Disorders of perceived auditory lateralization after lesions of the right hemisphere

The Neuropsychological Assessment of Unilateral Spatial Neglect Through Computerized and Virtual Reality Tools: A Scoping Review

Unilateral Spatial Neglect is a disabling neuropsychological deficit. Patients with spatial neglect fail to detect and report events, and to perform actions in the side of space contralateral to a hemispheric cerebral lesion. Neglect is assessed by evaluating the patients' abilities in daily life activities and by psychometric tests. Computer-based, portable and Virtual Reality technologies may provide more and precise data, and be more sensitive and informative, compared to current paper-and-pencil procedures. Studies since 2010, in which such technologies have been used, are reviewed. Forty-two articles meeting inclusion criteria are categorized according to their technological approaches (computer-, graphics tablet or tablet-, virtual reality-based assessment, and other). The results are promising. However, a definite golden standard, technologically based procedure cannot be still established. Developing technologically based tests is a laborious process, which requires technical and user experience improvements as well as normative data, to increase the evidence of efficacy for clinical evaluation of at least some of the tests considered in this review.

Perceptual and Electrophysiological Correlates of Fixed Versus Moving Sound Source Lateralization

Purpose The aims of the study were (a) to evaluate the effects of systematically varied factors of stimulus duration, interaural-level difference (ILD), and direction on perceptual and electrophysiological metrics of lateralization for fixed versus moving targets and (b) to evaluate the hemispheric activity underlying perception of fixed versus moving auditory targets. Method Twelve normal-hearing, young adult listeners were evaluated using perceptual and P300 tests of lateralization. Both perceptual and P300 tests utilized stimuli that varied for type (fixed and moving), direction (right and left), duration (100 and 500 ms), and magnitude of ILD (9 and 18 dB). Listeners provided laterality judgments and stimulus-type discrimination (fixed vs. moving) judgments for all combinations of acoustic factors. During P300 recordings, listeners discriminated between left- versus right-directed targets, as the other acoustic parameters were varied. Results ILD magnitude and stimulus type had statistically significant effects on laterality ratings, with larger magnitude ILDs and fixed type resulting in greater lateralization. Discriminability between fixed versus moving targets was dependent on stimulus duration and ILD magnitude. ILD magnitude was a significant predictor of P300 amplitude. There was a statistically significant inverse relationship between the perceived velocity of targets and P300 latency. Lateralized targets evoked contralateral hemispheric P300 activity. Moreover, a right-hemisphere enhancement was observed for fixed-type lateralized deviant stimuli. Conclusions Perceptual and P300 findings indicate that lateralization of auditory movement is highly dependent on temporal integration. Both the behavioral and physiological findings of this study suggest that moving auditory targets with ecologically valid velocities are processed by the central auditory nervous system within a window of temporal integration that is greater than that for fixed auditory targets. Furthermore, these findings lend support for a left hemispatial perceptual bias and right hemispheric dominance for spatial listening.

Effects of prism adaptation on auditory spatial attention in patients with left unilateral spatial neglect: a non-randomized pilot trial

A short period of adaptation to a prismatic shift of the visual field to the right briefly but significantly improves left unilateral spatial neglect. Additionally, prism adaptation affects multiple modalities, including processes of vision, auditory spatial attention, and sound localization. This non-randomized, single-center, controlled trial aimed to examine the immediate effects of prism adaptation on the sound-localization abilities of patients with left unilateral spatial neglect using a simple source localization test. Subjects were divided by self-allocation into a prism-adaptation group (n = 11) and a control group (n = 12). At baseline, patients with left unilateral spatial neglect showed a rightward deviation tendency in the left space. This tendency to right-sided bias in the left space was attenuated after prism adaptation. However, no changes were observed in the right space of patients with left unilateral spatial neglect after prism adaptation, or in the control group. Our results suggest that prism adaptation improves not only vision and proprioception but also auditory attention in the left space of patients with left unilateral spatial neglect. Our findings demonstrate that a single session of prism adaptation can significantly improve sound localization in patients with left unilateral spatial neglect. However, in this study, it was not possible to accurately determine whether the mechanism was a chronic change in head orientation or a readjustment of the spatial representation of the brain; thus, further studies need to be considered.

Prisms adaptation improves haptic object discrimination in hemispatial neglect

Neglect manifestations are typically explored in the visual modality. Although they are less commonly investigated tactile deficits also exist, and the aim of this study was to explore neglect in this modality. A haptic object discrimination task was designed to assess whether or not shape perception is impaired in seven right brain damaged patients with or without neglect. Each patient's performance on the object discrimination task was assessed before and after a brief period of prism adaptation, a bottom-up rehabilitation technique known to improve neglect symptoms. The results suggest that a haptic deficit - in the form of substantially more left errors - is present only in patients with neglect. Following prism adaptation, the left bias error rates in neglect patients were substantially reduced, and were similar to those observed in patients without neglect. Moreover, the haptic processing of the right side of objects also improved slightly. This finding suggests an expansion of the effects of prism adaptation to the unexposed, tactile modality supporting the cross-modal central effect hypothesis.

