Optic ataxia errors depend on remapped, not viewed, target location

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

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

Perceptual-Cognitive Integration for Goal-Directed Action in Naturalistic Environments

Real-world actions require one to simultaneously perceive, think, and act on the surrounding world, requiring the integration of (bottom-up) sensory information and (top-down) cognitive and motor signals. Studying these processes involves the intellectual challenge of cutting across traditional neuroscience silos, and the technical challenge of recording data in uncontrolled natural environments. However, recent advances in techniques, such as neuroimaging, virtual reality, and motion tracking, allow one to address these issues in naturalistic environments for both healthy participants and clinical populations. In this review, we survey six topics in which naturalistic approaches have advanced both our fundamental understanding of brain function and how neurologic deficits influence goal-directed, coordinated action in naturalistic environments. The first part conveys fundamental neuroscience mechanisms related to visuospatial coding for action, adaptive eye-hand coordination, and visuomotor integration for manual interception. The second part discusses applications of such knowledge to neurologic deficits, specifically, steering in the presence of cortical blindness, impact of stroke on visual-proprioceptive integration, and impact of visual search and working memory deficits. This translational approach-extending knowledge from lab to rehab-provides new insights into the complex interplay between perceptual, motor, and cognitive control in naturalistic tasks that are relevant for both basic and clinical research.

Direction of visual shift and hand congruency enhance spatial realignment during visuomotor adaptation

Although prism adaptation has been studied extensively for over 100 years to better understand how the motor system adapts to sensory perturbations, very few studies have systematically studied how the combination of the hand used to adapt, and the direction of visual shift, might influence adaptation. Given that sensory inputs and motor outputs from the same side are processed (at least initially) in the same hemisphere, we wondered whether there might be differences in how people adapt when the hand used and the direction of visual shift were congruent (e.g., adapting to rightward shifting prisms with the right hand), compared to incongruent (e.g., adapting to rightward shifting prisms with the left hand). In Experiment 1 we re-analyzed a previously published dataset (Striemer, Enns, and Whitwell Striemer et al., Cortex 115:201-215, 2019a) in which healthy adults (n = 17) adapted to 17° leftward or rightward optically displacing prisms using their left or right hand (tested in separate sessions, counterbalanced). Our results revealed a "congruency effect" such that adaptation aftereffects were significantly larger for reaches performed without visual feedback (i.e., straight-ahead pointing) when the direction of prism shift and the hand used were congruent, compared to incongruent. We replicated this same congruency effect in Experiment 2 in a new group of participants (n = 25). We suggest that a better understanding of the cognitive and neural mechanisms underlying the congruency effect will allow researchers to build more precise models of visuomotor learning, and may lead to the development of more effective applications of prism adaptation for the treatment of attentional disorders following brain damage.

Neuropsychological and Neurophysiological Mechanisms behind Flickering Light Stimulus Processing

The aim of this review is to summarise current knowledge about flickering light and the underlying processes that occur during its processing in the brain. Despite the growing interest in the topic of flickering light, its clinical applications are still not well understood. Studies using EEG indicate an appearing synchronisation of brain wave frequencies with the frequency of flickering light, and hopefully, it could be used in memory therapy, among other applications. Some researchers have focused on using the flicker test as an indicator of arousal, which may be useful in clinical studies if the background for such a relationship is described. Since flicker testing has a risk of inducing epileptic seizures, however, every effort must be made to avoid high-risk combinations, which include, for example, red-blue light flashing at 15 Hz. Future research should focus on the usage of neuroimaging methods to describe the specific neuropsychological and neurophysiological processes occurring in the brain during the processing of flickering light so that its clinical utility can be preliminarily determined and randomised clinical trials can be initiated to test existing reports.

Machine learning methods detect arm movement impairments in a patient with parieto-occipital lesion using only early kinematic information

Patients with lesions of the parieto-occipital cortex typically misreach visual targets that they correctly perceive (optic ataxia). Although optic ataxia was described more than 30 years ago, distinguishing this condition from physiological behavior using kinematic data is still far from being an achievement. Here, combining kinematic analysis with machine learning methods, we compared the reaching performance of a patient with bilateral occipitoparietal damage with that of 10 healthy controls. They performed visually guided reaches toward targets located at different depths and directions. Using the horizontal, sagittal, and vertical deviation of the trajectories, we extracted classification accuracy in discriminating the reaching performance of patient from that of controls. Specifically, accurate predictions of the patient's deviations were detected after the 20% of the movement execution in all the spatial positions tested. This classification based on initial trajectory decoding was possible for both directional and depth components of the movement, suggesting the possibility of applying this method to characterize pathological motor behavior in wider frameworks.

