrites des le debut du xxe siecle, ont ete appelees par Weiskrantz en 1974 blindsight et leur correlat neuro-anatomique reste discute a l’heure actuelle. De plus, il n’est pas rare que les patients atteints d’une amputation du champ visuel d’origine centrale presentent dans leur champ visuel aveugle des hallucinations visuelles dont les mecanismes physiopathologiques restent meconnus. Enfin, nous avons pu mettre en evidence l’incidence de la lateralisation d’une lesion occipitale sur le traitement visuel en champ central des patients hemianopsiques a la fois d’un point de vue comportemental mais egalement a l’aide de l’IRMf. Ces recherches rejoignent le concept recent de sightblind, c’est-a-dire l’existence d’un trouble visuel dans le champ visuel voyant des patients hemianopsiques. De par la diversite des troubles neurovisuels observes chez les patients hemianopsiques, ce trouble constitue un modele pathologique de choix pour etudier le role complexe du cortex visuel primaire dans la vision. Il ne fait aucun doute que l’ensemble de ces recherches, comme nous le discutons ici, aura des repercussions importantes egalement sur le plan clinique.

The aim of the present study is to investigate how quite specific sensory inputs (visual inputs from central or peripheral regions of the retina and haptic inputs) relate to complex cognitive performance. We compare individuals with severe peripheral visual field loss, Braille reader with central scotomata (SDB group), print readers with central scotomata, and normally sighted people on visual reading and spatial imagery tasks. Experiment 1 showed that the SDB subjects were significantly less accurate than the other groups on reading visual print letters, words, digits, and 4-digit numbers aloud. In experiment 2, SDB subjects also performed worse than the other subjects on imagery tasks that required indicating spatial characteristics of orally presented print letters, rotated capital letters, print words, and number shapes. Experiment 3 revealed that the SDB group improved their performance when instructed to draw the outlines of imagined stimuli shapes haptically. The findings suggest that visual memory needs perceptual practice to be maintained and that haptic inputs can be used to improve verbal and spatial imagery skills in visually impaired individuals.

La cecite corticale est une perte de sensation visuelle liee a des lesions atteignant les voies optiques en arriere du corps genouille lateral et plus particulierement les cortex visuels primaires. Les connaissances sur le fonctionnement visuel ont connu une progression considerable ces 20 dernieres annees, en partie grâce a l’amelioration des techniques d’investigation mais surtout grâce a la convergence des donnees provenant des differentes approches : psychophysique, psychologie cognitive, neurophysiologie et neuropsychologie. Cet enrichissement mutuel induit une meilleure comprehension des troubles neurovisuels complexes tels que la cecite corticale chez l’enfant et chez l’adulte, permet de mettre au point de nouvelles techniques de reeducation et d’en suivre la recuperation grâce aux progres de l’imagerie cerebrale fonctionnelle. En parallele, l’etude de ces troubles et la facon dont les processus visuels se desorganisent a la suite d’une lesion occipitale nous informent sur les processus cognitifs impliques dans la perception visuelle a l’etat normal.

International audience; Age-related macular degeneration (AMD) is characterized by a central vision loss. Here, we investigated the ability of AMD patients to process the spatial frequency content of scenes in their residual vision, depending of the luminance contrast level. AMD patients and normally-sighted elderly participants (controls) performed a categorization task involving large scenes (outdoors vs. indoors) filtered in low spatial frequencies (LSF), high spatial frequencies (HSF), and non-filtered scenes (NF). Luminance contrast of scenes was equalized between stimuli using a root-mean square (RMS) contrast normalization. In Experiment 1, we applied an RMS contrast of 0.1 (for luminance values between 0 and 1), a value situated between the mean contrast of LSF and HSF scenes in natural conditions. In Experiment 2, we applied an RMS contrast of 0.3, corresponding to the mean contrast of HSF scenes in natural conditions. In Experiment 3, we manipulated four levels of linearly-increasing RMS contrasts (0.05, 0.10, 0.15, and 0.20) for HSF scenes only. Compared to controls, AMD patients gave more non-responses in the categorization of HSF than NF or LSF scenes, irrespective of the contrast level of scenes. Performances improved as contrast increased in HSF scenes. Controls were not differentially affected by the spatial frequency content of scenes. Overall, results suggest that LSF processing is well preserved in AMD patients and allows efficient scene categorization in their parafoveal residual vision. The HSF processing deficit could be partially restored by enhancing luminance contrast.