Transcranial direct current stimulation of posterior temporal cortex modulates electrophysiological correlates of auditory selective spatial attention in posterior parietal cortex

Speech perception in "cocktail-party" situations, in which a sound source of interest has to be extracted out of multiple irrelevant sounds, poses a remarkable challenge to the human auditory system. Studies on structural and electrophysiological correlates of auditory selective spatial attention revealed critical roles of the posterior temporal cortex and the N2 event-related potential (ERP) component in the underlying processes. Here, we explored effects of transcranial direct current stimulation (tDCS) to posterior temporal cortex on neurophysiological correlates of auditory selective spatial attention, with a specific focus on the N2. In a single-blind, sham-controlled crossover design with baseline and follow-up measurements, monopolar anodal and cathodal tDCS was applied for 16 min to the right posterior superior temporal cortex. Two age groups of human subjects, a younger (n = 20; age 18-30 yrs) and an older group (n = 19; age 66-77 yrs), completed an auditory free-field multiple-speakers localization task while ERPs were recorded. The ERP data showed an offline effect of anodal, but not cathodal, tDCS immediately after DC offset for targets contralateral, but not ipsilateral, to the hemisphere of tDCS, without differences between groups. This effect mainly consisted in a substantial increase of the N2 amplitude by 0.9 μV (SE 0.4 μV; d = 0.40) compared with sham tDCS. At the same point in time, cortical source localization revealed a reduction of activity in ipsilateral (right) posterior parietal cortex. Also, localization error was improved after anodal, but not cathodal, tDCS. Given that both the N2 and the posterior parietal cortex are involved in processes of auditory selective spatial attention, these results suggest that anodal tDCS specifically enhanced inhibitory attentional brain processes underlying the focusing onto a target sound source, possibly by improved suppression of irrelevant distracters.

Association between prism adaptation and auditory cues on spatial navigation in individuals with unilateral neglect

BACKGROUND

Unilateral neglect is common among right-hemispheric stroke individuals and also concerns the auditory modality. Prism adaptation can improve auditory extinction during a dichotic listening task, but its effect during an ecological task has not been studied.

OBJECTIVE

The main objective was to evaluate whether lateralized cueing before and after prism adaptation improved virtual spatial navigation of stroke individuals with visual and auditory unilateral neglect. Secondary objectives were to assess spatial memory and obtain a better understanding of the mechanism of the cueing treatment by using an eye-tracker.

METHODS

We included 22 stroke individuals with left visual and auditory neglect, 14 individuals without neglect, and 12 healthy controls. After a familiarization task, participants underwent 3 evaluation sessions. Participants were first passively shown a path that they had then to actively reproduce by using a joystick. A path with lateralized beeping sounds indicating direction and a path without any sounds were followed in a randomized order. After prism adaptation, the participants followed a third path with lateralized beeping sounds. The time of navigation and number of trajectory mistakes were recorded. After navigation, spatial memory was assessed. Additionally, an eye-tracker was used during the navigation period.

RESULTS

The navigational performance of participants with neglect was significantly better with than without auditory cues, especially after prism adaptation. With auditory cues, participants without neglect reached the navigational performance of healthy controls. The spatial memory of individuals with neglect was significantly lower with auditory cues. Eye-tracking analyses showed that participants with neglect made more saccades and looked longer at the right-square angles in the absence of auditory cues.

CONCLUSIONS

This study demonstrates the positive effect of auditory cues in virtual spatial navigation of individuals with visual and auditory neglect and the potentiation of the help of cues after prism adaptation.

Implicit representation of the auditory space: contribution of the left and right hemispheres

Spatial cues contribute to the ability to segregate sound sources and thus facilitate their detection and recognition. This implicit use of spatial cues can be preserved in cases of cortical spatial deafness, suggesting that partially distinct neural networks underlie the explicit sound localization and the implicit use of spatial cues. We addressed this issue by assessing 40 patients, 20 patients with left and 20 patients with right hemispheric damage, for their ability to use auditory spatial cues implicitly in a paradigm of spatial release from masking (SRM) and explicitly in sound localization. The anatomical correlates of their performance were determined with voxel-based lesion-symptom mapping (VLSM). During the SRM task, the target was always presented at the centre, whereas the masker was presented at the centre or at one of the two lateral positions on the right or left side. The SRM effect was absent in some but not all patients; the inability to perceive the target when the masker was at one of the lateral positions correlated with lesions of the left temporo-parieto-frontal cortex or of the right inferior parietal lobule and the underlying white matter. As previously reported, sound localization depended critically on the right parietal and opercular cortex. Thus, explicit and implicit use of spatial cues depends on at least partially distinct neural networks. Our results suggest that the implicit use may rely on the left-dominant position-linked representation of sound objects, which has been demonstrated in previous EEG and fMRI studies.

Keeping track of sound objects in space: The contribution of early-stage auditory areas

The influential dual-stream model of auditory processing stipulates that information pertaining to the meaning and to the position of a given sound object is processed in parallel along two distinct pathways, the ventral and dorsal auditory streams. Functional independence of the two processing pathways is well documented by conscious experience of patients with focal hemispheric lesions. On the other hand there is growing evidence that the meaning and the position of a sound are combined early in the processing pathway, possibly already at the level of early-stage auditory areas. Here, we investigated how early auditory areas integrate sound object meaning and space (simulated by interaural time differences) using a repetition suppression fMRI paradigm at 7 T. Subjects listen passively to environmental sounds presented in blocks of repetitions of the same sound object (same category) or different sounds objects (different categories), perceived either in the left or right space (no change within block) or shifted left-to-right or right-to-left halfway in the block (change within block). Environmental sounds activated bilaterally the superior temporal gyrus, middle temporal gyrus, inferior frontal gyrus, and right precentral cortex. Repetitions suppression effects were measured within bilateral early-stage auditory areas in the lateral portion of the Heschl's gyrus and posterior superior temporal plane. Left lateral early-stages areas showed significant effects for position and change, interactions Category x Initial Position and Category x Change in Position, while right lateral areas showed main effect of category and interaction Category x Change in Position. The combined evidence from our study and from previous studies speaks in favour of a position-linked representation of sound objects, which is independent from semantic encoding within the ventral stream and from spatial encoding within the dorsal stream. We argue for a third auditory stream, which has its origin in lateral belt areas and tracks sound objects across space.

