Impaired spatial working memory across saccades contributes to abnormal search in parietal neglect

Seeing without a Scene: Neurological Observations on the Origin and Function of the Dorsal Visual Stream

In all vertebrates, visual signals from each visual field project to the opposite midbrain tectum (called the superior colliculus in mammals). The tectum/colliculus computes visual salience to select targets for context-contingent visually guided behavior: a frog will orient toward a small, moving stimulus (insect prey) but away from a large, looming stimulus (a predator). In mammals, visual signals competing for behavioral salience are also transmitted to the visual cortex, where they are integrated with collicular signals and then projected via the dorsal visual stream to the parietal and frontal cortices. To control visually guided behavior, visual signals must be encoded in body-centered (egocentric) coordinates, and so visual signals must be integrated with information encoding eye position in the orbit-where the individual is looking. Eye position information is derived from copies of eye movement signals transmitted from the colliculus to the frontal and parietal cortices. In the intraparietal cortex of the dorsal stream, eye movement signals from the colliculus are used to predict the sensory consequences of action. These eye position signals are integrated with retinotopic visual signals to generate scaffolding for a visual scene that contains goal-relevant objects that are seen to have spatial relationships with each other and with the observer. Patients with degeneration of the superior colliculus, although they can see, behave as though they are blind. Bilateral damage to the intraparietal cortex of the dorsal stream causes the visual scene to disappear, leaving awareness of only one object that is lost in space. This tutorial considers what we have learned from patients with damage to the colliculus, or to the intraparietal cortex, about how the phylogenetically older midbrain and the newer mammalian dorsal cortical visual stream jointly coordinate the experience of a spatially and temporally coherent visual scene.

Left Cerebellar Lesions may be Associated with an Increase in Spatial Neglect-like Symptoms

Each cerebellar hemisphere projects to the contralateral cerebral hemisphere. Previous research suggests a lateralization of cognitive functions in the cerebellum that mirrors the cerebral cortex, with attention/visuospatial functions represented in the left cerebellar hemisphere, and language functions in the right cerebellar hemisphere. Although there is good evidence supporting the role of the right cerebellum with language functions, the evidence supporting the notion that attention and visuospatial functions are left lateralized is less clear. Given that spatial neglect is one of the most common disorders arising from right cortical damage, we reasoned that damage to the left cerebellum would result in increased spatial neglect-like symptoms, without necessarily leading to an official diagnosis of spatial neglect. To examine this disconnection hypothesis, we analyzed neglect screening data (line bisection, cancellation, figure copying) from 20 patients with isolated unilateral cerebellar stroke. Results indicated that left cerebellar patients (n = 9) missed significantly more targets on the left side of cancellation tasks compared to a normative sample. No significant effects were observed for right cerebellar patients (n = 11). A lesion overlap analysis indicated that Crus II (78% overlap), and lobules VII and IX (66% overlap) were the regions most commonly damaged in left cerebellar patients. Our results are consistent with the notion that the left cerebellum may be important for attention and visuospatial functions. Given the poor prognosis typically associated with neglect, we suggest that screening for neglect symptoms, and visuospatial deficits more generally, may be important for tailoring rehabilitative efforts to help maximize recovery in cerebellar patients.

Increased scene complexity during free visual exploration reveals residual unilateral neglect in recovered stroke patients

Unilateral neglect is a common cognitive syndrome after stroke, which is defined as a spatially specific unawareness of the contralesional space. The syndrome is caused by disruptions of attentional networks in the brain, which impair the patients' ability to direct attention towards the contralesional space. During recovery, patients often learn to compensate by voluntarily directing their attention to the neglected side at the expense of cognitive resources. In this study, we examined the impact of the complexity of visual input on free visual exploration behavior of unilateral neglect and apparently recovered patients. We asked whether increasing scene complexity would allow the detection of residual unilateral neglect in recovered patients by increasing the amount of cognitive resources needed for visual processing and limiting capacities for compensation. Using virtual reality, we analyzed the spatial distribution of gaze of unilateral neglect patients, patients who had, according to conventional diagnostics, recovered from the syndrome, stroke patients with no history of unilateral neglect, and age-matched healthy controls. We manipulated the complexity of an immersive virtual scene presented on head mounted displays. We identified the orientation bias towards the ipsilesional side as a sensitive and specific marker of unilateral neglect, which was present in unilateral neglect and recovered patients but absent in stroke patients with no history of unilateral neglect and controls. Increasing scene complexity exacerbated the orientation shift in unilateral neglect patients and revealed that three out of nine (33%) recovered patients had a high probability of suffering from residual unilateral neglect as estimated by a generalized linear model using the median horizontal gaze position as a predictor.

Left and right temporal-parietal junctions (TPJs) as "match/mismatch" hedonic machines: A unifying account of TPJ function

Experimental and theoretical studies have tried to gain insights into the involvement of the Temporal Parietal Junction (TPJ) in a broad range of cognitive functions like memory, attention, language, self-agency and theory of mind. Recent investigations have demonstrated the partition of the TPJ in discrete subsectors. Nonetheless, whether these subsectors play different roles or implement an overarching function remains debated. Here, based on a review of available evidence, we propose that the left TPJ codes both matches and mismatches between expected and actual sensory, motor, or cognitive events while the right TPJ codes mismatches. These operations help keeping track of statistical contingencies in personal, environmental, and conceptual space. We show that this hypothesis can account for the participation of the TPJ in disparate cognitive functions, including "humour", and explain: a) the higher incidence of spatial neglect in right brain damage; b) the different emotional reactions that follow left and right brain damage; c) the hemispheric lateralisation of optimistic bias mechanisms; d) the lateralisation of mechanisms that regulate routine and novelty behaviours. We propose that match and mismatch operations are aimed at approximating "free energy", in terms of the free energy principle of decision-making. By approximating "free energy", the match/mismatch TPJ system supports both information seeking to update one's own beliefs and the pleasure of being right in one's own' current choices. This renewed view of the TPJ has relevant clinical implications because the misfunctioning of TPJ-related "match" and "mismatch" circuits in unilateral brain damage can produce low-dimensional deficits of active-inference and predictive coding that can be associated with different neuropsychological disorders.

Machine learning algorithms on eye tracking trajectories to classify patients with spatial neglect

BACKGROUND AND OBJECTIVE

Eye-movement trajectories are rich behavioral data, providing a window on how the brain processes information. We address the challenge of characterizing signs of visuo-spatial neglect from saccadic eye trajectories recorded in brain-damaged patients with spatial neglect as well as in healthy controls during a visual search task.

METHODS

We establish a standardized pre-processing pipeline adaptable to other task-based eye-tracker measurements. We use traditional machine learning algorithms together with deep convolutional networks (both 1D and 2D) to automatically analyze eye trajectories.

