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1

When did neuropsychology occur?

- Clinical Neuropsychology (WWI and II) - Localisation of function (Language two different areas in the brain, Broca1861, Wernicke, 1874). Soldiers who were damaged by bullet wounds
- Cognitive Neuropsychology - Cognitive effects of brain damage (models), looking a where damage is and behaviour shown, making a link
-Cognitive Neuroscience - Biological substrates of cognition e.g. what happens to the neurotransmitters and chemicals in the brain after damage

2

What is clinical neuropsychology?

- Psychologists increasingly interested in single case patient studies (1960’s -)
-Aim was to make a link between brain damage and behaviour
-Difficult to do, single case patient studies, basing all your findings through one patient
-But largely a description of deficits and localisation difficult

3

What is unilateral neglect?

- Following right hemisphere brain damage a patient without impairment of intellectual functioning appears to ignore, forget or turn away from the left side of space-as if that half of the world has ceased to exist...
- Mesulam, (1985, as cited in Robertson and Marshall, 1993)
-Failure to respond, report or acknowledge to the opposite side of the brain damage
-Occurs when there is damage to the right hemisphere of the brain, ignoring everything on the left side
-Intellectually the patient is fine

4

What happened in the 1970s with neuropsychology and how can it be applied?

- 1970’s-90’s -Went beyond description of deficits and localisation
-We can learn about cognitive systems by studying how they breakdown after brain damage (Coltheart –Scholarpedia)
-Applications: -Assessment and Rehabilitation, for different neurological disorders etc

5

Brain (1941): 3 patients with right parieto-occipital damage, first ever neglect patients

- Case 5 “When asked to describe how she would find her way from the tube station to her flat she described this in detail correctly and apparently visualising the landmarks, but she consistently said right instead of left for the turnings except on one occasion.”
-99% of the time they’ll tell you to make a right hand turn

6

Cases with missile wound right parieto-occipital region (including angular gyrus) - Paterson and Zangwill (1944) 2 cases

- Case 1 “The patient often collided with objects located on his left which he had clearly perceived a few moments before. He was liable to knock over dishes on his left-hand side and occasionally missed food on the left-side of his plate.”
- Case 2 (right parietal damage) “It was noticed that the patient totally neglected his left upper extremity (of his own body) despite good preservation of motor power”

7

Unilateral neglect is also called:

-Hemi-inattention
-Visual neglect
-Visual spatial neglect
-Unilateral spatial neglect

8

-Contralesional

(opposite side to brain damage)

9

-Ipsilesional

(same side as brain damage)

10

-Hemianopia

(a visual field defect)

11

What is Extinction?

- Patients do not report left-hand stimulus when it is paired with a right-hand stimulus
- Sometimes described as mild form of neglect
-Others consider it a separate related disorder
-Not just visual modality, tactile and even cross modal
-This is known as extinction
-Tested by being able to identify whether left, right or both hands are being waved
-Patient can identify right and left independently, but not both

12

Everyday examples of neglect

- Patients may:
-Eat food on the right hand side of plate only
-Dress only the right side of own body
-Shave the right side of their own face
-Deviate to right and may even go around in a circle

13

Clinical Tests of Neglect in Patients
- 1. Drawing

-from memory
-Copying
-Give the patient a simple drawing, asked to copy (usually a clock or daisy)
-Only ever draw the right hand side

14

Clinical Tests of Neglect in Patients
-2. Line bisection

-Give the patient horizontal line, asked to mark the middle of the line
-Found that they mark nearer to the right

15

Clinical Tests of Neglect in Patients
-3. Cancellation tasks

-Give the patient a page of symbols, ask to circle certain symbols
-Leave the left hand side uncircled

16

Clinical Tests of Neglect in Patients
-4. Reading

- Single words -neglect dyslexia
-Text reading -whole word omissions
-Missing out certain parts of words

17

What is neglect and how does it occur?