Objective: Visual Evoked Potentials (VEPs) following optic neuritis (ON) remain chronically prolonged, although standard visual tests indicate full recovery. We hypothesized that dynamic visual processes, such as motion perception, may be more vulnerable to slowed conduction in the optic nerve, and consequently be better associated with projection rates. Methods: Twenty-one patients with acute unilateral, first-ever ON were studied during 1 year. Static visual functions (visual acuity, color perception, visual field, and contrast sensitivity), dynamic visual functions (motion perception), and VEPs were assessed repeatedly. Results: Visual and electrophysiological measurements reached maximal performance 4 months following the acute phase, with no subsequent improvement. Whereas VEP amplitude and static visual functions recovered, VEP latency remained significantly prolonged, and motion perception remained impaired throughout the 12-month period. A strong correlation was found between VEP latencies and motion perception. Visual performance at 1 month was strongly predictive of visual outcome. For static functions, patients who showed partial recovery at 1 month subsequently achieved full recovery. For dynamic functions, the rate of improvement was constant across patients, independent of the initial deficit level. Interpretation: Conduction velocity in the visual pathways correlated closely with dynamic visual functions, implicating the need for rapid transmission of visual input to perceive motion. Motion perception level may serve as a tool to assess the magnitude of myelination in the visual pathways. The constancy across patients may serve as a baseline to assess the efficacy of currently developing neuroprotective and regenerative therapeutic strategies, targeting myelination in the central nervous system. ANN NEUROL 2012

The relationships between spatial neglect for perceptual objects and representational for imagined items are difficult to explore because of several methodological problems, including the dearth of comparable tests for real and imagined scenes. We asked 19 patients with right brain damage and 12 healthy controls to say whether an auditorily presented French geographical location was left or right of Paris, and recorded their vocal response times. Afterwards, participants performed a similar test with visually presented items. Although several patients had asymmetries of performance on the perceptual version of the test, only one patient was more accurate for right-sided than for left-sided imagined stimuli, thus showing evidence for imaginal neglect. However, this patient performed normally on place description and on mental number line bisection, perhaps as a consequence of different strategies he employed for these tasks. Overall, our results confirm previous evidence showing that imaginal neglect is less frequent than, and often occurs in association with, perceptual neglect. Imaginal neglect may result from the contribution of deficits partly distinct from those implicated in perceptual neglect, such as impaired endogenous orienting of attention or deficits of spatial working memory.

Perceptual bias in simple visuospatial tasks, such as line bisection seen among healthy dextrals, has often been attributed to the hemispheric activation hypothesis. The often reported leftward perceptual bias was explained by an activation of the right hemisphere during visuospatial tasks. However, imposed scanning direction and stimuli saliency have also been used to explain these spatial asymmetries. One example of scanning direction is the well-trained one resulting from reading direction. Here, we present studies that target the role of reading direction on nonverbal tasks: line bisection, esthetic preference, and straight-ahead pointing by comparing left-to-right and right-to-left readers. The findings are discussed regarding the interaction between cultural factors, such as reading habits, and biological factors, such as cerebral lateralization.

International audience; BACKGROUND: Bottom-up and top-down processes are involved in visual analysis of scenes. Here we examined the influence of top-down visual demand on natural scene processing. METHODS: We measured accuracy and response time in adults performing two stimuli-equivalent tasks. Unfiltered, low or high spatial frequency (SF) natural scenes were presented in central, left, or right visual fields (CVF, LVF, RVF). The tasks differed only by the instructed visual demand. In the detection task, participants had to decide whether a scene was present or not. In the categorization task, they had to decide whether the scene was a city or a forest. RESULTS: Higher accuracy was seen for the LVF in the detection task, but for categorization, greater accuracy was seen for the RVF. The interaction between Task and SF revealed coarse-to-fine processing in the categorization task for both accuracy and reaction time, which nearly disappeared in the detection task. Considering the interaction of Task, VF and SF, a left-hemisphere specialisation (i.e., RVF advantage) was observed for the categorisation of HSF scenes for accuracy alone, whereas a LVF advantage was seen for all SFs in the detection task for both accuracy and reaction time. CONCLUSION: Our results revealed that the nature of top-down visual demand is essential to understanding how visual analysis is achieved in each hemisphere. Moreover, this study examining the effects of visual demand, visual field presentation, and SF content of stimuli through the use of ecological stimuli provides a tool to enrich the clinical examination of visual and neurovisual patients.

L’imagerie mentale suscite un interet croissant au sein des etudes en neuropsychologie. Toutefois, la nature de ces images reste encore mal connue. L’observation de sujets porteurs de troubles visuels d’origine peripherique peut nous permettre d’approfondir nos connaissances dans ce domaine. Le but de cette etude etait de determiner si les troubles perceptifs de ces sujets affectaient leurs capacites d’imagerie mentale, du materiel orthographique, des couleurs, des visages et des relations spatiales. De plus, les effets de la modalite haptique lorsqu’elle peut participer a la resolution de tâches d’imagerie mentale visuelle ont ete evalues. Les resultats revelent que les capacites d’imagerie mentale du materiel orthographique, des couleurs et des visages sont affectees par le deficit visuel d’origine peripherique, mais qu’une strategie fondee sur l’ecriture permet aux sujets d’ameliorer leurs performances au cours des tâches d’imagerie du materiel orthographique.