Extinction as a deficit of the decision-making circuitry in the posterior parietal cortex

Extinction is a common neurologic deficit that often occurs as one of a constellation of symptoms seen with lesions of the posterior parietal cortex (PPC). Although extinction has typically been considered a deficit in the allocation of attention, new findings, particularly from nonhuman primate studies, point to one potential and important source of extinction as damage to decision-making circuits for actions within the PPC. This new understanding provides clues to potential therapies for extinction. Also the finding that the PPC is important for action decisions and action planning has led to new neuroprosthetic applications using PPC recordings as control signals to assist paralyzed patients.

Unilateral spatial neglect after posterior parietal damage

Unilateral spatial neglect is a disabling neurologic deficit, most frequent and severe after right-hemispheric lesions. In most patients neglect involves the left side of space, contralateral to a right-hemispheric lesion. About 50% of stroke patients exhibit neglect in the acute phase. Patients fail to orient, respond to, and report sensory events occurring in the contralateral sides of space and of the body, to explore these portions of space through movements by action effectors (eye, limbs), and to move the contralateral limbs. Neglect is a multicomponent higher-level disorder of spatial awareness, cognition, and attention. Spatial neglect may occur independently of elementary sensory and motor neurologic deficits, but it can mimic and make them more severe. Diagnostic tests include: motor exploratory target cancellation; setting the midpoint of a horizontal line (bisection), that requires the estimation of lateral extent; drawing by copy and from memory; reading, assessing neglect dyslexia; and exploring the side of the body contralateral to the lesion. Activities of daily living scales are also used. Patients are typically not aware of neglect, although they may exhibit varying degrees of awareness toward different components of the deficit. The neural correlates include lesions to the inferior parietal lobule of the posterior parietal cortex, which was long considered the unique neuropathologic correlate of neglect, to the premotor and to the dorsolateral prefrontal cortices, to the posterior superior temporal gyrus, at the temporoparietal junction, to subcortical gray nuclei (thalamus, basal ganglia), and to parietofrontal white-matter fiber tracts, such as the superior longitudinal fascicle. Damage to the inferior parietal lobule of the posterior parietal cortex is specifically associated with the mainly egocentric, perceptual, and exploratory extrapersonal, and with the personal, bodily components of neglect. Productive manifestations, such as perseveration, are not a correlate of posterior parietal cortex damage.

Supramodal effect of rightward prismatic adaptation on spatial representations within the ventral attentional system

Rightward prismatic adaptation (R-PA) was shown to alleviate not only visuo-spatial but also auditory symptoms in neglect. The neural mechanisms underlying the effect of R-PA have been previously investigated in visual tasks, demonstrating a shift of hemispheric dominance for visuo-spatial attention from the right to the left hemisphere both in normal subjects and in patients. We have investigated whether the same neural mechanisms underlie the supramodal effect of R-PA on auditory attention. Normal subjects underwent a brief session of R-PA, which was preceded and followed by an fMRI evaluation during which subjects detected targets within the left, central and right space in the auditory or visual modality. R-PA-related changes in activation patterns were found bilaterally in the inferior parietal lobule. In either modality, the representation of the left, central and right space increased in the left IPL, whereas the representation of the right space decreased in the right IPL. Thus, a brief exposure to R-PA modulated the representation of the auditory and visual space within the ventral attentional system. This shift in hemispheric dominance for auditory spatial attention offers a parsimonious explanation for the previously reported effects of R-PA on auditory symptoms in neglect.

For Better or Worse: The Effect of Prismatic Adaptation on Auditory Neglect

Patients with auditory neglect attend less to auditory stimuli on their left and/or make systematic directional errors when indicating sound positions. Rightward prismatic adaptation (R-PA) was repeatedly shown to alleviate symptoms of visuospatial neglect and once to restore partially spatial bias in dichotic listening. It is currently unknown whether R-PA affects only this ear-related symptom or also other aspects of auditory neglect. We have investigated the effect of R-PA on left ear extinction in dichotic listening, space-related inattention assessed by diotic listening, and directional errors in auditory localization in patients with auditory neglect. The most striking effect of R-PA was the alleviation of left ear extinction in dichotic listening, which occurred in half of the patients with initial deficit. In contrast to nonresponders, their lesions spared the right dorsal attentional system and posterior temporal cortex. The beneficial effect of R-PA on an ear-related performance contrasted with detrimental effects on diotic listening and auditory localization. The former can be parsimoniously explained by the SHD-VAS model (shift in hemispheric dominance within the ventral attentional system; Clarke and Crottaz-Herbette 2016), which is based on the R-PA-induced shift of the right-dominant ventral attentional system to the left hemisphere. The negative effects in space-related tasks may be due to the complex nature of auditory space encoding at a cortical level.

Widespread and Opponent fMRI Signals Represent Sound Location in Macaque Auditory Cortex

In primates, posterior auditory cortical areas are thought to be part of a dorsal auditory pathway that processes spatial information. But how posterior (and other) auditory areas represent acoustic space remains a matter of debate. Here we provide new evidence based on functional magnetic resonance imaging (fMRI) of the macaque indicating that space is predominantly represented by a distributed hemifield code rather than by a local spatial topography. Hemifield tuning in cortical and subcortical regions emerges from an opponent hemispheric pattern of activation and deactivation that depends on the availability of interaural delay cues. Importantly, these opponent signals allow responses in posterior regions to segregate space similarly to a hemifield code representation. Taken together, our results reconcile seemingly contradictory views by showing that the representation of space follows closely a hemifield code and suggest that enhanced posterior-dorsal spatial specificity in primates might emerge from this form of coding.

Hypertension is associated with dysfunction of both peripheral and central auditory system

OBJECTIVES

Arterial hypertension negatively influences the peripheral auditory system, causing sensorineural hearing loss. Much less is known about the detrimental effects of hypertension on the central auditory functions.