- Is most commonly caused by a stroke
-Stroke – Affects ~ 150,000 people in UK each year
-Brain needs supply of oxygen and blood
-Blood supply to part of brain is cut off - Resulting in damaged tissue
-Blockage occurs in the middle of the cerebral artery
-Neglect

18

Nature of Brain Damage associated with Neglect

- Neglect is most commonly observed in humans following damage to the right hemisphere (left neglect)
-Left hemisphere damage rarely leads to neglect, therefore only in the right
- Damage in the Posterior parietal cortex (Specifically Inferior parietal lobe)
-Brodman’s areas 39 and 40 (dorsal ‘where’ visual pathway)
-Left parietal damage rarely produces right sided neglect (and quickly recovers)

- Also some cases following sub-cortical damage
-Thalamus, basal ganglia, white matter (most to least involved)
-The right parietal cortex appears to play a dominant role in spatial cognition in humans

19

Right Hemisphere regions associated with Neglect

-IPL – Ang and Smg
-MFG
-IFG

20

What was Vallar & Perani, 1986 contour map?

-Contour map of lesion location of 8 patients with neglect. Right inferior parietal lobe (IPL)
-Damage to any cortical areas causes neglect

21

Functions of the Posterior Parietal Cortex (PPC)

- Visuo-motor control of behaviour
-Single cell recording shows these neurons involved in:
-Visually-guided reaching, Eye movements, Head (gaze) shifts

22

Effects of lesions to PPC in humans

-Mis-reaching (optic ataxia)
-Eye movement problems (fixed gaze)
-Constructional apraxia (difficulty putting things together)
-Simultanagnosia (inability to perceive more than one object at a time)
-Neglect (ignoring the left side of space)

23

Sensory explanations of Neglect

-Is neglect due to a visual field defect?
-e.g a left hemianopia
-Co-occur after stroke, visual field defects
-Visual field – confrontation
-Damage to visual pathway – visual field defect

24

Visual field defects

-Unilateral field loss
-Bitemporal hemianopia – patient has damage to midline. Partial blindness on the outer part of visual field
-Homonymous hemianopia – field loss on same side of each eye

25

Visual field defects do not cause neglect because...

-Neglect has been observed for the left side of a mental image
-Some neglect patients do not have visual field deficits
-Patients can neglect the left side of individual objects presented in their intact right visual field
-Hemianopic patients (with damage to visual pathways and cortex) do not show neglect

26

What was the ‘Piazza del Duomo’ demonstration?

-Bisiachand Luzzatti (1978)
-Two patients asked to describe a familiar scene (Cathedral Square in Milan) from memory
-Reported landmarks on right not those on left from both imaginary viewing positions
-Patients had a trained long term memory of both sides of the square, however neglected left side when asked to recall

27

(Bisiachand Luzzatti (1978) - neglect of shapes

- Triangle = direction of (imaginary) view
-Black squares indicate buildings reported
-Could neglect reflect a failure to build a representation of the left side of space?
-Or of directing attention to a representation

28

Volpe et al. Nature, (1979) Five patients with left extinction shown different objects...

-Presented items in right and left visual field
-Same/different judgments of stimuli
-Stimuli –LVF, RVF or both (150 ms)
Volpe et al., 1979
-Same/Different judgements: 88-100% correct
-Left-side (LVF) naming -0-49% correct
-Depending on the task, there is some sort of visual processing going on

29

‘Burning House’ study: Marshall & Halligan (1988)

- Single case study:
-Patient P.S. = Left neglect
-Shown a card with a normal and burning house
-Description implied houses were same
-‘Which house would prefer to live in?’
-Repeatedly chose non-burning house
-Two other reports of patients who chose burning house

30

Are there different systems for word and face recognition?

-Allow for two different cognitive processes or systems to function independently
- Allow inferences about how cognitive system is organised based on dissociations
-Patient X impaired at reading but not at face recognition.
-Assertion is: reading and face recognition involve separate cognitive processes

- But it might be that argued that reading is harder than face recognition and Patient X is impaired on harder recognition tasks
-Double-dissociation
-Patient Y –can read but can’t recognise faces (opposite pattern – double dissociation)
-Separate systems for word recognition and face recognition
-Two different systems for face recognition and word recognition