International audience; The present study aimed to show that bidirectional reading and language exposure influence the position of egocentric reference (ER), the perceived direction of the body's sagittal axis proposed to act as an anchor for movements in extracorporeal space. Directional factors (e.g., visual scanning bias and reading habits) have been proposed to influence visuospatial performance, such as in line bisection and figure drawing. In past studies, bidirectional readers have been less consistent in demonstrating a bias compared to unidirectional readers. Using a straight-ahead pointing task to assess egocentric reference, we compared 14 unidirectional left-to-right readers (Uni-LR) to three bidirectional reading groups that differed in the reading direction of their native language and/or the level of their second language literacy: 16 low-English literate, native right-to-left, bidirectional readers (Lo-Bi-RL), 13 high-English literate, native right-to-left, bidirectional readers (Hi-Bi-RL), and 15 native left-to-right, bidirectional readers (Bi-LR). Participants were asked to point straight-ahead while blindfolded using either a left-to-right or a right-to-left scanning direction to approach the subjective sagittal midline. Uni-LRs showed left-side spatial bias when scanning left-to-right and right-side bias during right-to-left scanning, Bi-LRs and Lo-Bi-RLs (i.e., intermediate level or less in their second language) demonstrated the opposite pattern, and Hi-Bi-RLs showed left-side spatial bias regardless of scanning direction. Results are discussed in terms of accuracy and spatial bias regarding the interaction between reading direction and spatial cognition based on the level of bidirectional literacy and language exposure.

International audience; The aim of the present study was to show that space perception depends on sensori-motor experience. We induced spatial biases by a non-conflictual lateralized sensori-motor task on twenty seven right-handed healthy volunteers (left-to-right readers). After a pre-test and before a post-test, which assessed visuo-motor and perceptual subjective midpoint in line bisection, participants performed a short lateralized pointing task (towards the left or right hemispace). Results indicated that this lateralized pointing task induced deviations towards the stimulated hemispace in both the visuo-motor and the perceptual estimations of the subjective line centre. These spatial biases varied as a function of pointing direction (left or right pointing), spatial location and line lengths. These findings suggest that a preceding non-conflictual lateralized sensori-motor experience influences subsequent space perception. Accordingly, ecological sensori-motor experience could be involved in asymmetric perception exhibited by normal individuals and neglect patients.

International audience; Left unilateral neglect, a dramatic condition which impairs awareness of left-sided events, has been classically reported after right hemisphere cortical lesions involving the inferior parietal region. More recently, the involvement of long range white matter tracts has been highlighted, consistent with the idea that awareness of events occurring in space depends on the coordinated activity of anatomically distributed brain regions. Damage to the superior longitudinal fasciculus (SLF), linking parietal to frontal cortical regions, or to the inferior longitudinal fasciculus (ILF), connecting occipital and temporal lobes, has been described in neglect patients. In this study, four right-handed patients with right hemisphere strokes underwent a high definition anatomical MRI with diffusion tensor imaging (DTI) sequences and a pencil and paper neglect battery of tests. We used DTI tractography to visualise the SLF, ILF and the inferior fronto-occipital fasciculus (IFOF), a pathway running the depth of the temporal lobe, not hitherto associated with neglect. Two patients with cortical involvement of the inferior parietal and superior temporal regions, but intact and symmetrical fasciculi, showed no signs of neglect. The other two patients with signs of left neglect had superficial damage to the inferior parietal cortex and white matter damage involving the IFOF. These findings suggest that superficial damage to the inferior parietal cortex per se may not be sufficient to produce visual neglect. In some cases, a lesion to the direct connections between ventral occipital and frontal regions (ie, IFOF) may contribute to the manifestation of neglect by impairing the top down modulation of visual areas from the frontal cortex.

Unilateral spatial neglect (USN) was defined 30 years ago as "a failure to report, respond, or orient to stimuli that are presented contralateral to a brain lesion, provided that this failure is not due to elementary sensory or motor disorders" by Heilman and Valenstein (1979). Even though this definition still holds, the last 30 years have been characterized by a profusion of clinical descriptions, neuroanatomical investigations and theoretical models of neglect. This article summarizes the wealth of neuroanatomical, clinical and experimental data concerning USN, by focusing on attentional and spatial deficits. Finally, some perspectives on neglect research are outlined.

International audience; Over the past several decades a growing amount of research has focused on the possibility of transiently reducing left neglect signs in right brain-damaged patients by using vestibular and/or visuo-proprioceptive stimulations. Here we review seminal papers dealing with these visuo-vestibulo-proprioceptive stimulations in normal controls, right brain-damaged (RBD) patients, and animals. We discuss these data in terms of clinical implications but also with regards to theoretical frameworks commonly used to explain the unilateral neglect syndrome. We undermine the effect of these stimulations on the position of the egocentric reference and extend the notion that the positive effects of these stimulation techniques may stem from a reorientation of attention towards the neglected side of space or from a recalibration of sensori-motor correlations. We conclude this review with discussing the possible interaction between experimental rehabilitation, models of neglect and basic spatial cognition research.

