This book covers all aspects of the disorder, from an historical survey of research to date, through the nature and anatomical bases of neglect, and on to review contemporary theories on the subject.

Patients may show a more-or-less complete deviation of the head and eyes towards the right (ipsilesional) side [that is, to the same side of egocentric space as the brain lesion responsible for their disorder]. If addressed by the examiner from the left (contralesional) side [the opposite side to their lesion], patients with severe extrapersonal neglect may fail to respond or may look for the speaker in the right side of the room, turning head and eyes more and more to (...) the right. Frequently these patients will not pick up food from the left half of the plate. Given a crossword puzzle, they may complete only the squares to the right. If walking is not prevented by hemiparesis, neglect patients may lose their bearings, since they do not make use of left sided cues. (shrink)

The extent to which visual information on the contralateral, unattended side influences the performance of patients with hemispatial neglect was studied in a visuomotor reaching task. We replicated the well-established finding that, relative to target-alone trials, normal subjects are slower to reach to targets in the presence of visual distractors which appear either ipsilateral or contralateral to the target, with greater interference in the former condition. Six patients with hemispatial neglect showed even greater interference than did the normal (...) subjects when the distractor appeared ipsilaterally but showed no significant interference from contralateral distractors. This pattern of performance was qualitatively similar for patients with lesions restricted to posterior regions and for patients with more extensive lesions involving both posterior and anterior brain regions. These findings suggest that, in the visuomotor domain, information on the contralateral side is processed minimally, if at all, in patients with hemispatial neglect. (shrink)

Encoding sensory events entails processing of several physical attributes. Is the processing of any of these attributes a pre-requisite of conscious awareness? This selective review examines a recent set of behavioral and event-related potentials, studies conducted in patients with visual and auditory unilateral neglect or extinction, with the aim of establishing what aspects of initial processing are impaired in these patients. These studies suggest that extinguished visual stimuli excite the sensory cortices, but perhaps to a lesser degree than (...) acknowledged stimuli do. However, encoding spatial attributes of auditory and visual stimuli appear to be preferentially impaired. In light of results from patients with other neuro-behavioral deficits, it is argued that egocentric spatial information is an essential pre-requisite for knowing that an external event occurred. In contrast, information handled by mostly domain-specific circuits, such as in the ventral temporal lobe, supports awareness of the identity of a stimulus, but not of its mere presence. Without spatial information, the stimulus identity will remain implicit. (shrink)

Unilateral neglect stems from a relatively selective impairment of exogenous, or stimulus-related, orienting of attention. This neuropsychological evidence parallels “change blindness” experiments, in which normal individuals lack awareness of salient details in the visual scene as a consequence of their attention being exogenously attracted by a competing event, suggesting that visual consciousness requires the integrity of exogenous orienting of attention.

Ninety-one right brain-damaged patients with left neglect and 43 right brain-damaged patients without neglect were asked to extend horizontal segments, either left- or rightward, starting from their right or left endpoints, respectively. Earlier experiments based on similar tasks had shown, in left neglect patients, a tendency to overextend segments toward the left side. This seemingly paradoxical phenomenon was held to undermine current explanations of unilateral neglect. The results of the present extensive research demonstrate that contralesional (...) overextension is also evident in most right brain-damaged patients without contralesional neglect. Furthermore, they show that in a minority of left neglect patients, the opposite behavior, i.e., right overextension can be found. The paper also reports the results of correlational analyses comprising the parameters of line-extension, line-bisection, and cancellation tasks, as well as the parameters relative to the Milner Landmark Task, by which a distinction is drawn between perceptual and response biases in unilateral neglect. A working hypothesis is then advanced about the brain dysfunction underlying neglect and an attempt is made at finding an explanation of neglect and the links between the mechanisms of space representation and consciousness through the study of the changes induced by unilateral brain lesions in the characteristics of space-coding neurons. Abbreviations: C, control group;GN+91,full group of neglect patients;GN+27,group of neglect patients with relative left overextension;GN+14,group of neglect patients with relative right overextension;GN-43,full group of non-neglect patients;GN-9,group of non-neglect patients with relative left overextension; H canc, H cancellation task; LE, left extension; LE/RE, ratio of left-right extension; N+, neglect patients; N-, non-neglect patients; PB Land-M, perceptual bias on Landmark motor task; PB Land-V, perceptual bias on Landmark verbal task; RB Land-M, response bias on Landmark motor task; RB Land-V, response bias on Landmark verbal task; RE, right extension. (shrink)