METHODS

We tested 32 arterial hypertension patients and 32 age and sex-matched healthy volunteers with the expanded tonal audiometry (0.125-12.5 kHz), distortion product otoacoustic emissions (0.75-8 kHz), horizontal minimum audible angle test for eight azimuths with binaural stimulation and the random gap detection test.

RESULTS

Peripheral hearing of the hypertensive patients was impaired in comparison with the controls within all audiometric frequencies (0.125-12.5 kHz) and within specific groups of frequencies. Distortion product otoacoustic emission results were significantly lower for frequencies 4 (P = 0.04) and 6 kHz (P < 0.001). The sound localization ability in the horizontal minimum audible angle test was significantly worse in the hypertensive patients in the 0°, 45°, 90°, 135°, and 270° azimuth when the interaural pure tone average (0.5-1-2 kHz) was set less than 20 dB hearing level (P < 0.05), and in the 0°, 90°, 225°, and 270°azimuth when the binaural pure tone average (0.5-1-2 kHz) was set 20 dB or less hearing level (P < 0.05). Gap detection thresholds in the random gap detection test did not differ between the two groups.

CONCLUSION

Arterial hypertension is independently related to the damage of the peripheral part of the auditory system resulting in high-frequency hearing loss. Hypertensive disturbances of central auditory processing are more discrete and concern the spatial hearing resolution.

Tuning to Binaural Cues in Human Auditory Cortex

Interaural level and time differences (ILD and ITD), the primary binaural cues for sound localization in azimuth, are known to modulate the tuned responses of neurons in mammalian auditory cortex (AC). The majority of these neurons respond best to cue values that favor the contralateral ear, such that contralateral bias is evident in the overall population response and thereby expected in population-level functional imaging data. Human neuroimaging studies, however, have not consistently found contralaterally biased binaural response patterns. Here, we used functional magnetic resonance imaging (fMRI) to parametrically measure ILD and ITD tuning in human AC. For ILD, contralateral tuning was observed, using both univariate and multivoxel analyses, in posterior superior temporal gyrus (pSTG) in both hemispheres. Response-ILD functions were U-shaped, revealing responsiveness to both contralateral and—to a lesser degree—ipsilateral ILD values, consistent with rate coding by unequal populations of contralaterally and ipsilaterally tuned neurons. In contrast, for ITD, univariate analyses showed modest contralateral tuning only in left pSTG, characterized by a monotonic response-ITD function. A multivoxel classifier, however, revealed ITD coding in both hemispheres. Although sensitivity to ILD and ITD was distributed in similar AC regions, the differently shaped response functions and different response patterns across hemispheres suggest that basic ILD and ITD processes are not fully integrated in human AC. The results support opponent-channel theories of ILD but not necessarily ITD coding, the latter of which may involve multiple types of representation that differ across hemispheres.

Multisensory integration in hemianopia and unilateral spatial neglect: Evidence from the sound induced flash illusion

Recent neuropsychological evidence suggests that acquired brain lesions can, in some instances, abolish the ability to integrate inputs from different sensory modalities, disrupting multisensory perception. We explored the ability to perceive multisensory events, in particular the integrity of audio-visual processing in the temporal domain, in brain-damaged patients with visual field defects (VFD), or with unilateral spatial neglect (USN), by assessing their sensitivity to the 'Sound-Induced Flash Illusion' (SIFI). The study yielded two key findings. Firstly, the 'fission' illusion (namely, seeing multiple flashes when a single flash is paired with multiple sounds) is reduced in both left- and right-brain-damaged patients with VFD, but not in right-brain-damaged patients with left USN. The disruption of the fission illusion is proportional to the extent of the occipital damage. Secondly, a reliable 'fusion' illusion (namely, seeing less flashes when a single sound is paired with multiple flashes) is evoked in USN patients, but neither in VFD patients nor in healthy participants. A control experiment showed that the fusion, but not the fission, illusion is lost in older participants (>50 year-old), as compared with younger healthy participants (<30 year-old). This evidence indicates that the fission and fusion illusions are dissociable multisensory phenomena, altered differently by impairments of visual perception (i.e. VFD) and spatial attention (i.e. USN). The occipital cortex represents a key cortical site for binding auditory and visual stimuli in the SIFI, while damage to right-hemisphere areas mediating spatial attention and awareness does not prevent the integration of audio-visual inputs in the temporal domain.

Auditory lateralisation deficits in neglect patients

Although visual deficits due to unilateral spatial neglect (USN) have been frequently described in the literature, fewer studies have been interested in directional hearing impairment in USN. The aim of this study was to explore sound lateralisation deficits in USN. Using a paradigm inspired by Tanaka et al. (1999), interaural time differences (ITD) were presented over headphones to give the illusion of a leftward or a rightward movement of sound. Participants were asked to respond "right" and "left" as soon as possible to indicate whether they heard the sound moving to the right or to the left side of the auditory space. We additionally adopted a single-case method to analyse the performance of 15 patients with right-hemisphere (RH) stroke and added two additional measures to underline sound lateralisation on the left side and on the right side. We included 15 patients with RH stoke (5 with a severe USN, 5 with a mild USN and 5 without USN) and 11 healthy age-matched participants. We expected to replicate findings of abnormal sound lateralisation in USN. However, although a sound lateralisation deficit was observed in USN, two different deficit profiles were identified. Namely, patients with a severe USN seemed to have left sound lateralisation impairment whereas patients with a mild USN seemed to be more influenced by a systematic bias in auditory representation with respect to body meridian axis (egocentric deviation). This latter profile was unexpected as sounds were manipulated with ITD and, thus, would not be perceived as coming from an external source of the head. Future studies should use this paradigm in order to better understand these two distinct profiles.