International audience; In addition to exhibiting a severe contralesional deficit, hemianopic patients may also show a subtle ipsilesional visual deficit, called sightblindness (the reverse case of 'blindsight). We have tested for the presence, nature and extent of such an ipsilesional visual field (IVF) deficit in hemianopic patients that we assigned to perform two visual tasks. Namely, we aimed to ascertain any links between this ipsilesional deficit, the lesion side, and the tasks performed or the stimuli used. We tested left and right homonymous hemianopic (right brain-damaged RBD and left brain-damaged LBD, respectively) patients and healthy controls. Natural-scene images, either non-filtered or filtered in low or high spatial frequency (LSF or HSF, respectively) were presented in the IVF of each subject. For the two tasks, detection ("Is an image present?") and categorization ("Is the image of a forest or a city?"), accuracy and response time were recorded. In the IVF the RBD (left hemianopes) patients made more errors on the categorization task than did their matched controls, regardless of image type. In contrast, the only task in which the LBD (right hemianopes) patients made more errors than did the controls was the HSF-images task. Furthermore, in both tasks (detection and categorization), the RBD patients performed worse than did the LBD patients. Homonymous hemianopic patients do indeed exhibit a specific visual deficit in their IVF, which was previously thought to be unaffected. We have demonstrated that the nature and severity of this ipsilesional deficit is determined by the side of the occipital lesion as well as by the tasks and the stimuli. Our findings corroborate the idea of hemispheric specialization at the occipital level, which might determine the nature and severity of ipsilesional deficits in hemianopic patients.

Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. Results: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients Presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

Normal subjects and patients with right hemisphere lesions with or without signs of left unilateral neglect judged the length of a horizontal line presented on the left or on the right side of space. In half of the trials, the line was presented with a centrally located square or diamond, and subjects had to identify the central stimulus before performing the judgment of length. The presence of the central stimulus improved accuracy of performance in controls and in patients without neglect; neglect patients, however, produced more overestimations of left-sided lines when these was presented with a central stimulus than when the lines occurred in isolation. This finding underlines the importance of attentional factors in length estimates performed by neglect patients in their neglected space.

Left unilateral neglect is a neurological condition characterized by an impairment in orienting and responding to events occurring on the left side. To gain insight into the brain mechanisms of space processing and to provide theoretical foundations for patient rehabilitation, it is important to explore the attentional bias shown by neglect patients in the light of existing models of normal attentional orienting. Three experiments tested the hypothesis that attentional bias in neglect involves primarily exogenous, or stimulus-based, orienting of attention, with relatively preserved endogenous, or voluntary, orienting. Six patients with right hemisphere damage and left unilateral neglect and 18 age-matched participants without brain damage performed a cued reaction time (RT) task to targets which could appear in one of two lateral boxes. Cues consisted of a brief brightening of the contour of one of the boxes. The target followed the cue at 150, 550, or 1000 ms stimulus-onset asynchrony (SOA). In experiment 1, the cues were not informative about the future location of the target, and thus elicited a purely exogenous orienting of attention. Controls showed slowed RTs to the cued locations at SOAs > 150 ms, consistent with the notion of inhibition of return (IOR). Neglect patients had no evidence of IOR for right targets; they showed a disproportionate cost for left targets preceded by right (invalid) cues; this cost was maximal at the shortest SOA, consistent with the idea of a biased exogenous orienting in neglect. In experiment 2, 80% of the cues were valid (i.e., they correctly predicted the location of the impending target), thus inducing an initially exogenous, and later endogenous, attentional shift toward the cued box. Neglect patients showed again a cost for left invalidly cued targets, which this time persisted at SOAs > 150 ms, as if patients' attention had been cued to the right side not only exogenously, but also endogenously, thus rendering more difficult an endogenous reorienting toward the left. In experiment 3, only 20% of the cues were valid, so that the best response strategy was to endogenously orient attention toward the box opposite to the cued one. Controls were able to take advantage of invalid cues to rapidly respond to targets. In this condition, neglect patients were able to nullify their spatial bias; they achieved their fastest RTs to left targets, which were in the range of their RTs to right targets. However, for neglect patients fast responses to left targets occurred only at 1000 ms SOA, while controls were able to redirect their attention to the uncued box already at 550 ms SOA. Altogether, these results suggest that endogenous orienting is relatively spared, if slowed, in unilateral neglect.

The aim of the present study was to determine the extent to which aesthetic preference, previously attributed to cerebral dominance, may be determined by reading habits. One hundred and sixty two normal subjects were presented pairs of images, one being the mirror-image of the other, and were asked for their aesthetic preference. Half of the subjects were left-to-right readers (French subjects) and the other half were right-to-left readers (Israeli subjects). We found a significant effect of reading habits on aesthetic preference, with left-to-right readers showing a preference for stimuli with a rightward directionality while right-to-left readers preferred stimuli with a leftward directionality. These findings raise the question of an interaction between cultural factors and cerebral dominance.

