Giuseppe Vallar

The present case study describes the patient N.G., who reported prosopagnosia along with difficulty in recognising herself in the mirror following a left‐sided temporo‐occipital hemispheric stroke. The neuropsychological and experimental investigation revealed only a mild form of apperceptive prosopagnosia, without visual agnosia, primarily caused by an impaired visual processing of face‐parts and body parts but not of full faces. Emotional expressions did not modulate her face processing. On the other hand, N.G. showed a marked impairment of visual self‐recognition, as assessed with visual matching‐to‐sample tasks, both at the level of body‐part and face‐part processing and at a full‐face level, featured by a deficit in the perceptual discrimination of her own face and body, as compared to the others' face and body. N.G.'s lesion mapping showed damage to the left inferior occipito‐temporal cortex, affecting the inferior occipital gyrus and compromising long‐range connections between the occipital/temporo‐occipital areas and the anterior fronto‐temporal areas. Overall, the present case report documents that visual processing of the person's own face may be selectively compromised by a left‐sided hemispheric lesion disconnecting extra‐striate body‐ and face‐selective visual areas to self‐representation regions. Moreover, others' (full) face processing may be preserved, as compared with the impaired ability to discriminate others' body and face parts.

Since the early 1900s, the terms body schema and body image denoted the internal representations of the body. Bonnier's (1905, Revue Neurologique , 13, 605) schema is a conscious spatial representation of the size, shape, and position of the body, and of body parts, whose dysfunction brings about aschématia , and hypo ‐, hyper‐ , and paraschématia . The two schemata of Head and Holmes (1911, Brain , 34, 102) are an unconscious plastic postural schema, for the maintenance of posture and balance and for the coding of the position of body parts, and a conscious superficial schema, for the localisation of somatosensory stimuli. Pick's (1922, Psychologische Forschung , 1, 303) body schema refers to a structural description of the body, including the position of body parts and their spatial relationships, defective in autotopagnosia. Schilder's (1935, The image and appearance of the human body ) body image is a comprehensive construct, covering physiological, evolutional, neurological and neuropsychological, psychiatric and sociological aspects. Lhermitte's (1939, L'image de notre corps ) image, based on the views of the abovementioned authors, is defective in bodily neuropsychological disorders. The two terms have been used interchangeably, to denote (hemi‐)asomatognosia, anosognosia, autotopagnosia, depersonalisation, personal neglect, phantom and supernumerary limbs, somatoparaphrenia. Their properties have been summarized with general dichotomies: schema for action in space (“where” system), image for perception (“what” system), after primary sensory processing. While schema and image fractionated into multiple representations of aspects of the body, the two terms are still used to refer to some of these representations, and to their disorders.

Patients suffering from Unilateral Spatial Neglect (USN) fail to pay attention to, respond to, and report sensory events occurring in the contralesional side of space. The traditional neuropsychological assessment of USN is based on paper-and-pencil tests, whose data recording and scoring may be subjected to human error. The utilization of technological devices can be expected to improve the assessment of USN. Therefore, we built Neurit.Space, a modified digital version of three paper-and-pencil tests, widely used to detect signs of USN, namely: Bells Cancellation, Line Bisection and Five Elements Drawing Test. Administration and data processing is fully automatic. Twelve right brain-damaged patients (six with and six without USN) and 12 age- and education-balanced healthy participants were enrolled in the study. All participants were administered both the computerized and the paper-and-pencil versions of the tests. The results of this preliminary study showed good sensitivity, specificity, and usability of Neurit.Space, suggesting that these digital tests are a promising tool for the evaluation of USN, both in clinical and in research settings.

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

The Semantic Association Test assesses several aspects of Semantic Memory (Categorical, Encyclopedic, Functional, and Visual Encyclopedic associations: CAs, EAs, FAs and VEAs), using a picture-to-picture matching paradigm. Normative data were collected from a group of 329 healthy participants (178 females) with mean 51.1 (range 20–90) years of age and mean 11.89 (range 5–19) years of education. Raw scores of healthy participants, pre-calculated correction factors for age and educational level, and Equivalent Scores are provided. The SAT was validated in a sample of 139 left brain–damaged persons with aphasia (PWA). Both groups (healthy participants and PWA) scored worse in the CA and EA conditions. The performance of the PWA group was overall defective, and global aphasics scored worse than persons with other types of aphasia. However, several PWA did not show impairments in the SAT. Dissociations were also found, with individual PWA showing defective performance confined to a single category. These results present the SAT as a tool that is useful to detect impairments of visual Semantic Memory, providing normative data from healthy participants and a validation study in PWA.