Choosing Sides: Impact of Prismatic Adaptation on the Lateralization of the Attentional System

Seminal studies revealed differences between the effect of adaptation to left- vs. right-deviating prisms (L-PA, R-PA) in normal subjects. Whereas L-PA leads to neglect-like shift in attention, demonstrated in numerous visuo-spatial and cognitive tasks, R-PA has only minor effects in specific aspects of a few tasks. The paucity of R-PA effects in normal subjects contrasts with the striking alleviation of neglect symptoms in patients with right hemispheric lesions. Current evidence from activation studies in normal subjects highlights the contribution of regions involved in visuo-motor control during prism exposure and a reorganization of spatial representations within the ventral attentional network (VAN) after the adaptation. The latter depends on the orientation of prisms used. R-PA leads to enhancement of the ipsilateral visual and auditory space within the left inferior parietal lobule (IPL), switching thus the dominance of VAN from the right to the left hemisphere. L-PA leads to enhancement of the ipsilateral space in right IPL, emphasizing thus the right hemispheric dominance of VAN. Similar reshaping has been demonstrated in patients. We propose here a model, which offers a parsimonious explanation of the effect of L-PA and R-PA both in normal subjects and in patients with hemispheric lesions. The model posits that prismatic adaptation induces instability in the synaptic organization of the visuo-motor system, which spreads to the VAN. The effect is lateralized, depending on the side of prism deviation. Successful pointing with prisms implies reaching into the space contralateral, and not ipsilateral, to the direction of prism deviation. Thus, in the hemisphere contralateral to prism deviation, reach-related neural activity decreases, leading to instability of the synaptic organization, which induces a reshuffling of spatial representations in IPL. Although reshuffled spatial representations in IPL may be functionally relevant, they are most likely less efficient than regular representations and may thus cause partial dysfunction. The former explains, e.g., the alleviation of neglect symptoms after R-PA in patients with right hemispheric lesions, the latter the occurrence of neglect-like symptoms in normal subjects after L-PA. Thus, opting for R- vs. L-PA means choosing the side of major IPL reshuffling, which leads to its partial dysfunction in normal subjects and to recruitment of alternative or enhanced spatial representations in patients with hemispheric lesions.

Impaired Spatial Inhibition Processes for Interhemispheric Anti-saccades following Dorsal Posterior Parietal Lesions

Anti-saccades are eye movements that require inhibition to stop the automatic saccade to the visual target and to perform instead a saccade in the opposite direction. The inhibitory processes underlying anti-saccades have been primarily associated with frontal cortex areas for their role in executive control. Impaired performance in anti-saccades has also been associated with the parietal cortex, but its role in inhibitory processes remains unclear. Here, we tested the assumption that the dorsal parietal cortex contributes to spatial inhibition processes of contralateral visual target. We measured anti-saccade performance in 2 unilateral optic ataxia patients and 15 age-matched controls. Participants performed 90 degree (across and within visual fields) and 180 degree inversion anti-saccades, as well as pro-saccades. The main result was that our patients took longer to inhibit visually guided saccades when the visual target was presented in the ataxic hemifield and the task required a saccade across hemifields. This was observed through anti-saccades latencies and error rates. These deficits show the crucial role of the dorsal posterior parietal cortex in spatial inhibition of contralateral visual target representations to plan an accurate anti-saccade toward the ipsilesional side.

Occipital cortex is modulated by transsaccadic changes in spatial frequency: an fMRI study

Previous neuroimaging studies have shown that inferior parietal and ventral occipital cortex are involved in the transsaccadic processing of visual object orientation. Here, we investigated whether the same areas are also involved in transsaccadic processing of a different feature, namely, spatial frequency. We employed a functional magnetic resonance imaging paradigm where participants briefly viewed a grating stimulus with a specific spatial frequency that later reappeared with the same or different frequency, after a saccade or continuous fixation. First, using a whole-brain Saccade > Fixation contrast, we localized two frontal (left precentral sulcus and right medial superior frontal gyrus), four parietal (bilateral superior parietal lobule and precuneus), and four occipital (bilateral cuneus and lingual gyri) regions. Whereas the frontoparietal sites showed task specificity, the occipital sites were also modulated in a saccade control task. Only occipital cortex showed transsaccadic feature modulations, with significant repetition enhancement in right cuneus. These observations (parietal task specificity, occipital enhancement, right lateralization) are consistent with previous transsaccadic studies. However, the specific regions differed (ventrolateral for orientation, dorsomedial for spatial frequency). Overall, this study supports a general role for occipital and parietal cortex in transsaccadic vision, with a specific role for cuneus in spatial frequency processing.

The posterior parietal cortex processes visuo-spatial and extra-retinal information for saccadic remapping: A case study