120 normal right-handed subjects, children and adults, with opposite reading habits (60 French, left-to-right readers, 60 Israeli, right-to-left readers) and 60 pre-school children (30 French and 30 Israeli), were submitted to a visuo-motor bisection task. Bisection is found to be dependent upon reading habits with a leftward deviation of the subjective middle for left-to-right readers, and a rightward bias for right-to-left readers. Even before formal reading learning, French and Israeli pre-school children differ significantly in bisecting a line. Results are discussed with respect to hemispheric activation theories and directional hypotheses.

Thirty normal subjects and a patient with a left unilateral neglect were submitted to a straight-ahead pointing task in the three following trunk orientations: head and trunk aligned at 0 degree, and trunk rotated 15 degrees to the left or to the right relative to the head. The position of the egocentric reference was found to be dependent upon the trunk orientation, lateralization of the motor response and starting position, and thus on motor direction. The results are discussed with regard to egocentric hypotheses of neglect, spatio-motor cueing and scanning direction.

The aim of this study was to explore the visuo-attentional skills of children with an ophthalmic disorder. Twenty-four patients and 60 healthy controls between the ages 4 and 7 years, all right-handed with normal or corrected-to-normal close visual acuity, were divided into four age groups. Patients' diagnoses included refractive disorders (e.g., myopia, hypermetropia), strabismus, amblyopia, cataract, and nystagmus. All participants performed nine paper-and-pencil visuospatial tasks aiming to assess selective attention (cancellation tasks), spatial working memory (symbol orientation task), fine visual analysis (embedded figures test), and simple perceptual analysis (shape-matching task). In healthy children, the results showed that performance on all visuo-attentional tasks improved with age. While perception, orientation of attention, and visual working memory develop by the time children begin school (age 5), more sophisticated abilities such as attention disengagement and motor control continue to develop during late childhood. Moreover, a spatial bias in attention orienting appeared with reading acquisition (6-7 years). In ophthalmic children, at 4 years of age defects were observed in all assessed functions, but at 7 years an attentional deficit was virtually the only one remaining. Overall, the results demonstrate that children with an ophthalmologic disorder may experience difficulties with visuospatial tasks despite corrected-to-normal visual acuity.

International audience; Theories on visual perception agree that visual recognition begins with global analysis and ends with detailed analysis. Different results from neurophysiological, computational, and behavioral studies all indicate that the totality of visual information is not immediately conveyed, but that information analysis follows a predominantly coarse-to-fine processing sequence (low spatial frequencies are extracted first, followed by high spatial frequencies). We tested whether such processing continues to occur in normally aging subjects. Young and aged participants performed a categorization task (indoor vs. outdoor scenes), using dynamic natural scene stimuli, in which they resorted to either a coarse-to-fine (CtF) sequence or a reverse fine-to-coarse sequence (FtC). The results show that young participants categorized CtF sequences more quickly than FtC sequences. However, sequence processing interacts with semantic category only for aged participants. The present data support the notion that CtF categorization is effective even in aged participants, but is constrained by the spatial features of the scenes, thus highlighting new perspectives in visual models.

Objective: To assess the recovery process in patients after an acute optic neuritis (ON) attack, comparing static and dynamic visual functions. Methods: In this prospective controlled study, 21 patients with unilateral, first-ever ON were followed over the course of 1 year. Standard visual tests, visual evoked potentials, and optical coherence tomography were assessed repeatedly. In addition, we developed a novel set of motion perceptual tasks to test dynamic visual deficits. fMRI examinations were performed to study the neuronal correlates for the behavioral findings. Results: Four months after the acute phase, the affected eyes had returned to normal performance levels in the routine visual testing. However, motion perception remained impaired throughout the 12-month period. In agreement with the clinical findings, fMRI studies showed recovery in cortical activation during static object recognition, as opposed to sustained deficit in tasks that require motion perception. Conclusions: Sustained motion perception deficit following ON may explain the continued visual complaints of patients long after recovery of visual acuity. Cortical activation patterns suggest that if plastic processes in higher visual regions contribute to the recovery of vision, this may be limited to static visual functions. Alternatively, cortical activation may reflect the visual percept (intact for visual acuity and impaired for motion perception), rather than demonstrating plastic processes. We suggest that motion perception should be included in the routine ophthalmologic tests following ON. Neurology ® 2011;76:2103–2111

The effect of scanning direction on perception of space is studied with a visuo-motor bisection task, among 120 normal dextrals with opposite reading habits (60 French subjects, 60 Israeli subjects). Bisection is found to depend upon subject's reading habits. Israeli bisected the line to the right of the objective centre, while French subjects placed their subjective middle to the left of the objective one. Results are discussed with respect to hemispheric activation theories, directional hypotheses and the neglect syndrome.