Testing the dual-pathway model for auditory processing in human cortex

Analogous to the visual system, auditory information has been proposed to be processed in two largely segregated streams: an anteroventral ("what") pathway mainly subserving sound identification and a posterodorsal ("where") stream mainly subserving sound localization. Despite the popularity of this assumption, the degree of separation of spatial and non-spatial auditory information processing in cortex is still under discussion. In the present study, a statistical approach was implemented to investigate potential behavioral dissociations for spatial and non-spatial auditory processing in stroke patients, and voxel-wise lesion analyses were used to uncover their neural correlates. The results generally provided support for anatomically and functionally segregated auditory networks. However, some degree of anatomo-functional overlap between "what" and "where" aspects of processing was found in the superior pars opercularis of right inferior frontal gyrus (Brodmann area 44), suggesting the potential existence of a shared target area of both auditory streams in this region. Moreover, beyond the typically defined posterodorsal stream (i.e., posterior superior temporal gyrus, inferior parietal lobule, and superior frontal sulcus), occipital lesions were found to be associated with sound localization deficits. These results, indicating anatomically and functionally complex cortical networks for spatial and non-spatial auditory processing, are roughly consistent with the dual-pathway model of auditory processing in its original form, but argue for the need to refine and extend this widely accepted hypothesis.

Auditory Spatial Deficits in the Early Stage of Ischemic Cerebral Stroke

BACKGROUND

Clinical research, together with computed tomography/magnetic resonance imaging findings, proves that ischemic stroke (IS) that damages auditory pathways can cause hearing loss and impairment of higher auditory processes such as sound localization. The goal of the study was to find possible correlations between the IS risk factors, ischemic lesion volume and localization, neurologic status, and the sound localization capability in acute IS patients.

METHODS

We consecutively enrolled 61 IS patients into the study. The control group consisted of 60 healthy volunteers. All neuro-otological evaluations were performed up to 30 days from the incidence of stroke. All the subjects underwent the horizontal minimum audible angle test (HMAAT) and standard tonal and speech audiometric assessments.

RESULTS

HMMAT results were significantly worse in the IS patients and were present in 82.0% of the patients. There were more patients with unilateral disturbances than with bilateral ones (54.1% versus 27.9%). It was the characteristics of the ischemic lesions that correlated strongly with the sound localization deterioration, that is, their bilateral (the 90° azimuth, P = .018; the 180°, P = .002), multiple (the 45°, P = .020; the 180°, P = .007; the 225°, P = .047), and lacunar character (the 90°, P = .015; the 225°, P = .042). Differences in the types of HMAAT results were significant for lesions in the frontal and the temporal lobe (P = .018 and P = .040). In addition, worse sound localization ability was more common in patients with poor speech discrimination and the bilateral sensorineural hearing loss. We have not found statistically significant correlations for other analyzed factors such as the cortical/subcortical character of the lesions, the patients' neurologic status, and cerebrovascular risk factors.

CONCLUSIONS

Sound localization impairment is common in IS patients and it is the multiple, bilateral, and lacunar character of the ischemic lesions that seems to be strongly positively correlated with the disturbance of the sound localization ability.

Lateralized parietotemporal oscillatory phase synchronization during auditory selective attention

Based on the infamous left-lateralized neglect syndrome, one might hypothesize that the dominating right parietal cortex has a bilateral representation of space, whereas the left parietal cortex represents only the contralateral right hemispace. Whether this principle applies to human auditory attention is not yet fully clear. Here, we explicitly tested the differences in cross-hemispheric functional coupling between the intraparietal sulcus (IPS) and auditory cortex (AC) using combined magnetoencephalography (MEG), EEG, and functional MRI (fMRI). Inter-regional pairwise phase consistency (PPC) was analyzed from data obtained during dichotic auditory selective attention task, where subjects were in 10-s trials cued to attend to sounds presented to one ear and to ignore sounds presented in the opposite ear. Using MEG/EEG/fMRI source modeling, parietotemporal PPC patterns were (a) mapped between all AC locations vs. IPS seeds and (b) analyzed between four anatomically defined AC regions-of-interest (ROI) vs. IPS seeds. Consistent with our hypothesis, stronger cross-hemispheric PPC was observed between the right IPS and left AC for attended right-ear sounds, as compared to PPC between the left IPS and right AC for attended left-ear sounds. In the mapping analyses, these differences emerged at 7-13Hz, i.e., at the theta to alpha frequency bands, and peaked in Heschl's gyrus and lateral posterior non-primary ACs. The ROI analysis revealed similarly lateralized differences also in the beta and lower theta bands. Taken together, our results support the view that the right parietal cortex dominates auditory spatial attention.

Exploring near and far regions of space: distance-specific visuospatial neglect after stroke

Visuospatial neglect has been observed in the horizontal (left/right) and vertical (up/down) dimension and depends on the distance at which a task is presented (near/far). Previously, studies have mainly focused on investigating the overall severity of neglect in near and far space in a group of neglect patients instead of examining subgroups of neglect patients with different types of distance-specific neglect. We investigated the spatial specificity (near vs. far space), frequency, and severity of neglect in the horizontal and vertical dimensions in a large group of stroke patients. We used three tasks to assess neglect in near (30 cm) and far (120 cm) space: a shape cancellation, letter cancellation, and a line bisection task. Patients were divided into four groups based on their performance: a group without neglect (N-F-), a near only neglect (N+F-), a far only neglect (N-F+), and a near and far neglect group (N+F+). About 40% of our sample showed neglect. Depending on the task, N+F- was observed in 8 to 22% of the sample, whereas N-F+ varied between 8% and 11%, and N+F+ varied between 11% to 14% of the sample. The current findings indicate that horizontal and vertical biases in performance can be confined to one region of space and are task dependent. We recommend testing for far space neglect during neuropsychological assessments in clinical practice, because this cannot be diagnosed using standard paper-and-pencil tasks.

