Acquired spatial dyslexia.

Acquired spatial dyslexia is a reading disorder frequently occurring after left or right posterior brain lesions. This article describes several types of spatial dyslexia with an attentional approach. After right posterior lesions, patients show left neglect dyslexia with errors on the left side of text, words, and non-words. The deficit is frequently associated with left unilateral spatial neglect. Severe left neglect dyslexia can be detected with unlimited exposure duration of words or non-words. Minor neglect dyslexia is detected with brief presentation of bilateral words, one in the left and one in the right visual field (phenomenon of contralesional extinction). Neglect dyslexia can be explained as a difficulty in orienting attention to the left side of verbal stimuli. With left posterior lesions, spatial dyslexia is also frequent but multiform. Right neglect dyslexia is frequent, but right unilateral spatial neglect is rare. Attentional dyslexia represents difficulty in selecting a stimulus, letter or word among other similar stimuli; it is a deficit of attentional selection, and the left hemisphere plays a crucial role in selection. Two other types of spatial dyslexia can be found after left posterior lesions: paradoxical ipsilesional extinction and stimulus-centred neglect dyslexia. Disconnections between left or right parietal attentional areas and the left temporal visual word form area could explain these deficits. Overall, a model of attention dissociating modulation, selection control, and selection positioning can help in understanding these reading disorders.

[Unilateral spatial neglect: 30 years of research, discoveries, hope, and (especially) questions]. / La négligence spatiale unilatérale : trente ans de recherches, de découvertes, d'espoirs et (surtout) de questions.

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.

Right spatial neglect after left hemisphere stroke: qualitative and quantitative study.

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.

Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke.

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.

Feature processing and superiority of three-quarter views in face recognition.

The specificity of face recognition is usually related to the hypothesis that it could be based mainly on global processing of the whole face. However, this does not mean that more analytic processes, like the local processing of some features, could not play a role in the recognition process in some circumstances. An experiment was conducted with 18 normal subjects in order to evaluate the role of analytic processes in the recognition of faces viewed from different angles. Makeup was applied to eyes and lips to enhance local processing (local cue). We found a positive effect of the makeup cue, which could be due to better recognition when the shape of eyes and lips are highlighted. Also, we found better recognition with left-sided views compared to right-sided views. Finally, the makeup effect was significant in left three-quarter views but not in right three-quarter views. If this effect is due to analytic processing of some facial features, it could be related to a left hemisphere operation.

Modulating the attentional bias in unilateral neglect: the effects of the strategic set.

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.

Variability of response times as a marker of diverted attention.

Anderson et al. (Variability not ability: another basis for performance decrements in neglect. Neuropsychologia 2000;38:785-796) have recently reported that variability of response times (RTs) progressively increases from the right to the left side in left neglect patients. Anderson et al. propose that this lack of consistency is an important determinant of patients' behaviour, and may result from a deficit independent of other mechanisms causing neglect. Here we suggest that an increase of variability, and not only of RTs, is to be expected when attention is exogenously biased away from the probed location. Consequently, space-based variability can be interpreted in the framework of existing models of unilateral neglect. According to one such model, a basic impairment in left neglect is a bias toward rightward exogenous orienting of attention. As a result, left targets often fail to rapidly capture patients' attention, thus yielding slow RTs. However, since the probability for a left target attracting attention is low but not null, relatively fast RTs can occur on those rare occasions in which a left target does capture patients' attention. The coexistence of these relatively fast with slow RTs could be at the basis of space-based variability in neglect. Empirical support for our hypothesis comes from the results of a re-analysis for variability of cued RTs obtained in 18 normal individuals and six left neglect patients. Cues were peripheral and non-informative, thus eliciting an exogenous attentional shift. For normal individuals, invalid trials yielded less consistent response times than valid trials at short (150 ms) cue-target interval; for neglect patients, a similar phenomenon occurred for left invalidly-cued targets, thus paralleling the disproportionate cost in RTs typically evoked by this condition in unilateral neglect. We conclude by discussing some possible determinants of gradient-shaped effects and by outlining the implications of space-based variability for current models of unilateral neglect.

[Presenting a battery for assessing spatial neglect. Norms and effects of age, educational level, sex, hand and laterality]. / Présentation d'une batterie de dépistage de la négligence spatiale. Normes et effets de l'âge, du niveau d'éducation, du sexe, de la main et de la latéralité.

