Illusions of length in spatial unilateral neglect

Sensitivity and Specificity of the Brentano Illusion Test in the Detection of Visual Hemi-Field Deficits in Patients with Unilateral Spatial Neglect

Stroke survivors with right-brain damage (RBD) often present with attentional deficits such as left unilateral spatial neglect. Some patients also present with contralesional visual hemi-field deficits. A late detection of visual hemi-field deficits (VHFD) contributes to hampering neurorehabilitation and functional outcome of patients with neglect. The Brentano Illusion Test (BRIT) may be used for an early detection of VHFD during the neuropsychological assessment. In the present study, we determined the sensitivity and specificity of the BRIT for screening VHFD in patients with neglect. Sixty-four consecutive RBD patients were examined. Forty-five presented with neglect. Of these, 23 presented with VHFD (hemianopia or quadrantanopia) as detected by the Humphrey automated static visual field testing (reference standard). Consecutive patients also included 19 participants without neglect, who did not have any VHFD. The sensitivity and specificity of the BRIT for neglect patients were 78.3% (95% CI: 61.4-95.1) and 90.9 (95% CI: 78.9-100.0), respectively. Positive predictive value (PPV) was 89.6% (95% CI: 76.4-100.0); negative predictive value (NPV) 80.7% (95% CI: 65.2-96.2). No false positives in the group without neglect were identified. We conclude that the BRIT is an effective tool for clinical neuropsychologists to screen for possible VHFD in neglect patients during the neuropsychological assessment, allowing the refinement of the clinical picture in the neuropsychological report. An early detection of VHFD also allows referring the patient to standard diagnostics for a formal visual field examination, right from the first neuropsychological assessment.

Time Interaction With Two Spatial Dimensions: From Left/Right to Near/Far

In this study, we explored the time and space relationship according to two different spatial codings, namely, the left/right extension and the reachability of stimulus along a near/far dimension. Four experiments were carried out in which healthy participants performed the time and spatial bisection tasks in near/far space, before and after short or long tool-use training. Stimuli were prebisected horizontal lines of different temporal durations in which the midpoint was manipulated according to the Muller-Lyer illusion. The perceptual illusory effects emerged in spatial but not temporal judgments. We revealed that temporal and spatial representations dynamically change according to the action potentialities of an individual: temporal duration was perceived as shorter and the perceived line’s midpoint was shifted to the left in far than in near space. Crucially, this dissociation disappeared following a long but not short tool-use training. Finally, we observed age-related differences in spatial attention which may be crucial in building the memory temporal standard to categorize durations.

Neglect's perspective on the Ponzo illusion

Visual illusions have been used to explore implicit perception in neglect. Previous studies have highlighted differences between length and surface illusion perception in neglect, but much less is known about depth illusion perception. In the Ponzo illusion (a classic depth illusion), two converging oblique lines modulate the perceived length of two horizontal lines. In the current study, we presented modified versions of the Ponzo illusion in which only one of the converging oblique lines was presented (alternatively the right or the left one). This manipulation allowed us to explore (1) how acute patients with neglect process depth illusions, and (2) whether awareness of both converging lines is necessary for the full effect of the illusion. To examine these questions, we had participants (i.e. healthy controls, patients with neglect and right brain-damaged patients) to make a perceptual judgment regarding the perceived length of the upper versus lower horizontal line within the Ponzo frame in four conditions: (1) the classic Ponzo illusion, (2) a "modified left" Ponzo illusion with a single oblique line on the left, (3) a "modified right" Ponzo illusion with a single oblique line on the right and (4) a control condition with parallel lines. The results indicated that all participants perceived the canonical Ponzo illusion and the modified right illusion. Critically, patients with neglect did not perceive the modified left illusion. In addition, for neglect patients, there was no difference in the strength of the perceived illusion when comparing the canonical illusion with the modified right illusion. Importantly, single case analysis revealed a high degree of variability in the neglect group that seemed to be linked with the amount of damage to occipital areas. Overall our results indicate that: (1) the classic Ponzo illusion might be perceived in neglect patients based solely on perception of the right side of the stimulus configuration, and (2) differences between types of illusions (i.e. depth vs. length), and variability between patients suggest that caution is needed when utilizing these kinds of illusions to assess implicit processing in neglect.

