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Hans-Otto Karnath

Publications and source records attributed to Hans-Otto Karnath.

14 recordsLinked to original sources
PubMed2004

The anatomy of spatial neglect based on voxelwise statistical analysis: a study of 140 patients.

A major challenge for any anatomical study of spatial neglect in neurological patients is that human lesions vary tremendously in extent and location between individuals. Approaches to this problem used in previous studies were to focus on subgroups of patients that are more homogeneous either with respect to the branch territory affected by the stroke or with respect to existing additional neurological symptoms (e.g. additional visual field defects). It could be argued that such strategies might bias the conclusions on the critical substrate associated with spatial neglect. The present study thus addressed the high variability inherent in naturally occurring lesions by using an unselected, but very large sample size and by comparing a neglect group with a non-neglect group using voxelwise statistical testing. We investigated an unselected 7 year sample of 140 consecutively admitted patients with right hemisphere strokes. Seventy-eight had spatial neglect, 62 did not show the disorder. The incidence of visual field defects was comparable in both groups. For assessing lesion location, in a first step, we used conventional lesion density plots together with subtraction analysis. Moreover, due to the large size of the sample voxelwise statistical testing was possible to objectively estimate which brain regions are more frequently compromised in neglect patients relative to patients without neglect. The results demonstrate that the right superior temporal cortex, the insula and subcortically putamen and caudate nucleus are the neural structures damaged significantly more often in patients with spatial neglect.

Adult↗
PubMed2004

Using human brain lesions to infer function: a relic from a past era in the fMRI age?

Recent technological advances, such as functional imaging techniques, allow neuroscientists to measure and localize brain activity in healthy individuals. These techniques avoid many of the limitations of the traditional method for inferring brain function, which relies on examining patients with brain lesions. This has fueled the zeitgeist that the classical lesion method is an inferior and perhaps obsolescent technique. However, although the lesion method has important weaknesses, we argue that it complements the newer activation methods (and their weaknesses). Furthermore, recent developments can address many of the criticisms of the lesion method. Patients with brain lesions provide a unique window into brain function, and this approach will fill an important niche in future research.

Brain↗
PubMed2004

How efficient is a simple copying task to diagnose spatial neglect in its chronic phase?

Twenty-five patients with spatial neglect were tested in the acute phase and about 1.3 years after a right-hemisphere stroke. Ten patients had developed chronic spatial neglect. We investigated how sensitive a simple copying task is in detecting spatial neglect in the chronic phase. When the stroke was acute, all 10 patients omitted a considerable number of contralesionally located items in the copying task. In the chronic phase, 60% of the chronic neglect patients still demonstrated noticeable neglect in the copying task. The data indicate that a simple task such as the copying of a multi-object scene is a helpful tool to detect residual symptoms of spatial neglect even more than 1 year after the stroke.

Aged↗
PubMed2003

Goal-directed hand movements are not affected by the biased space representation in spatial neglect.

Patients with spatial neglect exhibit a severe shift of spontaneous explorative movements to the right side, indicating a bias of long-living representations of space. Whether or not goal-directed movements likewise are affected by this rightward bias has been controversially discussed throughout the last decade. Unfortunately, substantial differences regarding patient selection and data analysis prevented a direct comparison of these results. We thus studied pointing movements in a new sample of subjects covering all different patient groups previously investigated on this issue. We analyzed all the different measures of hand path curvature used so far and, in addition, suggest a new measure that avoids the disadvantages of the previously used parameters. Despite their severe bias for exploratory movements, we did not find systematic, direction-specific deviations of goal-directed hand movements that were specific for the patients with spatial neglect. The results strongly suggest that the disturbance of long-living spatial representations underlying the bias of exploratory behavior in patients with neglect does not influence the performance of goal-directed movements. The data support the view of a dual mode of space representation in the posterior parietal and the superior temporal cortex.

Adult↗
PubMed2003

Neglect-like behavior in healthy subjects: dissociation of space exploration and goal-directed pointing after vestibular stimulation.