Statistical learning as a tool for rehabilitation in spatial neglect

We propose that neglect includes a disorder of representational updating. Representational updating refers to our ability to build mental models and adapt those models to changing experience. This updating ability depends on the processes of priming, working memory, and statistical learning. These processes in turn interact with our capabilities for sustained attention and precise temporal processing. We review evidence showing that all these non-spatial abilities are impaired in neglect, and we discuss how recognition of such deficits can lead to novel approaches for rehabilitating neglect.

Neural correlates of sound localization in complex acoustic environments

Listening to and understanding people in a “cocktail-party situation” is a remarkable feature of the human auditory system. Here we investigated the neural correlates of the ability to localize a particular sound among others in an acoustically cluttered environment with healthy subjects. In a sound localization task, five different natural sounds were presented from five virtual spatial locations during functional magnetic resonance imaging (fMRI). Activity related to auditory stream segregation was revealed in posterior superior temporal gyrus bilaterally, anterior insula, supplementary motor area, and frontoparietal network. Moreover, the results indicated critical roles of left planum temporale in extracting the sound of interest among acoustical distracters and the precuneus in orienting spatial attention to the target sound. We hypothesized that the left-sided lateralization of the planum temporale activation is related to the higher specialization of the left hemisphere for analysis of spectrotemporal sound features. Furthermore, the precuneus − a brain area known to be involved in the computation of spatial coordinates across diverse frames of reference for reaching to objects − seems to be also a crucial area for accurately determining locations of auditory targets in an acoustically complex scene of multiple sound sources. The precuneus thus may not only be involved in visuo-motor processes, but may also subserve related functions in the auditory modality.

The right parietal cortex and time perception: back to Critchley and the Zeitraffer phenomenon

We investigated the involvement of the posterior parietal cortex in time perception by temporarily disrupting normal functioning in this region, in subjects making prospective judgements of time or pitch. Disruption of the right posterior parietal cortex significantly slowed reaction times when making time, but not pitch, judgements. Similar interference with the left parietal cortex and control stimulation over the vertex did not significantly change performance on either pitch or time tasks. The results show that the information processing necessary for temporal judgements involves the parietal cortex, probably to optimise spatiotemporal accuracy in voluntary action. The results are in agreement with a recent neuroimaging study and are discussed with regard to a psychological model of temporal processing and a recent proposal that time is part of a parietal cortex system for encoding magnitude information relevant for action.

Lateralisation of sound in temporal-lobe epilepsy: comparison between pre- and postoperative performances and ERPs

OBJECTIVE

Our aim was to investigate if spatial hearing is impaired in mesial temporal lobe epilepsy and temporal lobectomy has an effect on this function.

METHODS

Thirteen patients with mesial temporal lobe epilepsy (TLE) due to sclerosis in their left (n=6) or right (n=7) hippocampus were studied. Their sound lateralisation performance indexed by d' was tested against that of a group of normal subjects (n=13). Patients' ERPs to lateralisation shifts induced by interaural disparities of intensity (IID) and time (ITD) were also recorded. Eight of the patients were re-tested after they underwent anterior temporal lobectomy, which involved the resection/removal of medial structures including amygdala, hippocampus and parahippocampal gyrus.

RESULTS

The sound-lateralisation performance of the TLE patients was significantly lower than normal subjects, and this disadvantage of the patients was specific to IID-based lateralisation. Amplitudes of their N1 and P2 responses to laterally shifting sounds were much lower than those reported previously for normal subjects. Lobectomy did not have a statistically significant effect on patients' sound-lateralisation performance nor on the amplitude of their auditory directional ERPs.

CONCLUSIONS

The results show that especially the IID-based sound-lateralisation performance is impaired in TLE patients and that lobectomy should not cause any further deterioration.

SIGNIFICANCE

This study suggests that a test for assessing the ability of sound lateralisation based on each of the IID and ITD cues should be included in the evaluation of TLE patients.

Auditory spatial deficits following hemispheric lesions: dissociation of explicit and implicit processing

Auditory spatial deficits occur frequently after hemispheric damage; a previous case report suggested that the explicit awareness of sound positions, as in sound localisation, can be impaired while the implicit use of auditory cues for the segregation of sound objects in noisy environments remains preserved. By assessing systematically patients with a first hemispheric lesion, we have shown that (1) explicit and/or implicit use can be disturbed; (2) impaired explicit vs. preserved implicit use dissociations occur rather frequently; and (3) different types of sound localisation deficits can be associated with preserved implicit use. Conceptually, the dissociation between the explicit and implicit use may reflect the dual-stream dichotomy of auditory processing. Our results speak in favour of systematic assessments of auditory spatial functions in clinical settings, especially when adaptation to auditory environment is at stake. Further, systematic studies are needed to link deficits of explicit vs. implicit use to disability in everyday activities, to design appropriate rehabilitation strategies, and to ascertain how far the explicit and implicit use of spatial cues can be retrained following brain damage.

Neglect: a multisensory deficit?

Neglect is a neurological syndrome characterised by a lack of conscious perception of events localised in the contralesional side of space. Here, we consider the possible multisensory nature of this disorder, critically reviewing the literature devoted to multisensory manifestations and processing in neglect. Although its most striking manifestations have been observed in the visual domain, a number of studies demonstrate that neglect can affect virtually any sensory modality, in particular touch and audition. Furthermore, a few recent studies have reported a correlation in severity between visual and non-visual neglect-related deficits evaluated in the same patients, providing some preliminary support for a multisensory conception of neglect. Sensory stimulation and sensorimotor adaptation techniques, aimed at alleviating neglect, have also been shown to affect several sensory modalities, including some that were not directly affected by the intervention. Finally, in some cases neglect can bias multisensory interactions known to occur in healthy individuals, leading to abnormal behaviour or uncovering multisensory compensation mechanisms. This evidence, together with neurophysiological and neuroimaging data revealing the multisensory role played by the areas that are most commonly damaged in neglect patients, seems to speak in favour of neglect as a multisensory disorder. However, since most previous studies were not conducted with the specific purpose of systematically investigating the multisensory nature of neglect, we conclude that more research is needed to appropriately assess this question, and suggest some methodological guidelines that we hope will help clarify this issue. At present, the conception of neglect as a multisensory disorder remains a promising working hypothesis that may help define the pathophysiology of this syndrome.