RESULTS

Our top-performing machine learning models classified neglect patients vs. healthy individuals with an Area Under the ROC curve (AUC) ranging from 0.83 to 0.86. Moreover, the 1D convolutional neural network scores correlated with the degree of severity of neglect behavior as estimated with standardized paper-and-pencil tests and with the integrity of white matter tracts measured from Diffusion Tensor Imaging (DTI). Interestingly, the latter showed a clear correlation with the third branch of the superior longitudinal fasciculus (SLF), especially damaged in neglect.

CONCLUSIONS

The study introduces new methods for both the pre-processing and the classification of eye-movement trajectories in patients with neglect syndrome. The proposed methods can likely be applied to other types of neurological diseases opening the possibility of new computer-aided, precise, sensitive and non-invasive diagnostic tools.

Exploring the use of dopaminergic medication to treat hemispatial inattention during in-patient post-stroke neurorehabilitation

Hemispatial inattention (HSI), a lateralised impairment of spatial processing, is a common consequence of stroke. It is a poor prognostic indicator for functional recovery and interferes with the progress during in-patient neurorehabilitation. Dopaminergic medication has shown promise in improving HSI in the chronic post-stroke period but is untested in more acute settings, e.g. during in-patient neurorehabilitation. We audited the use of dopaminergic medication in ten sequential patients with post-stroke HSI, on an open-label exploratory basis. Patients' response to medication was assessed individually, using a three-week Off-On-Off protocol. We employed a mixture of bedside and functional measures, and made a multidisciplinary judgement of efficacy in individual patients. In six out of 10 patients, there was a convincing improvement of HSI while on medication, which reversed when it was paused. There was a mean 57% relative increase in target detection in the star cancellation test on the most affected side (on vs. off medication). In the six responders, medication was therefore continued throughout their admission without adverse effects. The star cancellation test was sensitive to HSI in most patients but in two cases failed to detect changes that were picked up by a functional assessment (Kessler Functional Neglect Assessment Protocol). We found this multidisciplinary approach to be feasible in an in-patient neurorehabilitation setting. We suggest further research to explore the efficacy of dopaminergic medication in improving neurorehabilitation outcomes for patients with post-stroke HSI. We suggest that more detailed N-of-1 assessments of treatment response, with internal blinding, may be a productive approach.

Applying machine learning to dissociate between stroke patients and healthy controls using eye movement features obtained from a virtual reality task

Conventional neuropsychological tests do not represent the complex and dynamic situations encountered in daily life. Immersive virtual reality simulations can be used to simulate dynamic and interactive situations in a controlled setting. Adding eye tracking to such simulations may provide highly detailed outcome measures, and has great potential for neuropsychological assessment. Here, participants (83 stroke patients and 103 healthy controls) we instructed to find either 3 or 7 items from a shopping list in a virtual super market environment while eye movements were being recorded. Using Logistic Regression and Support Vector Machine models, we aimed to predict the task of the participant and whether they belonged to the stroke or the control group. With a limited number of eye movement features, our models achieved an average Area Under the Curve (AUC) of .76 in predicting whether each participant was assigned a short or long shopping list (3 or 7 items). Identifying participant as either stroke patients and controls led to an AUC of .64. In both classification tasks, the frequency with which aisles were revisited was the most dissociating feature. As such, eye movement data obtained from a virtual reality simulation contain a rich set of signatures for detecting cognitive deficits, opening the door to potential clinical applications.

Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects

Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.

Visual scanpath training to emotional faces following severe traumatic brain injury: A single case design

The visual scanpath to emotional facial expressions was recorded in BR, a 35-year-old male with chronic severe traumatic brain injury (TBI), both before and after he underwent intervention. The novel intervention paradigm combined visual scanpath training with verbal feedback and was implemented over a 3-month period using a single case design (AB) with one follow up session. At baseline BR's scanpath was restricted, characterised by gaze allocation primarily to salient facial features on the right side of the face stimulus. Following intervention his visual scanpath became more lateralised, although he continued to demonstrate an attentional bias to the right side of the face stimulus. This study is the first to demonstrate change in both the pattern and the position of the visual scanpath to emotional faces following intervention in a person with chronic severe TBI. In addition, these findings extend upon our previous work to suggest that modification of the visual scanpath through targeted facial feature training can support improved facial recognition performance in a person with severe TBI.

Impaired pre-saccadic shifts of attention in neglect patients

Every saccade is generally preceded by a mandatory shift of attention to the saccade endpoint, allowing us to process visual information more effectively. Whether this 'pre-saccadic shift of attention' is still intact in hemispatial neglect is unknown. Whereas neglect patients exhibit lateralized impairments of attention and often show impaired saccadic behaviour, it is not yet clear how the pre-saccadic shift of attention is affected during accurately executed eye movements. In this study, we used a gaze contingent visual discrimination task, in which neglect patients had to discriminate a probe presented before saccade onset. Results revealed an imbalance in discrimination performance between the two hemifields with poor performance to probes in the contralesional compared to the ipsilesional hemifield when accounting for saccadic impairments. These results suggest that attention and eye movements are both unique impairments of neglect patients. We hypothesize that the impaired pre-saccadic shift of attention could be one of the key problems of neglect and might underlie other spatial and non-spatial deficits often reported in neglect patients.

Mental representation of a line when patients with left unilateral spatial neglect bisect it: A study with an endpoint reproduction task

Patients with left unilateral spatial neglect (USN) typically place the subjective midpoint to the right of the objective centre. Based on the previous findings (e.g., Ishiai et al. 1989, Brain, 112, 1485), we hypothesized that the patients with left USN may see the representational image of a line that extends equally towards either side of the subjective midpoint depending not upon the information about the leftward extent. The present study tested whether patients with left USN would place the subjective midpoint at the centre of their mental representation of the line. The participants were 10 patients with left USN and 10 neurologically healthy controls. We devised a new 'endpoint reproduction task' using a computer display with a touch panel to seek the representational image when patients with left USN bisect lines and asked the participants to reproduce the location of the right or left endpoint after bisecting lines. The results showed that the representational image of the bisected line depends primarily on the location of the objective right endpoint, not on the location of the objective left endpoint in space. The analyses of the estimated right and left representational extents confirmed our hypotheses that patients with left USN would bisect a line seeing the representational line image that centred across their subjective midpoint. We believe that the findings of the present study with the use of the endpoint reproduction task will contribute to a better understanding of the visuospatial process underlying line bisection of patients with left USN.