International audience; Most studies of visual aesthetic preference report that right-handers prefer pictorial arrangements possessing left-to-right directionality and/or containing the region of greatest weight or interest on the right side. However, visual aesthetic preference has also been linked to directional scanning depending on the individual's reading/writing habits. The present study aims to assess the respective role of biological factors, related to the functional specialization of the two cerebral hemispheres, indexed by handedness, and cultural factors (age-related reading/writing habits) in visual aesthetic preference. For this purpose, we tested the effects of handedness, sex and age on visual aesthetic preference in 40 children and 40 adults. Results revealed effects of handedness, sex, and age as well as a relationship between directional scanning, reading/writing habits and handedness. The question of a dynamic model of cerebral specialization based on interplay between cerebral plasticity and cultural/environmental factors is raised. Key words: Aesthetic preference, development, vision, hemispheric specialization, handedness, sex, reading/writing habits.

Short Paper; International audience; In the present paper, we describe a virtual reality application developed for the study of unilateral spatial neglect, a post-stroke neurological disorder that results in failure to respond to stimuli presented contralaterally to the damaged hemisphere. Recently, it has been proposed that patients with unilateral spatial neglect experience sensorimotor decorrelation in the affected space. Consequently, it is possible that since the sensorimotor experience in the affected space is perturbed, patients avoid this space, which results in neglect behavior. Here, we evaluate this hypothesis using a virtual reality application built on the base of the Stringed Haptic Workbench, a large-scale visuo-haptic system. The results provide support for the hypothesis and demonstrate that the proposed application is suitable for the envisioned goal.

Calabria and Rossetti (2005) demonstrated that spatial biases related to the mental number line can be seen even when bisecting strings of number words. Strings of smaller magnitude number words were bisected further to the left than strings of larger magnitude number words. The current study investigated whether the left-to-right mental number line associated with number processing will result in similar spatial biases despite a habitual, right-to-left reading direction. Monolingual left-to-right readers were compared to bidirectional readers of English and Hebrew. Strings of Arabic numerals and of number words (e.g., THREE, EIGHT) were presented in separate conditions of English and Hebrew. Significant rightward biases were seen among native Hebrew readers, regardless of English reading level; whereas native English readers (both bidirectional and monodirectional) did not show significant biases to either the left or the right. The spatial bias in bisecting either Arabic numeral strings or number words was related to the habitual reading direction of the participant. There was no difference in spatial bias or for frequency of spatial bias based on numerical magnitude for either condition. We discuss the influence of cultural factors, such as reading direction and proficiency, on the representation of spatial and numerical material.

International audience; Unilateral spatial neglect is a disabling condition frequently occurring after stroke. People with neglect suffer from various spatial deficits in several modalities, which in many cases impair everyday functioning. A successful treatment is yet to be found. Several techniques have been proposed in the last decades, but only a few showed long-lasting effects and none could completely rehabilitate the condition. Diagnostic methods of neglect could be improved as well. The disorder is normally diagnosed with pen-and-paper methods, which generally do not assess patients in everyday tasks and do not address some forms of the disorder. Recently, promising new methods based on virtual reality have emerged. Virtual reality technologies hold great opportunities for the development of effective assessment and treatment techniques for neglect because they provide rich, multimodal, and highly controllable environments. In order to stimulate advancements in this domain, we present a review and an analysis of the current work. We describe past and ongoing research of virtual reality applications for unilateral neglect and discuss the existing problems and new directions for development.

International audience; We describe the case of a patient with right hemisphere damage and left unilateral neglect. The patient was asked to draw from memory common objects, either with or without visual feedback. In the conditions without visual feedback the patient was either blindfolded or he made "invisible" drawings using a pen with the cap on, the drawings being recorded with carbon paper underneath. Results showed more neglect without than with visual feedback, contrary to previously published cases. This patient's pattern of performance may result from the contribution of a deficit of spatial working memory. Alternatively or in addition, the patient, who was undergoing cognitive rehabilitation for neglect, may have found easier to compensate for his neglect with visual feedback, which allowed him to visually explore the left part of his drawings.

International audience; Background: Perception of the cardinal directions of the body, right-left, up-down, ahead-behind, which appears so absolute and fundamental to the organisation of behaviour can in fact, be modified. Perhaps unsurprisingly, it has been shown that prolonged distorted perception of the orientation of body axes can be a consequence of disordered sensori- motor signals, including long-term prismatic adaptation and lesions of the central nervous system. We report the novel and surprising finding that a long-lasting distortion of perception of personal space can also be induced by an ecological pointing task without the artifice of distorting normal sensori-motor relationships.Methodology/Principal Findings: Twelve right-handed healthy adults performed the task of pointing with their arms, without vision, to indicate their subjective ‘straight ahead’, a task often used to assess the Egocentric Reference. This was performed before, immediately, and one day after a second task intended to ‘modulate’ perception of spatial direction. The ‘modulating’ task lasted 5 minutes and consisted of asking participants to point with the right finger to targets that appeared only in one (right or left) half of a computer screen. Estimates of the ‘straight-ahead’ during pre-test were accurate (inferior to 0.3 degrees deviation). Significantly, up to one day after performing the modulating task, the subjective ‘straight- ahead’ was deviated (by approximately 3.2 degrees) to the same side to which subjects had pointed to targets.Conclusion/Significance: These results reveal that the perception of directional axes for behaviour is readily influenced by interactions with the environment that involve no artificial distortion of normal sensori-motor-spatial relationships and does not necessarily conform to the cardinal directions as defined by the anatomy of orthostatic posture. We thus suggest that perceived space is a dynamic construction directly dependent upon our past experience about the direction and/or the localisation of our sensori-motor spatial interaction with environment.