Optimally collecting information and controlling behaviour require that we constantly scan our visual environment through eye movements. How the dynamic interaction between short-lived retinal images and extra-retinal signals of eye motion results in our subjective experience of visual stability remains a major issue in Cognitive Neuroscience. The present study aimed to assess and determine the nature of the contribution of the posterior parietal cortex (PPC) to the saccadic remapping mechanisms which contribute to such perceptual visual constancy. Perceptual responses in transsaccadic visual localization tasks were measured in a patient presenting with a PPC lesion and manifesting optic ataxia in the left hemifield with no neglect. Two perceptual localization tasks, each with versus without an intervening saccade, were used: the saccadic suppression of displacement (SSD) task (Ostendorf, Liebermann, & Ploner, 2010) and the peri-saccadic flash localization (LOC) task (Zimmerman & Lappe, 2010). Compared to a group of age-matched healthy subjects, the patient showed a specific pattern of perceptual deficits in the ataxic (left) hemifield. First, a significant impairment occurred in the stationary eye conditions, attesting for an alteration of visuo-spatial encoding. Second, in the saccade conditions, an additional perceptual deficit (an error of ~5° along the saccade direction) was observed in both tasks and mainly in conditions where extra-retinal signals are thought to be critically involved, revealing a constant underestimation by extra-retinal signals of the saccade size, despite preserved saccade accuracy. These findings highlight a crucial role of the PPC in saccadic remapping processes underlying perceptual visual constancy and provide empirical evidence for models such as Ziesche and Hamker's (2014).

Reaching movements are automatically redirected to nearby options during target split

Motor behavior often occurs in environments with multiple goal options that can vary during the ongoing action. We explored this situation by requiring subjects to select between different target options during an ongoing reach. During split trials the original target was replaced with a left and a right flanking target, and participants had to select between them. This contrasted with the standard jump trials, where the original target would be replaced with a single flanking target, left or right. When participants were instructed to follow their natural tendency, they all tended to select the split target nearest the original. The near-target preference was more prominent with increased spatial disparity between the options and when participants could preview the potential options. Moreover, explicit instruction to obtain the "far" target during split trials resulted many errors compared with a "near" instruction, ~50% vs. ~15%. Online reaction times to target change were delayed in split trials compared with jump trials, ~200 ms vs. ~150 ms, but also highly automatic. Trials in which the instructed far target was correctly obtained were delayed by a further ~50 ms, unlike those in which the near target was incorrectly obtained. We also observed nonspecific responses from arm muscles at the jump trial latency during split trials. Taken together, our results indicate that online selection of reach targets is automatically linked to the spatial distribution of the options, though at greater delays than redirecting to a single target.NEW & NOTEWORTHY This work demonstrates that target selection during an ongoing reach is automatically linked to the option nearest a voided target. Online reaction times for two options are longer than redirection to a single option. Attempts to override the near-target tendency result in a high number of errors at the normal delay and further delays when the attempt is successful.

Bimanual visually guided movements are more than the sum of their parts: Evidence from optic ataxia

Many reaching actions involve both hands. An open question is whether two-handed reaching involves two simultaneous, independent unimanual reaches, or recruits additional or different processes than those mediating one-handed reaching. We tested optic ataxic patient MDK on a set of unimanual and bimanual reaching tasks. Although MDK was impaired in both types of reaching task, his bimanual reaching was considerably better than his unimanual reaching. These results imply that bimanual reaching involves different or additional processes relative to unimanual reaching. We suggest that bimanual reaching may involve monitoring of the distance between the two hands relative to the distance between the two targets.

Impairments in action and perception after right intraparietal damage

We examined visually-guided reaching and perception in an individual who underwent resection of a small tumor in right intraparietal sulcus (pIPS). In the first experiment, she reached to targets presented on a touch screen. Vision was occluded from reach onset on half of the trials, whereas on the other half she had vision during the entire reach. For visually-guided reaching, she demonstrated significantly more reach errors for targets left of fixation versus right of fixation. However, there were no hemispatial differences when reaching without vision. Furthermore, her performance was consistent for reaches with either hand, providing evidence that pIPS encodes location based on an eye-centered reference frame. Second, previous studies reported that optic ataxics are more accurate when reaching to remembered versus visible target locations. We repeated the first experiment, adding a five second delay between stimulus presentation and reach initiation. In contrast to prior reports, she was less accurate in delayed versus immediate reaching. Finally, we examined whether a small pIPS resection would disrupt visuospatial processing in a simple perceptual task. We presented two small circles in succession in either the same location or offset at varying distances, and asked whether the two circles were presented in the same or different position. She was significantly more impaired left of fixation compared to right of fixation, providing evidence for a perceptual deficit after a dorsal stream lesion.

Optic ataxia: beyond the dorsal stream cliché

This chapter reviews clinical and scientific approaches to optic ataxia. This double historic track allows us to address important issues such as the link between Bálint syndrome and optic ataxia, the alleged double dissociation between optic ataxia and visual agnosia, and the use of optic ataxia to argue for a specific vision-for-action occipitoposterior parietal stream. Clinical cases are described and reveal that perceptual deficits have been long shown to accompany ataxia. Importantly, the term ataxia appears to be misleading as patients exhibit a combination of visual and nonvisual perceptual, attentional, and visuomotor guidance deficits, which are confirmed by experimental approaches. Three major features of optic ataxia are described. The first is a spatial feature whereby the deficits exhibited by patients appear to be specific to peripheral vision, akin to the field effect. Visuomotor field examination allows us to quantify this deficit and reveals that it consists of a highly reliable retinocentric hypometria. The third is a temporal feature whereby these deficits are exacerbated under temporal constraints, i.e., when attending to dynamic stimuli. These two aspects combine in a situation where patients have to quickly respond to a target presented in peripheral vision that is experimentally displaced upon movement onset. In addition to the field effect, a hand effect can be described in conditions where the hand is not visible. Spatial and temporal aspects as well as field and hand effects may rely on several posterior parietal modules that remain to be precisely identified both anatomically and functionally. It is concluded that optic ataxia is not a visuomotor deficit and there is no dissociation between perception and action capacities in optic ataxia, hence a fortiori no double dissociation between optic ataxia and visual agnosia. Future directions for understanding the basic pathophysiology of optic ataxia are proposed.