Interaction between spatial neglect and attention deficit in patients with right hemisphere damage

Unilateral spatial neglect (USN) was originally regarded as a parietal syndrome, but it has become evident that USN is a disturbance in the widespread attention network. Here, we focused on an interaction between spatial neglect and non-spatial aspect of attention deficit, and aimed to establish a novel evaluation approach based on the characteristics of the spatial distribution of reaction times. We tested 174 patients with right hemisphere damage and divided them based on their prescreening scores on the Behavioral Inattention Test (BIT): (1) USN++ (n = 79: BIT<131), (2) USN+ (n = 47: BIT≥131 with history of USN), and (3) RHD (n = 48: without neglect symptom). The patients were asked to conduct a touch panel-based pointing task toward 2D-arranged (seven columns × five rows) circular targets on a PC monitor, and the reaction time to each object was recorded. To evaluate aspects of attention deficit and neglect symptoms, we calculated the total average of the reaction time for all objects (RT_mean) and the ratios of the right and left space (L/R_ratio), respectively. The results revealed that RT_mean and L/R_ratio can be regarded as independent evaluation parameters for attention deficit and neglect symptoms, respectively. Voxel-based lesion-symptom mapping based on RT_mean and L/R_ratio values revealed relevant lesions with attention-related brain areas (middle temporal gyrus, angular gyrus, and inferior frontal gyrus), and neglect-related brain areas (superior temporal gyrus and superior longitudinal fascicules). A cluster analysis with Gaussian mixture model detected six different states of USN with an interaction between neglect symptoms and attention deficit. Interestingly, the recovery process after USN can be properly explained by the transition pattern from one cluster to another. Our results suggest that a novel evaluation approach to distinguish between neglect symptoms and attention deficit, namely the characterization of the interaction between RT_mean and L/R_ratio, provides useful information for understanding pathological features of USN.

The Table-top Visual Search Ability Test for children and young people: Normative response time data from typically developing children

Five table-top tasks were developed to test the visual search ability of children and young people in a real-world context, and to assess the transfer of training-related improvements in visual search on computerised tasks to real-world activities. Each task involved searching for a set of target objects among distracting objects on a table-top. Performance on the Table-top Visual Search Ability Test for Children (TVSAT-C) was measured as the time spent searching for targets divided by the number of targets found. A total of 108 typically developing children (3–11 years old) and eight children with vision impairment (7–12 years old) participated in the study. A significant correlation was found between log-transformed age and log-transformed performance ( R2 = .65, p = 4 × 10−26) in our normative sample, indicating a monomial power law relationship between age and performance with an exponent of [Formula: see text], [Formula: see text] We calculated age-dependent percentiles and receiver operating characteristic curve analysis indicated the third percentile as the optimal cut-off for detecting a visual search deficit, giving a specificity of [Formula: see text], [Formula: see text] and sensitivity of [Formula: see text], [Formula: see text] for the test. Further studies are required to calculate measures of reliability and external validity, to confirm sensitivity for visual search deficits, and to investigate the most appropriate response modes for participants with conditions that affect manual dexterity. In addition, more work is needed to assess construct validity where semantic knowledge is required that younger children may not have experience with. We have made the protocol and age-dependent normative data available for those interested in using the test in research or practice, and to illustrate the smooth developmental trajectory of visual search ability during childhood.

Generative Models for Active Vision

The active visual system comprises the visual cortices, cerebral attention networks, and oculomotor system. While fascinating in its own right, it is also an important model for sensorimotor networks in general. A prominent approach to studying this system is active inference-which assumes the brain makes use of an internal (generative) model to predict proprioceptive and visual input. This approach treats action as ensuring sensations conform to predictions (i.e., by moving the eyes) and posits that visual percepts are the consequence of updating predictions to conform to sensations. Under active inference, the challenge is to identify the form of the generative model that makes these predictions-and thus directs behavior. In this paper, we provide an overview of the generative models that the brain must employ to engage in active vision. This means specifying the processes that explain retinal cell activity and proprioceptive information from oculomotor muscle fibers. In addition to the mechanics of the eyes and retina, these processes include our choices about where to move our eyes. These decisions rest upon beliefs about salient locations, or the potential for information gain and belief-updating. A key theme of this paper is the relationship between "looking" and "seeing" under the brain's implicit generative model of the visual world.

Bálint syndrome

This chapter starts by reviewing the various interpretations of Bálint syndrome over time. We then develop a novel integrative view in which we propose that the various symptoms, historically reported and labeled by various authors, result from a core mislocalization deficit. This idea is in accordance with our previous proposal that the core deficit of Bálint syndrome is attentional (Pisella et al., 2009, 2013, 2017) since covert attention improves spatial resolution in visual periphery (Yeshurun and Carrasco, 1998); a deficit of covert attention would thus increase spatial uncertainty and thereby impair both visual object identification and visuomotor accuracy. In peripheral vision, we perceive the intrinsic characteristics of the perceptual elements surrounding us, but not their precise localization (Rosenholtz et al., 2012a,b), such that without covert attention we cannot organize them to their respective and recognizable objects; this explains why perceptual symptoms (simultanagnosia, neglect) could result from visual mislocalization. The visuomotor symptoms (optic ataxia) can be accounted for by both visual and proprioceptive mislocalizations in an oculocentric reference frame, leading to field and hand effects, respectively. This new pathophysiological account is presented along with a model of posterior parietal cortex organization in which the superior part is devoted to covert attention, while the right inferior part is involved in visual remapping. When the right inferior parietal cortex is damaged, additional representational mislocalizations across saccades worsen the clinical picture of peripheral mislocalizations due to an impairment of covert attention.

Pathological structure of visuospatial neglect: A comprehensive multivariate analysis of spatial and non-spatial aspects

Visuospatial neglect (VSN) is a neurological syndrome of higher brain functions in which an individual fails to detect stimuli on a space that is contralateral to a hemispheric lesion. We performed a comprehensive multivariate analysis based on the principal component analysis (PCA) and cluster analysis in patients with right hemisphere stroke and then performed a determination of different elements of VSN. PCA-based cluster analysis detected distinct aspects of VSN as follows: cluster 1: low arousal and attention state, cluster 2: exogenous neglect, cluster 3: spatial working memory (SWM) deficit. Lesion analysis revealed neural correlates for each cluster and highlighted “disturbance of the ventral attention network” for the stagnation of exogenous attention and “parietal damage” for SWM deficit. Our results reveal a pathological structure of VSN as multiple components of an attention network deficit, and they contribute to the understanding of the mechanisms underlying VSN.

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This study attempted to establish the pathological structure of visuospatial neglect

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PCA revealed four distinct fundamental components underlying visuospatial neglect

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GMM-based clustering detected six subtypes of visuospatial attention network deficit

How does the number of targets affect visual search performance in visuospatial neglect?