Twenty-six patients suffering from damage to the right side of the brain, 19 of whom exhibited signs of left neglect, as well as 32 matched controls, ran 3 spatial cuing tasks. Patients were also tested with 2 cancellation tests, a line-bisection test, the copy of a complex drawing, and a visual extinction procedure. Results first showed correlations between extinction and cancellation tests performance on one hand, and between line bisection and copy on the other hand. Second, results demonstrated that an engagement deficit toward contralesional targets appeared to be the most striking feature of neglect, and the engagement score was correlated with the cancellation score and extinction. Most patients with neglect also presented a deficit in disengagement, a deficit of inhibition of return, and probably a deficit of alertness. Deficits in engagement and in disengagement, as well as poor scores in cancellation tests, seemed to be related with posterior cortical and subcortical lesions. Most important, even if an endogenous deficit (frequently related with a thalamic lesion) could aggravate the neglect behavior, neglect syndrome was mainly explained by a deficit of exogenous attention.

International audience; Studies on functional hemispheric asymmetries have suggested that the right vs. left hemisphere should be predominantly involved in low vs. high spatial frequency (SF) analysis, respectively. By manipulating exposure duration of filtered natural scene images, we examined whether the temporal characteristics of SF analysis (i.e., the temporal precedence of low on high spatial frequencies) may interfere with hemispheric specialization. Results showed the classical hemispheric specialization pattern for brief exposure duration and a trend to a right hemisphere advantage irrespective of the SF content for longer exposure duration. The present study suggests that the hemispheric specialization pattern for visual information processing should be considered as a dynamic system, wherein the superiority of one hemisphere over the other could change according to the level of temporal constraints: the higher the temporal constraints of the task, the more the hemispheres are specialized in SF processing.

International audience; When describing known places from memory, patients with left spatial neglect may mention more right- than left-sided items, thus showing representational, or imaginal, neglect. This suggests that these patients cannot either build or explore left locations in visual mental imagery. However, in place description there is no guarantee that patients are really employing visual mental imagery abilities, rather than verbal-propositional knowledge. Thus, patients providing symmetrical descriptions might be using other strategies than visual mental imagery. To address this issue, we devised a new test which strongly encourages the use of visual mental imagery. Twelve participants without brain damage and 12 right brain-damaged patients, of whom 7 had visual neglect, were invited to conjure up a visual mental image of the map of France. They subsequently had to state by pressing a left- or a right-sided key whether auditorily presented towns or regions were situated to the left or right of Paris on the imagined map. This provided measures of response time and accuracy for imagined locations. A further task, devised to assess response bias, used the words “left” or “right” as stimuli and the same keypress responses. Controls and non-neglect patients performed symmetrically. Neglect patients were slower for left than for right imagined locations. On single-case analysis, two patients with visual neglect had a greater response time asymmetry on the geographical task than predicted by the response bias task, but with symmetrical accuracy. The dissociation between response times and accuracy suggests that, in these patients, the left side of the mental map of space was not lost, but only “explored” less efficiently.

International audience; OBJECTIVES: Comparatively little research has been conducted on right neglect after left brain damage. The authors sought to assess contralateral neglect in subacute left hemisphere stroke patients using a comprehensive test battery validated in a large control group after right hemisphere stroke. METHODS: Seventy-eight left hemisphere stroke patients were assessed. The test battery included a preliminary assessment of anosognosia and visual extinction, a clinical assessment of gaze orientation and personal neglect, and paper-and-pencil tests of spatial neglect in the peripersonal space. Only nonverbal tests were used. RESULTS: Drawing and cancellation tasks revealed neglect in 10 to 13% of patients. The combined battery was more sensitive than any single test alone. A total of 43.5% of patients showed some degree of neglect on at least one measure. Anatomic analyses showed that neglect was more common and severe when the posterior association cortex was damaged. CONCLUSIONS: The frequency of occurrence of right neglect was, as expected, much lower than that reported in a study using the same assessment battery in right brain damage stroke patients. Nevertheless, neglect was found in a substantial proportion of patients at a subacute stage, suggesting that it should be considered in the rehabilitation planning of left brain damage stroke patients.