When left-neglect patients are required to extend horizontal segments to double their original length, relative left overextension is frequently observed. Less frequently, relative left underextension may also be found. It was hypothesized that this contrast could depend on the degree of horizontal anisometry of the medium for the representation of spatial properties. The present paper reports an experiment conducted in order to test that hypothesis, on the basis of which left overextension should be larger with shorter than with longer (...) segments and with segments lying in the right rather than in the left hemispace. Although supportive, the results unveiled unexpected complications: the expected effect of line length was found only in neglect patients with frontal damage, while the expected effect of side of presentation was found only in neglect patients without frontal damage. (shrink)

Studies on the syndrome called ‘unilateral visual or spatial neglect’ have been used by philosophers in discussions concerning perceptual phenomenology. Nanay , based on spatial neglects studies, argued that the property of being suitable for action is part of the perceptual phenomenology of neglect patients. In this paper, I argue that the studies on visual neglect conducted thus far do not support Nanay’s thesis that when patients succeed in detecting the neglected object, it’s action properties are (...) part of their perceptual phenomenology; instead, the support the view that the patients consciously see low-level properties such as color and shape. In the first section, I discuss unilateral neglect and extinction. In the second section, I analyze Nanay’s argument. In the third section, I explain why Nanay’s thesis does not follow from the studies on visual neglect. Nanay argues that when neglect patients are cued with an action-property of an object and succeed in perceiving the object in the contralesional side they are phenomenally aware of an action-property of it but they are not phenomenally aware of its low-level properties. Since the patients detect the object, they must be phenomenally aware of some of its properties. Failing to see the low-level properties, the patients should be phenomenally aware is the action-property. Against this, I argue that research on spatial neglect shows that the patients come to see the low-level properties. I also explain why my discussion also supports the more general claim that the studies on neglect and extinction conducted thus far do not establish that the action-properties are part of the patients’ phenomenology. Finally, in section four, I examine a possible objection against my account. My arguments do not entail that the action properties are not part of perceptual phenomenology; only that the neglect studies do not establish this. (shrink)

Unilateral spatial neglect 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 systems in combination with eye-tracking 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. 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. 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 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 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. (shrink)

Visual neglect has been associated with an imbalance in the level of activity in the saccadic system: activity in the contralesional field is suppressed, which makes target selection unlikely. We recorded eye movements of a patient with hemispatial neglect and a group of healthy participants during an oculomotor distractor paradigm. Results showed that the interfering effects of a distractor were very strong when presented in her ipsilesional visual field. However, when the distractor was presented in her contralesional field, (...) there were no interfering effects when the target was presented in her ipsilesional field. These findings could not be explained by the presence of a visual field defect as revealed by the results of two hemianopic patients. Our results are in line with an imbalance in the level of activity in the saccadic system in visual neglect because visual elements presented in the contralesional field did not compete for saccadic selection. (shrink)

Right brain-damaged patients with unilateral neglect, who ignore left-sided visual events, may also omit left-sided details when describing known places from memory. Modulating the orienting of visual attention may ameliorate imaginal neglect. A first step toward explaining these phenomena might be to postulate that space-related imagery is a cognitive activity involving attentional and intentional aspects.

We have shown that FEF lesion-induced extinction could be compensated for by changing the relative temporal onsets of two targets presented on either side of the midline. Monkeys were trained to make saccades to either of two identical visual stimuli presented with various stimulus onset asynchronies (SOA). In intact animals the targets were chosen with equal probability when they appeared simultaneously. After unilateral FEF lesions an SOA of 67–116 msec had to be introduced, with the contralesional target appearing first, (...) to obtain equal probability choice. With a smaller target separation, averaging saccades occurred with highest frequency at similar SOAs. Our findings suggest that neglect may be attributable to more time being required in the damaged hemisphere for converting sensory information into motor responses. (shrink)

During active vision, the eyes continually scan the visual environment using saccadic scanning movements. This target article presents an information processing model for the control of these movements, with some close parallels to established physiological processes in the oculomotor system. Two separate pathways are concerned with the spatial and the temporal programming of the movement. In the temporal pathway there is spatially distributed coding and the saccade target is selected from a Both pathways descend through a hierarchy of levels, the (...) lower ones operating automatically. Visual onsets have automatic access to the eye control system via the lower levels. Various centres in each pathway are interconnected via reciprocal inhibition. The model accounts for a number of well-established phenomena in target-elicited saccades: the gap effect, express saccades, the remote distractor effect, and the global effect. High-level control of the pathways in tasks such as visual search and reading is discussed; it operates through spatial selection and search selection, which generally combine in an automated way. The model is examined in relation to data from patients with unilateral neglect. (shrink)