Attention in neglect and extinction: assessing the degree of correspondence between visual and auditory impairments using matched tasks

Claims have been made for associated degrees of impairment on both visual and auditory performance in unilateral neglect and extinction. Since this evidence is primarily based on different tests in each modality, it is difficult to properly quantify the degree of association between performance in vision and audition. The current study compares visual and auditory extinction and temporal order judgments (TOJs) in two cases with clinical visual neglect. Stimuli in both modalities were precisely matched in their temporal and spatial parameters. The results reveal a mixed pattern of association between different auditory tests and their visual counterparts. This suggests that associations between visual and auditory neglect can occur but these are neither obligatory nor pervasive. Instead, our data support models of spatial impairment in neglect and extinction that acknowledge differences in the contribution of spatial information to performance in each modality in responses to changing task demands.

Visuo-haptic interactions in unilateral spatial neglect: the cross modal judd illusion

Unilateral spatial neglect (USN) has been mainly investigated in the visual modality; only few studies compared spatial neglect across different sensory modalities, and explored their multisensory interactions, with controversial results. We investigated the integration between vision and haptics, through a bisection task of a cross modal illusion, the Judd variant of the Müller-Lyer illusion. We examined right-brain-damaged patients with (n = 7) and without (n = 7) left USN, and neurologically unimpaired participants (n = 14) in the bisection of Judd stimuli under visual, haptic, and visuo-haptic presentation. Neglect patients showed the characteristic rightward bias in the bisection of the baseline stimuli in the visual modality, but not in the haptic and visuo-haptic conditions. The illusory effects were preserved in each group and in each modality, indicating that the processing of the cross modal illusion is independent of the presence of deficits of spatial attention and representation. Spatial neglect can be modality-specific, but visual and tactile sensory inputs are properly integrated.

Near and far space: Understanding the neural mechanisms of spatial attention

Visuospatial neglect is a multicomponent syndrome, and one dissociation reported is between neglect for near (peripersonal) and far (extrapersonal) space. Owing to patient heterogeneity and extensive lesions, it is difficult to determine the precise neural mechanisms underlying this dissociation using clinical methodology. In this study, transcranial magnetic stimulation was used to examine the involvement of three areas in the undamaged brain, while participants completed a conjunction search task in near and far space. The brain areas investigated were right posterior parietal cortex (rPPC), right frontal eye field (rFEF), and right ventral occipital cortex (rVO), each of which has been implicated in visuospatial processing. The results revealed a double dissociation, whereby rPPC was involved for search in near space only, whilst rVO only became necessary when the task was completed in far space. These data provide clear evidence for a dorsal and ventral dissociation between the processing of near and far space, which is compatible with the functional roles previously attributed to the two streams. For example, the involvement of the dorsal stream in near space reflects its role in vision for action, because it is within this spatial location that actions can be performed. The results also revealed that rFEF is involved in the processing of visual search in both near and far space and may contribute to visuospatial attention and/or the control of eye-movements irrespective of spatial frame. We discuss our results with respect to their clear ramifications for clinical diagnosis and neurorehabilitation.

When and where of auditory spatial processing in cortex: a novel approach using electrotomography

The modulation of brain activity as a function of auditory location was investigated using electro-encephalography in combination with standardized low-resolution brain electromagnetic tomography. Auditory stimuli were presented at various positions under anechoic conditions in free-field space, thus providing the complete set of natural spatial cues. Variation of electrical activity in cortical areas depending on sound location was analyzed by contrasts between sound locations at the time of the N1 and P2 responses of the auditory evoked potential. A clear-cut double dissociation with respect to the cortical locations and the points in time was found, indicating spatial processing (1) in the primary auditory cortex and posterodorsal auditory cortical pathway at the time of the N1, and (2) in the anteroventral pathway regions about 100 ms later at the time of the P2. Thus, it seems as if both auditory pathways are involved in spatial analysis but at different points in time. It is possible that the late processing in the anteroventral auditory network reflected the sharing of this region by analysis of object-feature information and spectral localization cues or even the integration of spatial and non-spatial sound features.

Biases of spatial attention in vision and audition

Neurologically normal observers misperceive the midpoint of horizontal lines as systematically leftward of veridical center, a phenomenon known as pseudoneglect. Pseudoneglect is attributed to a tonic asymmetry of visuospatial attention favoring left hemispace. Whereas visuospatial attention is biased toward left hemispace, some evidence suggests that audiospatial attention may possess a right hemispatial bias. If spatial attention is supramodal, then the leftward bias observed in visual line bisection should also be expressed in auditory bisection tasks. If spatial attention is modality specific then bisection errors in visual and auditory spatial judgments are potentially dissociable. Subjects performed a bisection task for spatial intervals defined by auditory stimuli, as well as a tachistoscopic visual line bisection task. Subjects showed a significant leftward bias in the visual line bisection task and a significant rightward bias in the auditory interval bisection task. Performance across both tasks was, however, significantly positively correlated. These results imply the existence of both modality specific and supramodal attentional mechanisms where visuospatial attention has a prepotent leftward vector and audiospatial attention has a prepotent rightward vector of attention. In addition, the biases of both visuospatial and audiospatial attention are correlated.