INTRODUCTION

Impairments in visual search are a common symptom in visuospatial neglect (VSN). The severity of the lateralized attention bias in visual search tasks can vary depending on the number of distractors: the more distractors, the more targets are missed. However, little is known about how the number of targets affect search performance in VSN. The aim of the current study was to examine the effect of the number of targets on hit rate in VSN.

METHODS

We included 23 stroke patients with right-brain damage and VSN, 55 with right-brain damage without VSN, and 49 with left-brain damage without VSN, all admitted for inpatient rehabilitation. In a visual search task, patients had to find and tap targets, presented along with non-targets. The location and number of targets varied from trial to trial, allowing the evaluation of the effects of number and location of targets on hit rate.

RESULTS

VSN patients detected a lower percentage of targets when more targets were present. For patients with right-brain damage without VSN, adding targets only reduced the hit rate of the most contralesional target. No effect of number of targets on hit rate was seen in patients with left-brain damage. Additionally, VSN patients found less contralesional targets than ipsilesional targets, made more delayed revisits, and had an initial rightward bias when compared to the other groups. There were no differences in search time, search consistency, or immediate revisits between groups. There was a moderate positive relation between the hit rate asymmetry score in our search task and conventional paper-and-pencil VSN tasks, and neglect behavior in daily life.

CONCLUSIONS

In VSN patients, a higher number of targets reduces the hit rate. The reduced hit rate in visual search evoked by additional targets should be taken into account when assessing visual search in VSN.

Long-lasting effects of a gaze-contingent intervention on change detection in healthy participants - Implications for neglect rehabilitation

Patients with spatial neglect show an ipsilesional exploration bias. We developed a gaze-contingent intervention that aims at reducing this bias and tested its effects on visual exploration in healthy participants: During a visual search, stimuli in one half of the search display are removed when the gaze moves into this half. This leads to a relative increase in the exploration of the other half of the search display - the one that can be explored without impediments. In the first experiment, we tested whether this effect transferred to visual exploration during a change detection task (under change blindness conditions), which was the case. In a second experiment, we modified the intervention (to an intermittent application) but the original version yielded more promising results. Thus, in the third experiment, the original version was used to test the longevity of its effects and whether its repeated application produced even stronger results. To this aim, we compared two groups: the first group received the intervention once, the second group repeatedly on three consecutive days. The change detection task was administered before the intervention and at four points in time after the last intervention (directly afterwards, + 1 hour, + 1 day, and +4 days). The results showed long-lasting effects of the intervention, most pronounced in the second group. Here the intervention changed the bias in the visual exploration pattern significantly until the last follow-up. We conclude that the intervention shows promise for the successful application in neglect patients.

Non-Spatial Impairments Affect False-Positive Neglect Diagnosis Based on Cancellation Tasks

OBJECTIVE

To diagnose egocentric neglect after stroke, the spatial bias of performance on cancellation tasks is typically compared to a single cutoff. This standard procedure relies on the assumption that the measurement error of cancellation performance does not depend on non-spatial impairments affecting the total number of cancelled targets. Here we assessed the impact of this assumption on false-positive diagnoses.

METHOD

We estimated false positives by simulating cancellation data using a binomial model. Performance was summarised by the difference in left and right cancelled targets (R-L) and the Centre of Cancellation (CoC). Diagnosis was based on a fixed cutoff versus cutoffs adjusted for the total number of cancelled targets and on single test performance versus unanimous or proportional agreement across multiple tests. Finally, we compared the simulation findings to empirical cancellation data acquired from 651 stroke patients.

RESULTS

Using a fixed cutoff, the rate of false positives depended on the total number of cancelled targets and ranged from 10% to 30% for R-L scores and from 10% to 90% for CoC scores. The rate of false positives increased even further when diagnosis was based on proportional agreement across multiple tests. Adjusted cutoffs and unanimous agreement across multiple tests were effective at controlling false positives. For empirical data, fixed versus adjusted cutoffs differ in estimation of neglect prevalence by 13%, and this difference was largest for patients with non-spatial impairments.

CONCLUSIONS

Our findings demonstrate the importance of considering non-spatial impairments when diagnosing neglect based on cancellation performance.

Keeping an eye on visual search patterns in visuospatial neglect: A systematic review

Patients with visuospatial neglect exhibit a failure to detect, respond, or orient towards information located in the side of space opposite to their brain lesion. To extend our understanding of the underlying cognitive processes involved in neglect, some studies have used eye movement measurements to complement behavioural data. We provide a qualitative synthesis of studies that have used eye-tracking in patients with neglect, with a focus on highlighting the utility of examining eye movements and reporting what eye-tracking has revealed about visual search patterns in these patients. This systematic review includes twenty studies that met the eligibility criteria. We extracted information pertaining to patient characteristics (e.g., age, type of stroke, time since stroke), neglect test(s) used, type of stimuli (e.g., static, dynamic), eye-tracker specifications (e.g., temporal and spatial resolution), and eye movement measurements (e.g., saccade amplitude, fixation duration). Five key themes were identified. First, eye-tracking is a useful tool to complement pen-and-paper neglect tests. Second, the lateral asymmetrical bias in eye movement patterns observed during active exploration also occurred while at rest. Third, the lateral asymmetrical bias was evident not only in the horizontal plane but also in the vertical plane. Fourth, eye movement patterns were modulated by stimulus- and task-related factors (e.g., visual salience, local perceptual features, image content, stimulus duration, presence of distractors). Fifth, measuring eye movements in patients with neglect is useful for determining and understanding other cognitive impairments, such as spatial working memory. To develop a fuller, and a more accurate, picture of neglect, future research would benefit from eye movement measurements.

Inferring What to Do (And What Not to)

In recent years, the "planning as inference" paradigm has become central to the study of behaviour. The advance offered by this is the formalisation of motivation as a prior belief about "how I am going to act". This paper provides an overview of the factors that contribute to this prior. These are rooted in optimal experimental design, information theory, and statistical decision making. We unpack how these factors imply a functional architecture for motivated behaviour. This raises an important question: how can we put this architecture to work in the service of understanding observed neurobiological structure? To answer this question, we draw from established techniques in experimental studies of behaviour. Typically, these examine the influence of perturbations of the nervous system-which include pathological insults or optogenetic manipulations-to see their influence on behaviour. Here, we argue that the message passing that emerges from inferring what to do can be similarly perturbed. If a given perturbation elicits the same behaviours as a focal brain lesion, this provides a functional interpretation of empirical findings and an anatomical grounding for theoretical results. We highlight examples of this approach that influence different sorts of goal-directed behaviour, active learning, and decision making. Finally, we summarise their implications for the neuroanatomy of inferring what to do (and what not to).