The Pointing Errors in Optic Ataxia Reveal the Role of "Peripheral Magnification" of the PPC

Interaction with visual objects in the environment requires an accurate correspondence between visual space and its internal representation within the brain. Many clinical conditions involve some impairment in visuo-motor control and the errors created by the lesion of a specific brain region are neither random nor uninformative. Modern approaches to studying the neuropsychology of action require powerful data-driven analyses and error modeling in order to understand the function of the lesioned areas. In the present paper we carried out mixed-effect analyses of the pointing errors of seven optic ataxia patients and seven control subjects. We found that a small parameter set is sufficient to explain the pointing errors produced by unilateral optic ataxia patients. In particular, the extremely stereotypical errors made when pointing toward the contralesional visual field can be fitted by mathematical models similar to those used to model central magnification in cortical or sub-cortical structure(s). Our interpretation is that visual areas that contain this footprint of central magnification guide pointing movements when the posterior parietal cortex (PPC) is damaged and that the functional role of the PPC is to actively compensate for the under-representation of peripheral vision that accompanies central magnification. Optic ataxia misreaching reveals what would be hand movement accuracy and precision if the human motor system did not include elaborated corrective processes for reaching and grasping to non-foveated targets.

Adaptation of Saccadic Sequences with and without Remapping

It is relatively easy to adapt visually-guided saccades because the visual vector and the saccade vector match. The retinal error at the saccade landing position is compared to the prediction error, based on target location and efference copy. If these errors do not match, planning processes at the level(s) of the visual and/or motor vector processing are assumed to be inaccurate and the saccadic response is adjusted. In the case of a sequence of two saccades, the final error can be attributed to the last saccade vector or to the entire saccadic displacement. Here, we asked whether and how adaptation can occur in the case of remapped saccades, such as during the classic double-step saccade paradigm, where the visual and motor vectors of the second saccade do not coincide and so the attribution of error is ambiguous. Participants performed saccades sequences to two targets briefly presented prior to first saccade onset. The second saccade target was either briefly re-illuminated (sequential visually-guided task) or not (remapping task) upon first saccade offset. To drive adaptation, the second target was presented at a displaced location (backward or forward jump condition or control-no jump) at the end of the second saccade. Pre- and post-adaptation trials were identical, without the re-appearance of the target after the second saccade. For the 1st saccade endpoints, there was no change as a function of adaptation. For the 2nd saccade, there was a similar increase in gain in the forward jump condition (52% and 61% of target jump) in the two tasks, whereas the gain decrease in the backward condition was much smaller for the remapping task than for the sequential visually-guided task (41% vs. 94%). In other words, the absolute gain change was similar between backward and forward adaptation for remapped saccades. In conclusion, we show that remapped saccades can be adapted, suggesting that the error is attributed to the visuo-motor transformation of the remapped visual vector. The mechanisms by which adaptation takes place for remapped saccades may be similar to those of forward sequential visually-guided saccades, unlike those involved in adaptation for backward sequential visually-guided saccades.

Motor Preparation of Manual Aiming at a Visual Target Manipulated in Size, Luminance Contrast, and Location

We conducted two experiments to investigate whether the motor preparation of manual aiming to a visual target is affected by either the physical characteristics (size or luminance contrast) or spatial characteristics (location) of the target. Reaction time (RT) of both finger lifting (ie stimulus-detection time) and manual aiming (ie movement-triggering time) to the onset of the target was measured. The difference of RT (DRT) between two tasks (ie the difference of task complexity) was examined to clarify the temporal characteristics of manual aiming per se during visuomotor integration. Results show classical characteristics: RT decreased as either the target size or luminance contrast increased. Furthermore, the task-complexity and target-location factors significantly interacted with each other, where the aiming RT was longer than the finger-lifting RT and the effects of target location on RT differed for each task. However, the task factor did not interact with either the size or luminance-contrast factor, implying that the motor preparation of manual aiming is associated with the spatial characteristics rather than the physical characteristics of the target. Inspection of DRT revealed that the time needed for motor preparation for an ipsilateral target was significantly shorter than that for a contralateral target. This was the case both for the left and for the right hand. Foveal targets required longer processing time, implying a disadvantageous function of motor preparation for the gazed target. The left-hand superiority for the target appearing in the left visual field was also observed. Such lateralised effect and left-hand advantage to the left visual field in manual aiming suggest that visuospatial information processing is activated during the preparation of aiming action, with faster processing in the right hemisphere.