Evidence has been reported favoring the view of a dual mode of space representation for action and spatial cognition. While the dorsal system seems to be mainly involved in direct coding of space for action by means of several effector-specific representations, the ventral system appears to be responsible for more enduring and conscious representations underlying spatial cognition and awareness. In accordance with this view are recent studies documenting dissociations between exploratory and goal-directed movements in patients with brain damage. Patients with neglect exhibit a spatial bias of exploratory movements to the ipsilesional side, while goal-directed movements land precisely on target. The exploratory bias was found susceptible to asymmetric sensory stimulation such as caloric vestibular stimulation, inducing transient reduction of contralateral neglect. The present study compared exploratory and goal-directed hand movements in healthy subjects following cold caloric stimulation of the right vestibular organ. We observed a rightward shift of tactile exploration, while goal-directed pointing remained unaffected. Asymmetric vestibular stimulation in healthy subjects thus produced a neglect-like behavior with a similar dissociation between impaired exploratory and nonimpaired goal-directed hand movements. The stimulation provoked a further, very characteristic symptom of neglect patients: a deviation of spontaneous head orientation toward the right. The present observations strengthen substantially the assumption of different modes of space representation for action and spatial cognition in humans.

Adolescent↗
PubMed2003

Disturbed sound lateralization in patients with spatial neglect.

Previous studies on auditory space perception in patients with neglect have investigated localization of free-field-sound stimuli or lateralization of dichotic stimuli that are perceived intracranially. Since those studies in part revealed contradictory results, reporting either systematic errors to the left or systematic errors to the right, we reassessed the ability of auditory lateralization in patients with right hemispheric lesions with and without neglect. Unexpectedly, about half of the patients with neglect showed erratic judgments on sound position, that is, they were completely unable to lateralize sounds. The remaining neglect patients only showed a small deviation of the auditory median plane to the left side, indicating that they perceived the sounds as slightly shifted to the right side. The comparison between both groups revealed higher severity of neglect in the group of neglect patients who were unable to perform the task, suggesting that the inability of sound lateralization was associated with the strength of clinical neglect. However, we also observed 1 out of 9 patients with left brain damage who was not able to lateralize spatial sounds. This patient did not show any symptoms of spatial neglect. Thus, it may be that a spatial auditory deficit, such as that observed here in right-brain-damaged patients, only co-occurs with spatial neglect if the right superior temporal cortex is lesioned.

Adult↗
PubMed2003

The cortical substrate of visual extinction.

Neuroimaging studies investigated the attentional systems of the human brain revealing two networks, one for voluntary allocation of attention and another for stimulus-driven attentional processes. Whereas lesions of the latter system were supposed to lead to spatial neglect, we show that such lesions rather are typical for the occurrence of visual extinction. Extinction describes the inability of brain-damaged patients to detect a contralesional target in the presence of a competing ipsilesional stimulus. In a sample of consecutively admitted patients with right hemisphere stroke, we found dissociable cortical substrates for spatial neglect and visual extinction. There was a surprising congruency between the typical lesion site in patients with extinction and the activation clusters found in previous neuroimaging studies of healthy subjects. The results show that the temporo-parietal junction (TPJ), considered to be a crucial part of the stimulus-driven attentional network, is the neural substrate of visual extinction.

Aged↗
PubMed2003

Lasting amelioration of spatial neglect by treatment with neck muscle vibration even without concurrent training.

OBJECTIVE: It has been shown recently that neck muscle vibration in combination with an exploration training leads to lasting amelioration of spatial neglect. The present study evaluated whether vibration of the left posterior neck muscles alone has the potential to induce lasting reduction in spatial neglect. DESIGN: A multiple baseline design was used to control for spontaneous recovery or uncontrolled change caused by external events. PATIENTS: Six patients with spatial neglect following right hemisphere stroke. METHODS: Daily vibration treatment of the left posterior neck muscles for 20 minutes on 10 consecutive days. During vibration, patients did not perform any specific activities. RESULTS: We observed significant amelioration of spatial neglect after terminating the vibration therapy. The improvement was found to be stable at follow-up testing about 1.4 years later. CONCLUSION: Vibration of the left posterior neck muscles is a useful, non-invasive tool supplementing the established methods of spatial neglect treatment. It does not necessarily require the patient's co-operation, which is an important advantage especially in the early phases of rehabilitation.

Activities of Daily Living↗
PubMed2003

Understanding and treating "pusher syndrome".

"Pusher syndrome" is a clinical disorder following left or right brain damage in which patients actively push away from the nonhemiparetic side, leading to a loss of postural balance. The mechanism underlying this disorder and its related anatomy have only recently been identified. Investigation of patients with severe pushing behavior has shown that perception of body posture in relation to gravity is altered. The patients experience their body as oriented "upright" when the body actually is tilted to the side of the brain lesion (to the ipsilesional side). In contrast, patients with pusher syndrome show no disturbed processing of visual and vestibular inputs determining visual vertical. These new insights have allowed the authors to suggest a new physical therapy approach for patients with pusher syndrome where the visual control of vertical upright orientation, which is undisturbed in these patients, is the central element of intervention.