Game theoretical mapping of white matter contributions to visuospatial attention in stroke patients with hemineglect

White matter bundles linking gray matter nodes are key anatomical players to fully characterize associations between brain systems and cognitive functions. Here we used a multivariate lesion inference approach grounded in coalitional game theory (multiperturbation Shapley value analysis, MSA) to infer causal contributions of white matter bundles to visuospatial orienting of attention. Our work is based on the characterization of the lesion patterns of 25 right hemisphere stroke patients and the causal analysis of their impact on three neuropsychological tasks: line bisection, letter cancellation, and bells cancellation. We report that, out of the 11 white matter bundles included in our MSA coalitions, the optic radiations, the inferior fronto-occipital fasciculus and the anterior cingulum were the only tracts to display task-invariant contributions (positive, positive, and negative, respectively) to the tasks. We also report task-dependent influences for the branches of the superior longitudinal fasciculus and the posterior cingulum. By extending prior findings to white matter tracts linking key gray matter nodes, we further characterize from a network perspective the anatomical basis of visual and attentional orienting processes. The knowledge about interactions patterns mediated by white matter tracts linking cortical nodes of attention orienting networks, consolidated by further studies, may help develop and customize brain stimulation approaches for the rehabilitation of visuospatial neglect.

Encoding strategy mediates the effect of electrical stimulation over posterior parietal cortex on visual short-term memory

Over past decades, converging neuroimaging and electrophysiological findings have suggested a crucial role of posterior parietal cortex (PPC) in supporting the storage capacity of visual short-term memory (VSTM). Moreover, a few recent studies have shown that electrical stimulation over PPC can enhance VSTM capacity, making it a promising method for improving VSTM function. However, the reliability of these results is still in question because null findings have also been observed. Among studies that reported significant effects, some found increased VSTM capacity only in people with low capacity. Here, we hypothesized that subjects' encoding strategy might be a key source of these variable results. To directly test this hypothesis, we stimulated PPC using transcranial direct-current stimulation (tDCS) in male and female human subjects instructed to employ different encoding strategies during a VSTM recall task. We found that VSTM capacity was higher in subjects who were instructed to remember all items in the supra-capacity array of visual stimuli (i.e., the remember-all group), compared to subjects who were told to focus on a subset of these stimuli (i.e., the remember-subset group). As predicted, anodal tDCS over PPC significantly enhanced VSTM capacity only in the remember-subset group, but not in the remember-all group. Additionally, no effect of encoding strategy or its interaction with electrical stimulation was found on VSTM precision. Together, these results suggest that encoding strategy has a selective influence on VSTM capacity and this influence of encoding strategy mediates the effect of electrical stimulation over PPC on VSTM function.

Unbalancing the Attentional Priority Map via Gaze-Contingent Displays Induces Neglect-Like Visual Exploration

Selective spatial attention is a crucial cognitive process that guides us to the behaviorally relevant objects in a complex visual world by using exploratory eye movements. The spatial location of objects, their (bottom-up) saliency and (top-down) relevance is assumed to be encoded in one “attentional priority map” in the brain, using different egocentric (eye-, head- and trunk-centered) spatial reference frames. In patients with hemispatial neglect, this map is supposed to be imbalanced, leading to a spatially biased exploration of the visual environment. As a proof of concept, we altered the visual saliency (and thereby attentional priority) of objects in a naturalistic scene along a left-right spatial gradient and investigated whether this can induce a bias in the exploratory eye movements of healthy humans (n = 28; all right-handed; mean age: 23 years, range 19–48). We developed a computerized mask, using high-end “gaze-contingent display (GCD)” technology, that immediately and continuously reduced the saliency of objects on the left—“left” with respect to the head (body-centered) and the current position on the retina (eye-centered). In both experimental conditions, task-free viewing and goal-driven visual search, this modification induced a mild but significant bias in visual exploration similar to hemispatial neglect. Accordingly, global eye movement parameters changed (reduced number and increased duration of fixations) and the spatial distribution of fixations indicated an attentional bias towards the right (rightward shift of first orienting, fixations favoring the scene’s outmost right over left). Our results support the concept of an attentional priority map in the brain as an interface between perception and behavior and as one pathophysiological ground of hemispatial neglect.

Visual Exploration Area in Neglect: A New Analysis Method for Video-Oculography Data Based on Foveal Vision

Video-oculography during free visual exploration (FVE) is a valuable tool to evaluate visual attention spatial allocation in neglect patients after right-hemispheric stroke. In conventional FVE analyses, the position of a visual fixation is conceived as a single point in space. Here, we describe a new complementary method to analyze FVE data based on foveal vision, leading to an accurate estimate of the portion of the picture that was effectively explored. In 15 neglect patients and 20 healthy controls, visual exploration areas (i.e., considering 1° visual angle around every single fixation) were computed. Furthermore, the proportion of single and overlapping fixations was analyzed. Overlapping fixations were further categorized into capture fixations (successive overlapping fixation, putatively reflecting problem of disengagement) and re-capture fixations (temporally distant overlapping fixations, putatively reflecting spatial working memory deficits). The results of this new analysis approach were compared to the ones of conventional approaches. Conventional analyses showed the typical visual attention deficits in neglect patients versus healthy controls: significantly less fixations and time spent within the left and significantly more fixations and time spent within the right screen half. According to the results of our new approach, patients showed a significantly smaller visual exploration area within the left screen half. However, the right visual exploration area did not differ between groups. Furthermore, in neglect patients, the proportion of overlapping fixations within the right screen half was significantly higher than within the left screen half, as well as significantly higher than in healthy controls within either screen halves. Whereas neglect patients showed significantly more capture fixations than healthy controls, the number of re-capture fixations did not differ between groups. These results suggest that, in neglect patients, the efficiency of visual exploration is also reduced within the right screen half and that impaired disengagement might be an important mechanism leading to overlapping fixations. Our new analysis of the visual exploration area, based on foveal vision, may be a promising additional approach in visual attention research. It allows to accurately measure the portion of the picture that was effectively explored, disentangle single from overlapping fixations, and distinguish between capture and re-capture fixations.