No effect of delay on the spatial representation of serial reach targets

When reaching for remembered target locations, it has been argued that the brain primarily relies on egocentric metrics and especially target position relative to gaze when reaches are immediate, but that the visuo-motor system relies stronger on allocentric (i.e., object-centered) metrics when a reach is delayed. However, previous reports from our group have shown that reaches to single remembered targets are represented relative to gaze, even when static visual landmarks are available and reaches are delayed by up to 12 s. Based on previous findings which showed a stronger contribution of allocentric coding in serial reach planning, the present study aimed to determine whether delay influences the use of a gaze-dependent reference frame when reaching to two remembered targets in a sequence after a delay of 0, 5 or 12 s. Gaze was varied relative to the first and second target and shifted away from the target before each reach. We found that participants used egocentric and allocentric reference frames in combination with a stronger reliance on allocentric information regardless of whether reaches were executed immediately or after a delay. Our results suggest that the relative contributions of egocentric and allocentric reference frames for spatial coding and updating of sequential reach targets do not change with a memory delay between target presentation and reaching.

Optic ataxia: from Balint's syndrome to the parietal reach region

Optic ataxia is a high-order deficit in reaching to visual goals that occurs with posterior parietal cortex (PPC) lesions. It is a component of Balint's syndrome that also includes attentional and gaze disorders. Aspects of optic ataxia are misreaching in the contralesional visual field, difficulty preshaping the hand for grasping, and an inability to correct reaches online. Recent research in nonhuman primates (NHPs) suggests that many aspects of Balint's syndrome and optic ataxia are a result of damage to specific functional modules for reaching, saccades, grasp, attention, and state estimation. The deficits from large lesions in humans are probably composite effects from damage to combinations of these functional modules. Interactions between these modules, either within posterior parietal cortex or downstream within frontal cortex, may account for more complex behaviors such as hand-eye coordination and reach-to-grasp.

Decoupled visually-guided reaching in optic ataxia: differences in motor control between canonical and non-canonical orientations in space

Guiding a limb often involves situations in which the spatial location of the target for gaze and limb movement are not congruent (i.e. have been decoupled). Such decoupled situations involve both the implementation of a cognitive rule (i.e. strategic control) and the online monitoring of the limb position relative to gaze and target (i.e. sensorimotor recalibration). To further understand the neural mechanisms underlying these different types of visuomotor control, we tested patient IG who has bilateral caudal superior parietal lobule (SPL) damage resulting in optic ataxia (OA), and compared her performance with six age-matched controls on a series of center-out reaching tasks. The tasks comprised 1) directing a cursor that had been rotated (180° or 90°) within the same spatial plane as the visual display, or 2) moving the hand along a different spatial plane than the visual display (horizontal or para-sagittal). Importantly, all conditions were performed towards visual targets located along either the horizontal axis (left and right; which can be guided from strategic control) or the diagonal axes (top-left and top-right; which require on-line trajectory elaboration and updating by sensorimotor recalibration). The bilateral OA patient performed much better in decoupled visuomotor control towards the horizontal targets, a canonical situation in which well-categorized allocentric cues could be utilized (i.e. guiding cursor direction perpendicular to computer monitor border). Relative to neurologically intact adults, IG's performance suffered towards diagonal targets, a non-canonical situation in which only less-categorized allocentric cues were available (i.e. guiding cursor direction at an off-axis angle to computer monitor border), and she was therefore required to rely on sensorimotor recalibration of her decoupled limb. We propose that an intact caudal SPL is crucial for any decoupled visuomotor control, particularly when relying on the realignment between vision and proprioception without reliable allocentric cues towards non-canonical orientations in space.

Testing for optic ataxia in a blind field

Optic ataxia is a component of Balint's syndrome and is a disorder that results from damage to the posterior parietal cortex (PPC) leading to deficits in reaching and grasping objects presented in the visual field opposite to the damaged hemisphere. It is also often the case that Balint's syndrome is accompanied by visual field defects due to the proximity of parietal and occipital cortices and also due to the subcortical pathway relaying visual information from the retina to the visual cortex passing underneath the parietal cortex. The presence of primary visual defects such as hemianopia often prevents clinicians from diagnosing higher-level visual deficits such as optic ataxia; the patient cannot reach to targets he/she cannot see. Here, we show that through the use of a paradigm that takes advantage of remapping mechanisms, we were able to observe optic ataxia in the blind field. We measured reach endpoints of a patient presenting with left optic ataxia as well as a quadrantanopia in the left lower visual field in eye-static and eye-dynamic conditions. In static conditions, we first asked the patient to reach to targets viewed in her non-optic ataxic intact right visual field (fixating on the left of the target array). In this case, the patient showed undershoots equivalent to controls. Next, we asked her to reach to (the same) targets viewed in the upper left optic ataxic but intact visual field (fixating to the right of the target array). The undershooting pattern increased greatly, consistent with unilateral left optic ataxia. In dynamic conditions, we asked her to view targets in her good (right lower) visual field before reorienting her line of sight to the opposite side, causing the internal representation of the target to be updated into the opposite (ataxic) blind visual field. The patient then reached to the remembered (and updated) location of the target. We found errors typical of optic ataxia for reaches guided toward the quadrantanopic field. This confirmed that reaching errors depended on the updated internal representation of the target and not on where the target was viewed initially. In both the patient and the controls, the updating of target location was partial, with reaching errors observed subsequent to an eye movement made from left to right fixation positions being intermediate between the left and right static conditions. Thus, using this remapping paradigm, we were able to observe optic ataxia in the blind field. In conclusion, this remapping paradigm would allow clinicians to test for visuo-manual transformation deficits (optic ataxia) even when it is associated with hemianopia.