Do we (sometimes) perceive apples as edible? One could argue that it is just a manner of speaking to say so: we do not really see an object as edible, we see it as having certain shape, size and color and we only infer on the basis of these properties that it is. I argue that we do indeed see objects as edible, and do not just believe that they are. My argument proceeds in two steps. First, I point out (...) that Susanna Siegel's influential argument in favor of the claim that we represent sortal properties perceptually does not work. Second, I argue that we can fix this argument if we replace the sortal property in question with the property of being edible, climbable or Q-able in general. (shrink)

Recently, several theorists have proposed that we can perceive a range of high-level features, including natural kind features (e.g., being a lemur), artifactual features (e.g., being a mandolin), and the emotional features of others (e.g., being surprised). I clarify the claim that we perceive high-level features and suggest one overlooked reason this claim matters: it would dramatically expand the range of actions perception-based theories of action might explain. I then describe the influential phenomenal contrast method of arguing for high-level perception (...) and discuss some of the objections that have been raised against this strategy. Finally, I describe two emerging defenses of high-level perception, one of which appeals to a certain class of perceptual deficits and one of which appeals to adaptation effects. I sketch a challenge for the latter approach. (shrink)

I am looking at an apple. The apple has a lot of properties and some, but not all, of these are part of my phenomenology at this moment: I am aware of these properties. And some, but not all, of these properties that I am aware of are part of my perceptual (or sensory) phenomenology. If I am attending to the apple’s color, this property will be part of my perceptual phenomenology. The property of being a granny smith apple from (...) Chile is unlikely to be part of my perceptual phenomenology. Here are two problems for anyone who is interested in conscious experience in general, and perceptual experience in particular: (a) How can we tell which properties are part of our phenomenology and which ones are not? (b) How can we tell which properties are part of our perceptual phenomenology and which ones are part of our non-perceptual phenomenology? I will focus on (b) in this paper. My aim is twofold: I propose a methodology for answering the question of which properties are part of our perceptual phenomenology and I provide an example for how this methodology could be applied. (shrink)

In this article I argue that contractarian theory is a fruitful approach for dealing with questions of legitimacy in light of globalisation. I try to point out that impaired conditions for providing collective goods in nation-states do not call the legitimacy of globalisation into question, even if the provision of such goods meets with consent amongst the citizens of the nation-state. The need to raise taxes as a consequence of the transfer of mobile resources to other countries can indicate the (...) existence of state activities which lack legitimacy from the contractarian perspective. However, the impossibility of applying the exclusion principle in providing collective goods indeed entails legitimatory problems of globalisation. In this respect, a need for international agreements exists. Nevertheless, unilateral attempts by nation-states to withraw the domestic economy from global influences can interfere with the welfare of other collectives and they therefore lack legitimacy, a moral consequence which is in danger of being neglected even from a contractarian approach. (shrink)

Neuronal aggregates involved in conscious awareness are not evenly distributed throughout the CNS but comprise key components referred to as the neural network correlates of consciousness (NNCC). A critical node in this network is the posterior cingulate, precuneal, and retrosplenial cortices. The cytological and neurochemical composition of this region is reviewed in relation to the Brodmann map. This region has the highest level of cortical glucose metabolism and cytochrome c oxidase activity. Monkey studies suggest that the anterior thalamic projection likely (...) drives retrosplenial and posterior cingulate cortex metabolism and that the midbrain projection to the anteroventral thalamic nucleus is a key coupling site between the brainstem system for arousal and cortical systems for cognitive processing and awareness. The pivotal role of the posterior cingulate, precuneal, and retrosplenial cortices in consciousness is demonstrated with posterior cingulate epilepsy cases, midcingulate lesions that de-afferent this region and are associated with unilateral sensory neglect, observations from stroke and vegetative state patients, alterations in blood flow during sleep, and the actions of general anesthetics. Since this region is critically involved in self reflection, it is not surprising that it is similarly a site for the NNCC. Interestingly, information processing during complex cognitive tasks and during aversive sensations such as pain induces efforts to terminate self reflection and result in decreased processing in posterior cingulate and precuneal cortices. (shrink)