The relationship between visuospatial neglect, spatial working memory and search behavior

Visuospatial neglect (VSN) is characterized by a lateralized attentional deficit in the visual domain. In addition, patients with VSN might have an impairment in the temporary storage of spatial information in working memory (spatial working memory; SWM) that, like VSN, could impair systematic searching behavior. Several studies have demonstrated either SWM impairments or impaired searching behavior in VSN patients. Here, we related SWM performance to search behavior in patients with and without VSN. We assessed SWM using a novel task in a group of 182 stroke patients (24 with VSN, 158 without) and 65 healthy controls. We related SWM performance to available stroke-related and cognitive data. Patients with VSN exhibited lower SWM performance than patients without VSN and healthy controls. Additional control analyses indicated that differences in SWM performance are specific to visuospatial processing, instead of e.g. verbal working memory or the general level of physical disability. Last, we related SWM performance to visual search performance on cancellation tasks, one where their cancellation markings remained visible and another one where their prior cancellations markings were invisible to the patient and therefore patients had to remember which targets they had canceled. SWM performance correlated with search organization. Together, these results from a large sample of stroke patients corroborate the findings of earlier studies, while excluding several alternative explanations: SWM impairment is a part of the neglect syndrome, and SWM impairments are related to search behavior.

Perceptual awareness and active inference

Perceptual awareness depends upon the way in which we engage with our sensorium. This notion is central to active inference, a theoretical framework that treats perception and action as inferential processes. This variational perspective on cognition formalizes the notion of perception as hypothesis testing and treats actions as experiments that are designed (in part) to gather evidence for or against alternative hypotheses. The common treatment of perception and action affords a useful interpretation of certain perceptual phenomena whose active component is often not acknowledged. In this article, we start by considering Troxler fading - the dissipation of a peripheral percept during maintenance of fixation, and its recovery during free (saccadic) exploration. This offers an important example of the failure to maintain a percept without actively interrogating a visual scene. We argue that this may be understood in terms of the accumulation of uncertainty about a hypothesized stimulus when free exploration is disrupted by experimental instructions or pathology. Once we take this view, we can generalize the idea of using bodily (oculomotor) action to resolve uncertainty to include the use of mental (attentional) actions for the same purpose. This affords a useful way to think about binocular rivalry paradigms, in which perceptual changes need not be associated with an overt movement.

Representational drawing following brain injury

Research has shown that damage to either the left or right hemisphere can lead to deficits in visuoconstructional skills including drawing and figure copying. Nevertheless, research would suggest that the nature of the deficits arising from left and right brain injury are distinct in nature if not severity, with the right hemisphere, and parietal cortex specifically, seen as critical for obtaining accurate spatial relations and the left hemisphere important for effective organisation (i.e., executive function). Much of this work on drawing and figure copying following brain damage has rested on qualitative assessments or crude marking scales with descriptive anchors for what constitutes good or poor performance. We employed quantitative analyses of drawings developed to assess accuracy in novice and expert artists. We analyzed drawings of a cube and a star in 50 patients (23, left brain damaged: LBD; 27 right brain damaged: RBD) who had suffered strokes. Our analysis was sensitive to the presence of neglect on the cube (i.e., missing left sided details) with voxel-wise lesion symptom mapping (VLSM) highlighting involvement of expected brain regions (superior temporal and supramarginal gyri). With left-sided omissions removed from analyses, we failed to find any difference between LBD and RBD patients. While the presence of left neglect appeared to exaggerate errors, this was only significant for errors of scale and proportion for the star drawing. VLSM of the distinct error domains demonstrated white matter involvement (and a minor contribution from the right insula) with respect to scale errors of the cube only. Finally, blinded judgements of hemisphere of lesion based on qualitative assessment of the drawings were no better than chance. These results suggest that figure copying is a complex task relying on large scale neural networks involving both hemispheres. Clearly, models of visuoconstructional capacity that emphasise right hemisphere dominance are not entirely accurate.

Dynamic Causal Modelling of Active Vision

In this paper, we draw from recent theoretical work on active perception, which suggests that the brain makes use of an internal (i.e., generative) model to make inferences about the causes of sensations. This view treats visual sensations as consequent on action (i.e., saccades) and implies that visual percepts must be actively constructed via a sequence of eye movements. Oculomotor control calls on a distributed set of brain sources that includes the dorsal and ventral frontoparietal (attention) networks. We argue that connections from the frontal eye fields to ventral parietal sources represent the mapping from “where”, fixation location to information derived from “what” representations in the ventral visual stream. During scene construction, this mapping must be learned, putatively through changes in the effective connectivity of these synapses. Here, we test the hypothesis that the coupling between the dorsal frontal cortex and the right temporoparietal cortex is modulated during saccadic interrogation of a simple visual scene. Using dynamic causal modeling for magnetoencephalography with (male and female) human participants, we assess the evidence for changes in effective connectivity by comparing models that allow for this modulation with models that do not. We find strong evidence for modulation of connections between the two attention networks; namely, a disinhibition of the ventral network by its dorsal counterpart.

SIGNIFICANCE STATEMENT This work draws from recent theoretical accounts of active vision and provides empirical evidence for changes in synaptic efficacy consistent with these computational models. In brief, we used magnetoencephalography in combination with eye-tracking to assess the neural correlates of a form of short-term memory during a dot cancellation task. Using dynamic causal modeling to quantify changes in effective connectivity, we found evidence that the coupling between the dorsal and ventral attention networks changed during the saccadic interrogation of a simple visual scene. Intuitively, this is consistent with the idea that these neuronal connections may encode beliefs about “what I would see if I looked there”, and that this mapping is optimized as new data are obtained with each fixation.

Distorted gaze direction input to attentional priority map in spatial neglect

A contribution of the gaze signals to the attention imbalance in spatial neglect is presumed. Direct evidence however, is still lacking. Theoretical models for spatial attention posit an internal representation of locations that are selected in the competition for neural processing resources – an attentional priority map. Following up on our recent research showing an imbalance in the allocation of attention after an oculoproprioceptive perturbation in healthy volunteers, we investigated here whether the lesion in spatial neglect distorts the gaze direction input to this representation.

Information about one's own direction of gaze is critical for the coordinate transformation between retinotopic and hand proprioceptive locations. To assess the gaze direction input to the attentional priority map, patients with left spatial neglect performed a cross-modal attention task in their normal, right hemispace. They discriminated visual targets whose location was cued by the patient's right index finger hidden from view. The locus of attention in response to the cue was defined as the location with the largest decrease in reaction time for visual discrimination in the presence vs. absence of the cue. In two control groups consisting of healthy elderly and patients with a right hemisphere lesion without neglect, the loci of attention were at the exact location of the cues. In contrast, neglect patients allocated attention at 0.5⁰-2⁰ rightward of the finger for all tested locations. A control task using reaching to visual targets in the absence of visual hand feedback ruled out a general error in visual localization. These findings demonstrate that in spatial neglect the gaze direction input to the attentional priority map is distorted. This observation supports the emerging view that attention and gaze are coupled and suggests that interventions that target gaze signals could alleviate spatial neglect.

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The mechanisms of left inattention in spatial neglect are incompletely understood.