Role of posterior parietal cortex in reaching movements in humans: clinical implication for 'optic ataxia'

OBJECTIVE

To clarify the spatio-temporal profile of cortical activity related to reaching movement in the posterior parietal cortex (PPC) in humans.

METHODS

Four patients with intractable partial epilepsy who underwent subdural electrode implantation were studied as a part of pre-surgical evaluation. We investigated the Bereitschaftspotential (BP) associated with reaching and correlated the findings with the effect of electrical stimulation of the same cortical area.

RESULTS

BPs specific for reaching, as compared with BPs for simple movements by the hand or arm contralateral to the implanted hemisphere, were recognized in all patients, mainly around the intraparietal sulcus (IPS), the superior parietal lobule (SPL) and the precuneus. BPs near the IPS had the earlier onset than BPs in the SPL. Electrical stimulation of a part of the PPC, where the reach-specific BPs were recorded, selectively impaired reaching.

CONCLUSIONS

Intracranial BP recording and cortical electrical stimulation delineated human reach-related areas in the PPC.

SIGNIFICANCE

The present study for the first time by direct cortical recording in humans demonstrates that parts of the cortices around the IPS and SPL play a crucial role in visually-guided reaching.

Guidelines and quality measures for the diagnosis of optic ataxia

Since the first description of a systematic mis-reaching by Bálint in 1909, a reasonable number of patients showing a similar phenomenology, later termed optic ataxia (OA), has been described. However, there is surprising inconsistency regarding the behavioral measures that are used to detect OA in experimental and clinical reports, if the respective measures are reported at all. A typical screening method that was presumably used by most researchers and clinicians, reaching for a target object in the peripheral visual space, has never been evaluated. We developed a set of instructions and evaluation criteria for the scoring of a semi-standardized version of this reaching task. We tested 36 healthy participants, a group of 52 acute and chronic stroke patients, and 24 patients suffering from cerebellar ataxia. We found a high interrater reliability and a moderate test-retest reliability comparable to other clinical instruments in the stroke sample. The calculation of cut-off thresholds based on healthy control and cerebellar patient data showed an unexpected high number of false positives in these samples due to individual outliers that made a considerable number of errors in peripheral reaching. This study provides first empirical data from large control and patient groups for a screening procedure that seems to be widely used but rarely explicitly reported and prepares the grounds for its use as a standard tool for the description of patients who are included in single case or group studies addressing optic ataxia similar to the use of neglect, extinction, or apraxia screening tools.

Waiting for a hand: saccadic reaction time increases in proportion to hand reaction time when reaching under a visuomotor reversal

Although eye movement onset typically precedes hand movement onset when reaching to targets presented in peripheral vision, arm motor commands appear to be issued at around the same time, and possibly in advance, of eye motor commands. A fundamental question, therefore, is whether eye movement initiation is linked or yoked to hand movement. We addressed this issue by having participants reach to targets after adapting to a visuomotor reversal (or 180° rotation) between the position of the unseen hand and the position of a cursor controlled by the hand. We asked whether this reversal, which we expected to increase hand reaction time (HRT), would also increase saccadic reaction time (SRT). As predicted, when moving the cursor to targets under the reversal, HRT increased in all participants. SRT also increased in all but one participant, even though the task for the eyes—shifting gaze to the target—was unaltered by the reversal of hand position feedback. Moreover, the effects of the reversal on SRT and HRT were positively correlated across participants; those who exhibited the greatest increases in HRT also showed the greatest increases in SRT. These results indicate that the mechanisms underlying the initiation of eye and hand movements are linked. In particular, the results suggest that the initiation of an eye movement to a manual target depends, at least in part, on the specification of hand movement.

Inactivation of the parietal reach region causes optic ataxia, impairing reaches but not saccades

Lesions in human posterior parietal cortex can cause optic ataxia (OA), in which reaches but not saccades to visual objects are impaired, suggesting separate visuomotor pathways for the two effectors. In monkeys, one potentially crucial area for reach control is the parietal reach region (PRR), in which neurons respond preferentially during reach planning as compared to saccade planning. However, direct causal evidence linking the monkey PRR to the deficits observed in OA is missing. We thus inactivated part of the macaque PRR, in the medial wall of the intraparietal sulcus, and produced the hallmarks of OA, misreaching for peripheral targets but unimpaired saccades. Furthermore, reach errors were larger for the targets preferred by the neural population local to the injection site. These results demonstrate that PRR is causally involved in reach-specific visuomotor pathways, and reach goal disruption in PRR can be a neural basis of OA.