The neural mechanisms underlying the Müller-Lyer illusion and its interaction with visuospatial judgments

Arrows terminating a line can distort the perceived line length. This so-called Müller-Lyer illusion can be used in healthy human subjects to mimic the performance of neglect patients in visuospatial judgments (e.g., in the landmark task). In this study, we investigated the neural mechanisms underlying the Müller-Lyer illusion, the landmark task, and their interaction. This was achieved by parametrically manipulating the magnitude of the Müller-Lyer illusion both in a landmark and in a luminance (control) task. As expected, the landmark task activated right posterior parietal cortex and right temporo-occipital cortex. In contrast, the neural processes associated with the strength of the Müller-Lyer illusion were located bilaterally in the lateral occipital cortex as well as the right superior parietal cortex. The data not only converge with but also extend neuropsychological data that indicate maintained line-length illusion in neglect patients. In addition, our results support the size-constancy scaling hypothesis as a putative mechanism underlying line-length illusions. Furthermore, activation that was driven by both the task and the strength of the Müller-Lyer illusion was observed in right intraparietal sulcus, thus arguing in favor of an interaction of illusory information with the top-down processes underlying visuospatial judgments in right parietal cortex.

Numbers and space: a cognitive illusion?

This study investigated the relationships between numerical and spatial representations by means of a bisection task, exploring the view that the core representation of number meaning is spatially organized as a mental number line. In Experiment nos. 1 (bisection of digit strings) and 2 (bisection of flanked lines) spatial biases towards the larger digit were found to be related only to processing of relative magnitude. Experiment nos. 3 (bisection of an unfilled space) and 4 (bisection of flanked lines/unfilled spaces) aimed at disclosing perceptual, attentional, and numerical constraints on the bias induced by the position of the larger digit. This effect is interpreted in terms of a cognitive illusion of length, whereby a spatial bias compensates for the numerical disparity. This seems to operate in a categorical fashion ("small/large"), and to be congruent with the assumption that relatively large numbers are associated with the right side of a mental representational space.

Causes of cross-over in unilateral neglect: between-group comparisons, within-patient dissociations and eye movements

Patients with left unilateral neglect bisect long horizontal lines to the right of the true centre. However, when given short lines, many of the same patients mark the midpoint to the left of the true centre, towards the otherwise neglected space. This paradoxical phenomenon has been termed 'cross-over' and is difficult to explain based on current accounts of the neglect syndrome. To explore the causes of cross-over, in a first study we evaluated bisection of 20, 100 and 200 mm horizontal lines in groups of unilateral brain-damaged patients with neglect and hemianopia, with neglect and no hemianopia, with hemianopia and no neglect and without neglect or hemianopia. Cross-over of 20 mm lines was found only in neglect patients with hemianopia. To ascertain further the influence of visual field defects on cross-over, in a second study we compared the performance of two right-brain-damaged patients with contralesional neglect and inferior quadrantanopia with that of a patient with inferior quadrantanopia and no neglect. Patients bisected lines oriented so as to cross or uncross the blind quadrant of the visual field. When short 20 mm lines crossed the blind quadrant, neglect patients showed cross-over; when the same lines crossed the seeing quadrants cross-over was absent. These findings were confirmed by the examination of a neglect patient with sparing of the central 5 degrees of the contralesional left visual hemifield in the right eye and no sparing in the left eye. In monocular viewing, cross-over was present when 20 mm lines were bisected with the left eye and absent when bisected with the right eye. Recording of eye movements showed that at the moment of bisection left eye fixations shifted towards the contralesional line endpoint whereas right eye fixations remained anchored to the centre of the line. With long lines, both eyes deviated ipsilesionally. These results show that in neglect patients ipsilesional deviation in the bisection of long lines turns into apparently paradoxical contralesional bisection of short ones only when these cross a retinotopically blind sector of the neglected space. Cross-over seems to depend on the small spatial effects produced by reflexive contralesional gaze shifts allowing eccentric fixations with the seeing hemifield. During the bisection of long lines, these effects are cancelled out by the strong attentional deviation induced by the marked extension of the ipsilesional line segment. This explanation establishes coherence between cross-over and current accounts of the neglect syndrome.