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Attention loci in visual space are displaced to the right of somatosensory cues.

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This indicates a distorted gaze direction input to the attentional priority map.

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Distorted gaze direction input could lead to left-right attention imbalance.

Re-fixation and perseveration patterns in neglect patients during free visual exploration

The literature suggests that neglect patients not only show impairments in directing attention toward the left, contralesional space, but also present with perseverative behavior. Moreover, previous studies described re-fixations during visual search tasks, and interpreted this finding as an impairment of spatial working memory. The aim of the present study was to study re-fixations and perseverations (i.e., recurrent re-fixations to same locations) during free visual exploration, a task with high ecological validity. We hypothesized that: (1) neglect patient would perform re-fixations more frequently than healthy controls within the right hemispace; and, (2) the re-fixation behavior of neglect patients would be characterized by perseverative fixations. To test these hypotheses, we assessed 22 neglect patients and 23 healthy controls, measuring their eye movements during free exploration of naturalistic pictures. The results showed that neglect patients tend to re-fixate locations within the ipsilesional hemispace when they freely explore naturalistic pictures. Importantly, the saliency of discrete locations within the pictures has a stronger influence on fixation behavior within the contralesional than within the ipsilesional hemispace in neglect patients. Finally, the results indicated that, for re-fixations, saliency plays a more important role within the contralesional than the ipsilesional hemispace. Moreover, we found evidence that re-fixation behavior of neglect patients is characterized by frequent recurrent re-fixations back to the same spatial locations which may be interpreted as perseverations. Hence, with the present study, we could better elucidate the mechanism leading to re-fixations and perseverative behavior during free visual exploration in neglect patients.

Unilateral neglect post stroke: Eye movement frequencies indicate directional hypokinesia while fixation distributions suggest compensational mechanism

INTRODUCTION

Eye movements and spatial attention are closely related, and eye-tracking can provide valuable information in research on visual attention. We investigated the pathology of overt attention in right hemisphere (RH) stroke patients differing in their severity of neglect symptoms by using eye-tracking during a dynamic attention task.

METHODS

Eye movements were recorded in 26 RH stroke patients (13 with and 13 without unilateral spatial neglect, and a matched group of 26 healthy controls during a Multiple Object Tracking task. We assessed the frequency and spatial distributions of fixations, as well as frequencies of eye movements to the left and to the right side of visual space so as to investigate individuals' efficiency of visual processing, distribution of attentional processing resources, and oculomotoric orienting mechanisms.

RESULTS

Both patient groups showed increased fixation frequencies compared to controls. A spatial bias was found in neglect patients' fixation distribution, depending on neglect severity (indexed by scores on the Behavioral Inattention Test). Patients with more severe neglect had more fixations within the right field, while patients with less severe neglect had more fixations within their left field. Eye movement frequencies were dependent on direction in the neglect patient group, as they made more eye movements toward the right than toward the left.

CONCLUSION

The patient groups' higher fixation rates suggest that patients are generally less efficient in visual processing. The spatial bias in fixation distribution, dependent on neglect severity, suggested that patients with less severe neglect were able to use compensational mechanisms in their contralesional space. The observed relation between eye movement rates and directions observed in neglect patients provides a measure of the degree of difficulty these patients may encounter during dynamic situations in daily life and supports the idea that directional oculomotor hypokinesia may be a relevant component in this syndrome.

Influence of reward learning on visual attention and eye movements in a naturalistic environment: A virtual reality study

Rewards constitute crucial signals that motivate approach behavior and facilitate the perceptual processing of objects associated with favorable outcomes in past encounters. Reward-related influences on perception and attention have been reliably observed in studies where a reward is paired with a unidimensional low-level visual feature, such as the color or orientation of a line in visual search tasks. However, our environment is drastically different and composed of multidimensional and changing visual features, encountered in complex and dynamic scenes. Here, we designed an immersive virtual reality (VR) experiment using a 4-frame CAVE system to investigate the impact of rewards on attentional orienting and gaze patterns in a naturalistic and ecological environment. Forty-one healthy participants explored a virtual forest and responded to targets appearing on either the left or right side of their path. To test for reward-induced biases in spatial orienting, targets on one side were associated with high reward, whereas those on the opposite side were paired with a low reward. Eye-movements recording showed that left-side high rewards led to subsequent increase of eye gaze fixations towards this side of the path, but no such asymmetry was found after exposure to right-sided high rewards. A milder spatial bias was also observed after left-side high rewards during subsequent exploration of a virtual castle yard, but not during route turn choices along the forest path. Our results indicate that reward-related influences on attention and behavior may be better learned in left than right space, in line with a right hemisphere dominance, and could generalize to another environment to some extent, but not to spatial choices in another decision task, suggesting some domain- or context-specificity. This proof-of-concept study also outlines the advantages and the possible drawbacks of the use of the 3D CAVE immersive platform for VR in neuroscience.

Eye Movements in the "Morris Maze" Spatial Working Memory Task Reveal Deficits in Strategic Planning

Analysis of eye movements can provide insights into processes underlying performance of cognitive tasks. We recorded eye movements in healthy participants and people with idiopathic Parkinson disease during a token foraging task based on the spatial working memory component of the widely used Cambridge Neuropsychological Test Automated Battery. Participants selected boxes (using a mouse click) to reveal hidden tokens. Tokens were never hidden under a box where one had been found before, such that memory had to be used to guide box selections. A key measure of performance in the task is between search errors (BSEs) in which a box where a token has been found is selected again. Eye movements were found to be most commonly directed toward the next box to be clicked on, but fixations also occurred at rates higher than expected by chance on boxes farther ahead or back along the search path. Looking ahead and looking back in this way was found to correlate negatively with BSEs and was significantly reduced in patients with Parkinson disease. Refixating boxes where tokens had already been found correlated with BSEs and the severity of Parkinson disease symptoms. It is concluded that eye movements can provide an index of cognitive planning in the task. Refixations on locations where a token has been found may also provide a sensitive indicator of visuospatial memory integrity. Eye movement measures derived from the spatial working memory task may prove useful in the assessment of executive functions as well as neurological and psychiatric diseases in the future.