Visuo-motor adaptation to optical prisms (Prism Adaptation, PA), displacing the visual scene laterally, is a behavioral method used for the experimental investigation of visuomotor plasticity, and, in clinical settings, for temporarily ameliorating and rehabilitating unilateral spatial neglect. This study investigated the building up of PA, and the presence of the typically occurring subsequent Aftereffects (AEs) in a brain-damaged patient (TMA), suffering from apperceptive agnosia and a right visual half-field defect, with bilateral atrophy of the parieto-occipital cortices, regions involved in PA and AEs. Base-Right prisms and control neutral lenses were used. PA was achieved by repeated pointing movements toward three types of stimuli: visual, auditory, and bimodal audio-visual. The presence and the magnitude of AEs were assessed by proprioceptive, visual, visuo-proprioceptive, and auditory-proprioceptive straight-ahead pointing tasks. The patient’s brain connectivity was investigated by Diffusion Tensor Imaging (DTI). Unlike control participants, TMA did not show any adaptation to prism exposure, but her AEs were largely preserved. These findings indicate that AEs may occur even in the absence of PA, as indexed by the reduction of the pointing error, showing a dissociation between the classical measures of PA and AEs. In the PA process, error reduction, and its feedback, may be less central to the building up of AEs, than the sensorimotor pointing activity per se.

Humans are the only species capable of experiencing pleasure from esthetic stimuli, such as art and music. Neuroimaging evidence suggests that the left dorsolateral prefrontal cortex (DLPFC) plays a critical role in esthetic judgments, both in music and in visual art. In the last decade, non-invasive brain stimulation (NIBS) has been increasingly employed to shed light on the causal role of different brain regions contributing to esthetic appreciation. In Experiment #1, musician (N = 20) and non-musician (N = 20) participants were required to judge musical stimuli in terms of “liking” and “emotions”. No significant differences between groups were found, although musicians were slower than non-musicians in both tasks, likely indicating a more analytic judgment, due to musical expertise. Experiment #2 investigated the putative causal role of the left dorsolateral pre-frontal cortex (DLPFC) in the esthetic appreciation of music, by means of transcranial direct current stimulation (tDCS). Unlike previous findings in visual art, no significant effects of tDCS were found, suggesting that stimulating the left DLPFC is not enough to affect the esthetic appreciation of music, although this conclusion is based on negative evidence,.

Temporal Binding Window (TBW) represents a reliable index of efficient multisensory integration process, which allows individuals to infer which sensory inputs from different modalities pertain to the same event. TBW alterations have been reported in some neurological and neuropsychiatric disorders and seem to negatively affects cognition and behavior. So far, it is still unknown whether deficits of multisensory integration, as indexed by an abnormal TBW, are present even in Multiple Sclerosis. We addressed this issue by testing 25 participants affected by relapsing–remitting Multiple Sclerosis (RRMS) and 30 age-matched healthy controls. Participants completed a simultaneity judgment task (SJ2) to assess the audio-visual TBW; two unimodal SJ2 versions were used as control tasks. Individuals with RRMS showed an enlarged audio-visual TBW (width range = from − 166 ms to + 198 ms), as compared to healthy controls (width range = − 177/ + 66 ms), thus showing an increased tendency to integrate temporally asynchronous visual and auditory stimuli. Instead, simultaneity perception of unimodal (visual or auditory) events overall did not differ from that of controls. These results provide first evidence of a selective deficit of multisensory integration in individuals affected by RRMS, besides the well-known motor and cognitive impairments. The reduced multisensory temporal acuity is likely caused by a disruption of the neural interplay between different sensory systems caused by multiple sclerosis.