Learning-induced plasticity in human audition: objects, time, and space

The human auditory system is comprised of specialized but interacting anatomic and functional pathways encoding object, spatial, and temporal information. We review how learning-induced plasticity manifests along these pathways and to what extent there are common mechanisms subserving such plasticity. A first series of experiments establishes a temporal hierarchy along which sounds of objects are discriminated along basic to fine-grained categorical boundaries and learned representations. A widespread network of temporal and (pre)frontal brain regions contributes to object discrimination via recursive processing. Learning-induced plasticity typically manifested as repetition suppression within a common set of brain regions. A second series considered how the temporal sequence of sound sources is represented. We show that lateralized responsiveness during the initial encoding phase of pairs of auditory spatial stimuli is critical for their accurate ordered perception. Finally, we consider how spatial representations are formed and modified through training-induced learning. A population-based model of spatial processing is supported wherein temporal and parietal structures interact in the encoding of relative and absolute spatial information over the initial ~300 ms post-stimulus onset. Collectively, these data provide insights into the functional organization of human audition and open directions for new developments in targeted diagnostic and neurorehabilitation strategies.

Effect of prism adaptation on left dichotic listening deficit in neglect patients: glasses to hear better?

Unilateral neglect is a disabling syndrome frequently observed following right hemisphere brain damage. Symptoms range from visuo-motor impairments through to deficient visuo-spatial imagery, but impairment can also affect the auditory modality. A short period of adaptation to a rightward prismatic shift of the visual field is known to improve a wide range of hemispatial neglect symptoms, including visuo-manual tasks, mental imagery, postural imbalance, visuo-verbal measures and number bisection. The aim of the present study was to assess whether the beneficial effects of prism adaptation may generalize to auditory manifestations of neglect. Auditory extinction, whose clinical manifestations are independent of the sensory modalities engaged in visuo-manual adaptation, was examined in neglect patients before and after prism adaptation. Two separate groups of neglect patients (all of whom exhibited left auditory extinction) underwent prism adaptation: one group (n = 6) received a classical prism treatment ('Prism' group), the other group (n = 6) was submitted to the same procedure, but wore neutral glasses creating no optical shift (placebo 'Control' group). Auditory extinction was assessed by means of a dichotic listening task performed three times: prior to prism exposure (pre-test), upon prism removal (0 h post-test) and 2 h later (2 h post-test). The total number of correct responses, the lateralization index (detection asymmetry between the two ears) and the number of left-right fusion errors were analysed. Our results demonstrate that prism adaptation can improve left auditory extinction, thus revealing transfer of benefit to a sensory modality that is orthogonal to the visual, proprioceptive and motor modalities directly implicated in the visuo-motor adaptive process. The observed benefit was specific to the detection asymmetry between the two ears and did not affect the total number of responses. This indicates a specific effect of prism adaptation on lateralized processes rather than on general arousal. Our results suggest that the effects of prism adaptation can extend to unexposed sensory systems. The bottom-up approach of visuo-motor adaptation appears to interact with higher order brain functions related to multisensory integration and can have beneficial effects on sensory processing in different modalities. These findings should stimulate the development of therapeutic approaches aimed at bypassing the affected sensory processing modality by adapting other sensory modalities.

Potencial Cognitivo P300 em pacientes com lesão isquêmica do hemisfério direito

TEMA: avaliação do potencial cognitivo P300 em indivíduos com lesão de hemisfério direito provocada por acidente vascular cerebral isquêmico. OBJETIVO: caracterizar os achados do potencial cognitivo P300 em indivíduos destros com lesão isquêmica do hemisfério cerebral direito, bem como comparar seus resultados aos obtidos em indivíduos normais. MÉTODO: foram realizadas anamnese, avaliação audiológica convencional e potencial cognitivo (P300), em 17 indivíduos com lesão do hemisfério direito (grupo pesquisa) e 25 normais (grupo controle), com idades entre 20 e 70 anos. RESULTADOS: na análise dos dados qualitativos do P300, não houve diferença estatisticamente significante entre os grupos para o resultado normal. Para a análise dos dados quantitativos, ocorreu diferença estatisticamente significante entre os grupos com relação à latência da onda P300, sendo que o grupo pesquisa apresentou latência maior. Além disso, houve uma tendência estatisticamente significante entre as orelhas direita e esquerda dentro do grupo pesquisa, mostrando aumento de latência da onda P300 na orelha direita. CONCLUSÃO: Indivíduos destros com lesão de hemisfério direito e limiares auditivos normais, apresentaram resultados eletrofisiológicos da audição indicativos de déficit no sistema nervoso auditivo central. Foram observados comprometimentos nas regiões geradoras deste potencial (áreas subcorticais e corticais). Dificuldades auditivas não foram percebidas pelos indivíduos, sugerindo que, provavelmente tal sinal possa estar relacionado à uma heminegligência auditiva. Tornam-se necessários mais estudos que avaliem a via auditiva central destes indivíduos para uma melhor caracterização dos achados eletrofisiológicos.

Spatial asymmetries in viewing and remembering scenes: consequences of an attentional bias?

Given a single fixation, memory for scenes containing salient objects near both the left and right view boundaries exhibited a rightward bias in boundary extension (Experiment 1). On each trial, a 500-msec picture and 2.5-sec mask were followed by a boundary adjustment task. Observers extended boundaries 5% more on the right than on the left. Might this reflect an asymmetric distribution of attention? In Experiments 2A and 2B, free viewing of pictures revealed that first saccades were more often leftward (62%) than rightward (38%). In Experiment 3, 500-msec pictures were interspersed with 2.5-sec masks. A subsequent object recognition memory test revealed better memory for left-side objects. Scenes were always mirror reversed for half the observers, thus ruling out idiosyncratic scene compositions as the cause of these asymmetries. Results suggest an unexpected leftward bias of attention that selectively enhanced the representations, causing a smaller boundary extension error and better object memory on the views' left sides.