Accidental Falls↗
PubMed2002

Simulating and testing visual exploration in spatial neglect based on a new model for cortical coordinate transformation.

Most studies of object and space perception have focused on neural representations of either object-centered or egocentric coordinate systems. But daily life requires interactions of both kinds of coordinates. We have recently proposed an 'integrated space-object (ISO-) map' combining both coordinate systems in one representation. Based on a lesioned version of this model, here we present results from visual search simulations demonstrating that the model accounts for contralesional neglect during space-centered and object-centered exploration tasks. Interestingly, the model simulations also predicted an amelioration of neglect symptoms during exploration with more ipsilesional object positions. By measuring the eye movements of neglect patients during different exploratory tasks, we confirmed all model predictions. These results corroborate the view that the brain might combine coordinates for object and space perception in an integrated coordinate system as suggested by the ISO-map model.

Aged↗
PubMed2002

Task-dependent differences in the exploratory behaviour of patients with spatial neglect.

The present study analysed task-dependent effects on the exploratory behaviour of neglect patients during their spontaneous search of the surroundings. We were asking whether different tasks would be associated with different structuring of the visual display and, therefore, would result in different forms of neglect in one and the same brain-damaged subjects. Neglect patients' eye and head movements were recorded when they searched for a target within a homogeneous stimulus array surrounding the subjects. Subsequently, they explored the same array which was now segmented into different areas. When the patients' attention was allocated to the whole surrounding space, all patients completely neglected the left hemispace and spontaneously attended to the right hemispace. No significant left-right asymmetry was detected in a selected segment located in the periphery of the attended, right hemispace. However, all patients completely ignored the left part of this segment when they had to concentrate visual search on this segment alone. The results suggest an important influence of task-dependent effects on the exploratory behaviour of neglect patients. They show that one and the same physical stimulus at one and the same location in a scene might be attended or, in another situation, neglected, just depending on the behavioural goal of the subject. The findings support the idea that the brain organises and reorganises continuously the representation of the same physical input according to the changing task requirements.

Aged↗
PubMed2002

Impaired perception of temporal order in auditory extinction.

It has been proposed that patients with extinction show a chronic bias of spatial attention towards the ipsilesional side. In this case, the law of 'prior entry' predicts that ipsilesional events should be perceived earlier than physically synchronous contralesional stimuli. In line with this prediction, previous studies have revealed substantial delays of awareness for contralesional visual and tactile events in patients with visual and with tactile extinction. The present study provides evidence that a 'prior entry' bias also occurs in the auditory modality. Patients with auditory extinction perceived two acoustic events (one presented to the left ear, the other to the right ear) as being 'simultaneous' when the contralesional sound was leading by 270 ms. The magnitude of this asynchrony was quite similar to that measured previously in the visual modality. Thus, the pathological delay of awareness for contralesional events may be independent of the sensory modality of the stimuli.

Acoustic Stimulation↗
PubMed2002

The effect of whole-body tilt on sound lateralization.

The effect of passive whole-body tilt in the frontal plane on the lateralization of dichotic sound was investigated in human subjects. Pure-tone pulses (1 kHz, 100 ms duration) with various interaural time differences were presented via headphones while the subject was in an upright position or tilted 45 degrees or 90 degrees to the left or right. Subjects made two-alternative forced-choice (left/right) judgements on the intracranial sound image. During body tilt, the auditory median plane of the head, computed from the resulting psychometric functions, was always shifted to the upward ear, indicating a shift of the auditory percept to the downward ear, that is, in the direction of gravitational linear acceleration. The mean maximum magnitude of the auditory shift obtained with 90 degrees body tilt was 25 micro s. On the one hand, these findings suggest a certain influence of the otolith information about body position relative to the direction of gravity on the representation of auditory space. However, in partial contradiction to previous work, which had assumed existence of a significant 'audiogravic illusion', the very slight magnitude of the present effect rather reflects the excellent stability in the neural processing of auditory spatial cues in humans. Thus, it might be misleading to use the term 'illusion' for this quite marginal effect.

Adult↗