The Anatomy of Inference: Generative Models and Brain Structure

To infer the causes of its sensations, the brain must call on a generative (predictive) model. This necessitates passing local messages between populations of neurons to update beliefs about hidden variables in the world beyond its sensory samples. It also entails inferences about how we will act. Active inference is a principled framework that frames perception and action as approximate Bayesian inference. This has been successful in accounting for a wide range of physiological and behavioral phenomena. Recently, a process theory has emerged that attempts to relate inferences to their neurobiological substrates. In this paper, we review and develop the anatomical aspects of this process theory. We argue that the form of the generative models required for inference constrains the way in which brain regions connect to one another. Specifically, neuronal populations representing beliefs about a variable must receive input from populations representing the Markov blanket of that variable. We illustrate this idea in four different domains: perception, planning, attention, and movement. In doing so, we attempt to show how appealing to generative models enables us to account for anatomical brain architectures. Ultimately, committing to an anatomical theory of inference ensures we can form empirical hypotheses that can be tested using neuroimaging, neuropsychological, and electrophysiological experiments.

Spatial remapping in visual search: Remapping cues are provided at attended and ignored locations

We experience the world as stable and continuous, despite the fact that visual input is overwritten on the retina with each new ocular fixation. Spatial remapping is the process that integrates selected visual information into successive (continuous) representations of our spatial environment, thereby allowing us to keep track of objects, and experience the world as stable, despite frequent eye (re-)fixations. The present paper investigates spatial remapping in the context of visual pop-out search. Within standard instances of the pop-out paradigm, reactions to stimuli at previously attended locations are facilitated (faster and more accurate), and reactions to stimuli at previously ignored locations are inhibited (slower and less accurate). The mechanisms that support facilitation at previously attended locations, and inhibition at previously ignored locations, serve to enhance the efficiency of visual search. It is thus natural to expect that information about which locations were previously attended to or ignored is stored and remapped as a concomitant to successive representations of the spatial environment. Using variants of the pop-out paradigm, we corroborate this expectation, and show that information concerning the prior status of locations, as attended to or ignored, is remapped following attention shifts, with some degradation of information concerning ignored locations.

Post-stroke visual neglect affects goal-directed locomotion in different perceptuo-cognitive conditions and on a wide visual spectrum

BACKGROUND

Unilateral spatial neglect (USN), a highly prevalent and disabling post-stroke deficit, has been shown to affect the recovery of locomotion. However, our current understanding of USN role in goal-directed locomotion control, and this, in different cognitive/perceptual conditions tapping into daily life demands, is limited.

OBJECTIVES

To examine goal-directed locomotion abilities in individuals with and without post-stroke USN vs. healthy controls.

METHODS

Participants (n = 45, n = 15 per group) performed goal-directed locomotion trials to actual, remembered and shifting targets located 7 m away at 0° and 15° right/left while immersed in a 3-D virtual environment.

RESULTS

Greater end-point mediolateral displacement and heading errors (end-point accuracy measures) were found for the actual and the remembered left and right targets among those with post-stroke USN compared to the two other groups (p <  0.05). A delayed onset of reorientation to the left and right shifting targets was also observed in USN+ participants vs. the other two groups (p <  0.05). Results on clinical near space USN assessment and walking speed explained only a third of the variance in goal-directed walking performance.

CONCLUSION

Post-stroke USN was found to affect goal-directed locomotion in different perceptuo-cognitive conditions, both to contralesional and ipsilesional targets, demonstrating the presence of lateralized and non-lateralized deficits. Beyond neglect severity and walking capacity, other factors related to attention, executive functioning and higher-order visual perceptual abilities (e.g. optic flow perception) may account for the goal-directed walking deficits observed in post-stroke USN+. Goal-directed locomotion can be explored in the design of future VR-based evaluation and training tools for USN to improve the currently used conventional methods.

Updating impairments and the failure to explore new hypotheses following right brain damage

We have shown recently that damage to the right hemisphere impairs the ability to update mental models when evidence suggests an old model is no longer appropriate. We argue that this deficit is generic in the sense that it crosses multiple cognitive and perceptual domains. Here, we examined the nature of this updating impairment to determine more precisely the underlying mechanisms. We had right (RBD, N = 12) and left brain damaged (LBD, N = 10) patients perform versions of our picture-morphing task in which pictures gradually morph from one object (e.g., shark) to another (e.g., plane). Performance was contrasted against two groups of healthy older controls, one matched on age (HCO-age-matched, N = 9) and another matched on general level of cognitive ability (HCO-cognitively-matched, N = 9). We replicated our earlier findings showing that RBD patients took longer than LBD patients and HCOs to report seeing the second object in a sequence of morphing images. The groups did not differ when exposed to a morphing sequence a second time, or when responding to ambiguous images outside the morphing context. This indicates that RBD patients have little difficulty alternating between known representations or labeling ambiguous images. Instead, the difficulty lies in generating alternate hypotheses for ambiguous information. Lesion overlay analyses, although speculative given the sample size, are consistent with our fMRI work in healthy individuals in implicating the anterior insular cortex as critical for updating mental models.

Computational Neuropsychology and Bayesian Inference

Computational theories of brain function have become very influential in neuroscience. They have facilitated the growth of formal approaches to disease, particularly in psychiatric research. In this paper, we provide a narrative review of the body of computational research addressing neuropsychological syndromes, and focus on those that employ Bayesian frameworks. Bayesian approaches to understanding brain function formulate perception and action as inferential processes. These inferences combine ‘prior’ beliefs with a generative (predictive) model to explain the causes of sensations. Under this view, neuropsychological deficits can be thought of as false inferences that arise due to aberrant prior beliefs (that are poor fits to the real world). This draws upon the notion of a Bayes optimal pathology – optimal inference with suboptimal priors – and provides a means for computational phenotyping. In principle, any given neuropsychological disorder could be characterized by the set of prior beliefs that would make a patient’s behavior appear Bayes optimal. We start with an overview of some key theoretical constructs and use these to motivate a form of computational neuropsychology that relates anatomical structures in the brain to the computations they perform. Throughout, we draw upon computational accounts of neuropsychological syndromes. These are selected to emphasize the key features of a Bayesian approach, and the possible types of pathological prior that may be present. They range from visual neglect through hallucinations to autism. Through these illustrative examples, we review the use of Bayesian approaches to understand the link between biology and computation that is at the heart of neuropsychology.

The Computational Anatomy of Visual Neglect

Visual neglect is a debilitating neuropsychological phenomenon that has many clinical implications and-in cognitive neuroscience-offers an important lesion deficit model. In this article, we describe a computational model of visual neglect based upon active inference. Our objective is to establish a computational and neurophysiological process theory that can be used to disambiguate among the various causes of this important syndrome; namely, a computational neuropsychology of visual neglect. We introduce a Bayes optimal model based upon Markov decision processes that reproduces the visual searches induced by the line cancellation task (used to characterize visual neglect at the bedside). We then consider 3 distinct ways in which the model could be lesioned to reproduce neuropsychological (visual search) deficits. Crucially, these 3 levels of pathology map nicely onto the neuroanatomy of saccadic eye movements and the systems implicated in visual neglect.