Halligan and Marshall [Cortex 27 (1991) 623] devised a new test to evaluate the hypothesis that in visual neglect, left space is systematically compressed rightwards. In the critical condition of the original study, rows of horizontally arranged numbers with a target arrow pointing to one of them from the opposite margin of the display were presented. When asked to verbally identify the number indicated by the arrow, a right brain-damaged patient with left neglect and hemianopia often indicated a number to the right of the target. The more the target was located on the left, the greater the response shift rightward, as if rightward compression were linearly proportional to the co-ordinates of Euclidian space. However, a possible alternative account could be that the patient’s attention was attracted by the numbers located to the right of the target digit, thus biasing her responses toward numbers on the right. To explore this hypothesis, we asked normal participants and patients with right hemisphere lesions, with and without neglect or hemianopia, to mark on the margin of a sheet the approximate location indicated by an arrow situated on the opposite margin. In three different conditions, the arrow indicated either one of several numbers or lines in a row, or a blank location on the sheet margin. Only patients with left neglect, and especially those with associated hemianopia, deviated rightward, and then crucially only on those conditions where visible targets were present, consistent with the attentional bias account.

Recently, the hypothesis has been proposed that the crucial mechanism leading to neglect is the disturbed transformation of sensory input into a supramodal egocentric frame of reference (ER), which causes in turn a deviation of this reference frame toward the side ipsilateral to the brain lesion. This egocentric coordinate system is normally centered on the midsagittal plane, but a unilateral brain lesion may cause a deviation of the egocentric reference due to an imbalance between the differentially lateralized neural processes which build this representation. Although neglect signs are often defined in an egocentric frame, and an ER shift may be observed in some right-brain-damaged patients (RBD), I present here several data that rule out any causal link between the deviation of the egocentric reference and the presence and/or severity of left-neglect signs in RBD patients.

Inhibition of return (IOR) is thought to reflect a bias against returning attention to previously attended locations. According to this view, IOR should occur only if attention is withdrawn from the target location prior to target appearance. In the present study, endogenous attention and exogenous cueing were manipulated orthogonally. IOR was observed both when a target appeared at an unexpected location, and when a target appeared at the expected location. A similar pattern of results was obtained in a reanalysis of data from a study with Neglect patients. These results suggest that IOR is independent of endogenous orienting.

After right posterior brain damage, patients may ignore events occurring on their left, a condition known as unilateral neglect. Although deficits at different levels of impairment may be at work in different patients, the frequency and severity of attentional problems in neglect patients have been repeatedly underlined. Recent advances in the knowledge of the mechanisms of spatial attention in normals may help characterizing these deficits. The present review focuses on studies exploring several aspect of attentional processing in unilateral neglect, with particular reference to the dichotomy between 'exogenous', or stimulus-related, and 'endogenous', or strategy-driven, orienting of attention. A large amount of neuropsychological evidence suggests that a basic mechanism leading to left neglect behavior is an impaired exogenous orienting toward left-sided targets. In contrast, endogenous processes seem to be relatively preserved, if slowed, in left unilateral neglect. Other component deficits, such as a general slowing of the operations of spatial attention, might contribute to neglect behavior. These results are presented and discussed, and their implications for hemispheric specialization in attentional orienting and for the mechanisms of visual consciousness are explored.

Patients with unilateral spatial neglect due to right-hemisphere lesions typically fail to attend to and explore left-sided stimulus objects [32] . It has been postulated that in right-brain damaged (RBD) patients an ipsilesional displacement of the egocentric frame of reference (ER), whether visual or tactile, may be responsible for a contralesional supramodal spatial bias causing their left neglect behavior [39] . However, this hypothesis had been proposed without testing, in the same patients, the position of the ER or their performance in the visual and tactile modalities. Thus, the aim of the present study was to test the hypothesis that an ipsilateral shift of the ER is responsible for a supramodal spatial bias in neglect. For this purpose, a within-subject design is required. Consequently, 12 left neglect patients and 12 control subjects were asked to perform a proprioceptive straight-ahead pointing task while blindfolded, as well as visual and tactile bisection tasks. In the left neglect patients, we found: (i) no systematic deviation of the ER on the ipsilesional right side; (ii) a significant rightward bias in visual bisection, and normal performance in tactile bisection; (iii) no correlation among the three tasks; (iv) that only visual bisection correlated with the severity of neglect. These results are discussed with regard to the egocentric and attentional hypothesis of neglect.

We describe a patient, VSB, whose reading was impaired as a consequence of a left temporal- parietal lesion, whereas writing was relatively preserved. At variance with other pure alexic patients described in the literature, VSB claimed to have become unable to mentally visualise letters and words. Indeed, his performance on a series of tests tapping visual mental imagery for orthographic material was severely impaired. However, performance on the same tests was dramatically ameliorated by allowing VSB to trace each item with his finger. Visual mental imagery for non-orthographic items was comparatively spared. The pattern of dissociation shown by VSB between impaired visual mental imagery and relatively preserved motor-based knowledge for orthographic material lends support to the view that separate codes, respectively based on visual appearance and on motor engrams, may be used to access knowledge of the visual form of letters and words.