Behavioral investigation on the frames of reference involved in visuomotor transformations during peripheral arm reaching

BACKGROUND

Several psychophysical experiments found evidence for the involvement of gaze-centered and/or body-centered coordinates in arm-movement planning and execution. Here we aimed at investigating the frames of reference involved in the visuomotor transformations for reaching towards visual targets in space by taking target eccentricity and performing hand into account.

METHODOLOGY/PRINCIPAL FINDINGS

We examined several performance measures while subjects reached, in complete darkness, memorized targets situated at different locations relative to the gaze and/or to the body, thus distinguishing between an eye-centered and a body-centered frame of reference involved in the computation of the movement vector. The errors seem to be mainly affected by the visual hemifield of the target, independently from its location relative to the body, with an overestimation error in the horizontal reaching dimension (retinal exaggeration effect). The use of several target locations within the perifoveal visual field allowed us to reveal a novel finding, that is, a positive linear correlation between horizontal overestimation errors and target retinal eccentricity. In addition, we found an independent influence of the performing hand on the visuomotor transformation process, with each hand misreaching towards the ipsilateral side.

CONCLUSIONS

While supporting the existence of an internal mechanism of target-effector integration in multiple frames of reference, the present data, especially the linear overshoot at small target eccentricities, clearly indicate the primary role of gaze-centered coding of target location in the visuomotor transformation for reaching.

A test revealing the slow acquisition and the dorsal stream substrate of visuo-spatial perception

We propose a battery of simple clinical tests to assess the development of elementary visuo-spatial perception. We postulate that most of the tasks we selected rely on the visual dorsal stream, although the dual-stream theory (Milner & Goodale, 1995) discards the role of the dorsal stream for visual perception. In order to test the contribution of this anatomical substrate in visuo-spatial perception, we evaluated the performance of two adult patients with acquired bilateral occipito-parietal (dorsal stream) damage. Additionally, the developmental evolution was assessed by testing 96 children from 4 to 12 years old (4 two-year age groups of 24 children). In order to determine the point at which children achieved adult performance, and to provide a control group for the two patients, we also tested a group of 14 healthy adults. The results highlighted the necessity for age-dependent normative values: adult performance was achieved only at the age of 8 for length and size comparisons and at 12 for dot localisation. In contrast, the ability to judge angles and midlines did not reach adult performance even in the oldest group of children, suggesting further acquisition through adolescence. Occipito-parietal lesions strongly and differentially affected elementary visuo-spatial tasks. In overall scores, the two adult patients were approximately at the level of 6-year olds, below the outlier limit of the adult group. They were on average within the adult interquartile range for processing length and size but clearly outside for the 4 other subtests (Angle, Midline, Position perception and Position selection). As a whole, these data both shed light on the neuroanatomical bases of visuo-spatial perception and allow for age-specific comparisons in children with developmental disorders potentially linked to visuo-spatial and/or attentional defects.

The role of the caudal superior parietal lobule in updating hand location in peripheral vision: further evidence from optic ataxia

Patients with optic ataxia (OA), who are missing the caudal portion of their superior parietal lobule (SPL), have difficulty performing visually-guided reaches towards extra-foveal targets. Such gaze and hand decoupling also occurs in commonly performed non-standard visuomotor transformations such as the use of a computer mouse. In this study, we test two unilateral OA patients in conditions of 1) a change in the physical location of the visual stimulus relative to the plane of the limb movement, 2) a cue that signals a required limb movement 180° opposite to the cued visual target location, or 3) both of these situations combined. In these non-standard visuomotor transformations, the OA deficit is not observed as the well-documented field-dependent misreach. Instead, OA patients make additional eye movements to update hand and goal location during motor execution in order to complete these slow movements. Overall, the OA patients struggled when having to guide centrifugal movements in peripheral vision, even when they were instructed from visual stimuli that could be foveated. We propose that an intact caudal SPL is crucial for any visuomotor control that involves updating ongoing hand location in space without foveating it, i.e. from peripheral vision, proprioceptive or predictive information.

Three-dimensional transformations for goal-directed action

Much of the central nervous system is involved in visuomotor transformations for goal-directed gaze and reach movements. These transformations are often described in terms of stimulus location, gaze fixation, and reach endpoints, as viewed through the lens of translational geometry. Here, we argue that the intrinsic (primarily rotational) 3-D geometry of the eye-head-reach systems determines the spatial relationship between extrinsic goals and effector commands, and therefore the required transformations. This approach provides a common theoretical framework for understanding both gaze and reach control. Combined with an assessment of the behavioral, neurophysiological, imaging, and neuropsychological literature, this framework leads us to conclude that (a) the internal representation and updating of visual goals are dominated by gaze-centered mechanisms, but (b) these representations must then be transformed as a function of eye and head orientation signals into effector-specific 3-D movement commands.