The aim of this study was to build up a battery for assessing spatial neglect, then to analyse the norms and potential effects of age, education level, sex, hand used, and laterality. It was also to contribute evaluating the pseudoneglect phenomenon described by Heilman, which consists in a tendency of normal subjects to neglect the right peripersonal space. Tasks selected were presented to important groups of normal subjects, most often larger than 450. The battery comprised of a bell cancellation test, scene copy, clock drawing, two line bisection tasks, identification of overlapping figures, text reading, writing task, and the representational task of the France map. For each of them, different variables were selected, especially investigating the difference between performance in the right and the left hemispaces. This study allowed defining the threshold values (percentiles 5 and 95) for deciding of the pathological character of a patient performance. It also showed that the pseudoneglect phenomenon is more obvious in some tasks such as line bisection, and probably also in the representational task of the France map and writing. His importance and at times his side were influenced by the factors we studied, with between tasks differences, but also by the nature of the task to be performed, and especially his verbal component.

Preparatory attention: experiment and theory.

This study investigated attention to a spatial location using a new spatial preparation task. Participants responded to a target dot presented in the center of a display and ignored a distractor dot presented to the right or left of the center. In an attempt to vary the level of preparatory attention directed to the target, the distractor dot was presented prior to the onset time of the target and the relative frequency of distractor dots to target dots within a block of trials was varied. The results from the first three experiments showed that when instructions induce weak preparatory attention to the target location, response times to a target on target-only trials increase substantially as the percentage of trials containing a distractor increases from 0 to 75%. In Experiments 2 and 3, instructions and display saliency were used to induce strong preparatory attention to the target location, resulting in almost constant response times across distractor percentages. Experiment 4 varied percentage of target trials in the absence of distractors, with the result that response times decreased as target trial percentage increased. Accounts of these data by early "activity-based" and late "criterion-based" attention theories are compared, and the early theory is given a more detailed description within the context of a cognitive neuroscience theory of attention.

Facilitation instead of inhibition for repeated right-sided events in left neglect.

When two visual events appear consecutively in the same spatial location, our response to the second event is slower than that to the first. This inhibition for repeated events may reflect a bias toward sampling novel locations, a bias useful for exploring the visual space. Patients with right hemisphere damage and left neglect explore asymmetrically a visual scene. They are initially attracted by right-sided items and become stuck to them, being unable to reorient their attention toward the left. Here we show that neglect patients show facilitation instead of inhibition for repeated events on the right, non-neglected side. Patients without neglect showed normal inhibition. Our observation may explain why neglect patients' exploration of space cannot extend beyond a few right-sided objects.

[Writing disorder using a word processor: role of the left hand]. / Trouble de l'écriture sur traitement de texte: rôle de la main gauche.

A young female secretary developed a writing disorder, exclusively expressed when using a word processor, following an ischemic vascular event involving the insula and the right posterior parietal region. There was no disturbance of laterality. The neurological examination, completed by neuropsychological tests eliminated any persistent phasic or gnostic disorders. The analysis of the text produced revealed abnormalities leading to the conclusion that the left hand was responsible for all the errors observed. A sensorimotor integration disorder produced a melokinetic apraxia which appeared to be the cause of the writing disorder which would have most likely remained unknown had the subject not been a secretary.

Perception of visual letter strings in a case of left neglect: manipulation of the word form.

Patients with lesions in the right parietal lobe neglect the left side of nonwords much more than the left side of words. This has been interpreted in terms of a more automatic process in reading words. The case of a patient with left visual neglect after a vascular right parietooccipital lesion is presented. He showed the phenomenon of a word superiority effect over nonword in reading at the beginning in a clinical test with static cards; 6 months later, after some recovery, the same phenomenon could be demonstrated only with tachistoscopic presentation, and it occurred even inside the good right visual hemifield. The word form of visually presented stimuli was manipulated, showing that there was a striking effect particularly when spacing the letters of words in a task that requires naming the stimulus. The patient's performance is interpreted in terms of an attentional deficit occurring at an early level of spatial information processing.

[Prosopagnosia without hemianopsia after unilateral right occipitotemporal lesion]. / Prosopagnosie sans hémianopsie après lésion unilatérale occipito-temporale droite.

Three atypical features were noted in a patient with prosopagnosia due to a right occipital hematoma: prosopagnosia was unassociated with achromatopsia, spatial disorientation or left visual field alexia; the right visual field was normal and the left field only slightly impaired; the lesion was apparently unilateral.