Sign language and pantomime production differentially engage frontal and parietal cortices

We investigated the functional organization of neural systems supporting language production when the primary language articulators are also used for meaningful, but non-linguistic, expression such as pantomime. Fourteen hearing non-signers and 10 deaf native users of American Sign Language (ASL) participated in an H(2) (15)O-PET study in which they generated action pantomimes or ASL verbs in response to pictures of tools and manipulable objects. For pantomime generation, participants were instructed to "show how you would use the object." For verb generation, signers were asked to "generate a verb related to the object." The objects for this condition were selected to elicit handling verbs that resemble pantomime (e.g., TO-HAMMER (hand configuration and movement mimic the act of hammering) and non-handling verbs that do not (e.g., POUR-SYRUP, produced with a "Y" handshape). For the baseline task, participants viewed pictures of manipulable objects and an occasional non-manipulable object and decided whether the objects could be handled, gesturing "yes" (thumbs up) or "no" (hand wave). Relative to baseline, generation of ASL verbs engaged left inferior frontal cortex, but when non-signers produced pantomimes for the same objects, no frontal activation was observed. Both groups recruited left parietal cortex during pantomime production. However, for deaf signers the activation was more extensive and bilateral, which may reflect a more complex and integrated neural representation of hand actions. We conclude that the production of pantomime versus ASL verbs (even those that resemble pantomime) engage partially segregated neural systems that support praxic versus linguistic functions.

Right-hemispheric dominance for visual remapping in humans

We review evidence showing a right-hemispheric dominance for visuo-spatial processing and representation in humans. Accordingly, visual disorganization symptoms (intuitively related to remapping impairments) are observed in both neglect and constructional apraxia. More specifically, we review findings from the intervening saccade paradigm in humans--and present additional original data--which suggest a specific role of the asymmetrical network at the temporo-parietal junction (TPJ) in the right hemisphere in visual remapping: following damage to the right dorsal posterior parietal cortex (PPC) as well as part of the corpus callosum connecting the PPC to the frontal lobes, patient OK in a double-step saccadic task exhibited an impairment when the second saccade had to be directed rightward. This singular and lateralized deficit cannot result solely from the patient's cortical lesion and, therefore, we propose that it is due to his callosal lesion that may specifically interrupt the interhemispheric transfer of information necessary to execute accurate rightward saccades towards a remapped target location. This suggests a specialized right-hemispheric network for visuo-spatial remapping that subsequently transfers target location information to downstream planning regions, which are symmetrically organized.

Dissociation between intentional and automatic remapping: different levels of inter-hemispheric transfer

In order to efficiently interact with our environment we need to constantly to update the spatial representation of visual targets for movement. This is required not only when we move our eyes but also when we want to reach toward a location different from the actual physical target (for example symmetrical). These two types of remapping are very different in nature, one being automatic, and the other intentional. However, they both have been shown to involve the posterior parietal cortex (PPC). To further investigate the role of this brain region in automatic and intentional remapping processes and the level of inter-hemispheric transfer of visuo-motor information in these two conditions of reaching, we tested two patients with unilateral optic ataxia (OA) in two different tasks: reaching to a memorised visual target after an intervening eye movement (trans-saccadic remapping) and an anti-reaching task. We showed that lesions of the PPC had different implications for these two tasks. In the trans-saccadic remapping task, movements toward the contralesional field were disrupted, even when the visual target was presented in the ipsilesional field. In contrast, in the anti-reaching task, the patients were mostly impaired in conditions where the target was presented in the contralesional field, even if the movement was executed toward the ipsilesional field. We postulate that the transfer of the visuo-motor information between hemispheres occurs before the parietal cortex in trans-saccadic remapping (transfer of visual information), and at the parietal level or after in anti-reaching (transfer of visuo-motor information).

Gaze-centered spatial updating of reach targets across different memory delays

Previous research has demonstrated that remembered targets for reaching are coded and updated relative to gaze, at least when the reaching movement is made soon after the target has been extinguished. In this study, we want to test whether reach targets are updated relative to gaze following different time delays. Reaching endpoints systematically varied as a function of gaze relative to target irrespective of whether the action was executed immediately or after a delay of 5 s, 8 s or 12 s. The present results suggest that memory traces for reach targets continue to be coded in a gaze-dependent reference frame if no external cues are present.

Human posterior parietal cortex flexibly determines reference frames for reaching based on sensory context

Current models of sensorimotor transformations emphasize the dominant role of gaze-centered representations for reach planning in the posterior parietal cortex (PPC). Here we exploit fMRI repetition suppression to test whether the sensory modality of a target determines the reference frame used to define the motor goal in the PPC and premotor cortex. We show that when targets are defined visually, the anterior precuneus selectively encodes the motor goal in gaze-centered coordinates, whereas the parieto-occipital junction, Brodman Area 5 (BA 5), and PMd use a mixed gaze- and body-centered representation. In contrast, when targets are defined by unseen proprioceptive cues, activity in these areas switches to represent the motor goal predominantly in body-centered coordinates. These results support computational models arguing for flexibility in reference frames for action according to sensory context. Critically, they provide neuroanatomical evidence that flexibility is achieved by exploiting a multiplicity of reference frames that can be expressed within individual areas.