Objective: To assess the relative frequency of occurrence of motor, perceptual, peripersonal, and personal neglect subtypes, the association of neglect and other related deficits (e.g., deficient nonlateralized attention, anosognosia), and the neuroanatomic substrates of neglect in patients with right hemisphere stroke in rehabilitation settings. Methods: The authors assessed 166 rehabilitation inpatients and outpatients with right hemisphere stroke with measures of neglect and neglect subtypes, attention, motor and sensory function, functional disability, and family burden. Detailed lesion analyses were also performed. Results: Neglect was present in 48% of right hemisphere stroke patients. Patients with neglect had more motor impairment, sensory dysfunction, visual extinction, basic (nonlateralized) attention deficit, and anosognosia than did patients without neglect. Personal neglect occurred in 1% and peripersonal neglect in 27%, motor neglect in 17%, and perceptual neglect in 21%. Neglect severity predicted scores on the Functional Independence Measure and Family Burden Questionnaire more accurately than did number of lesioned regions. Conclusions: The neglect syndrome per se, rather than overall stroke severity, predicts poor outcome in right hemisphere stroke. Dissociations between tasks assessing neglect subtypes support the existence of these subtypes. Finally, neglect results from lesions at various loci within a distributed system mediating several aspects of attention and spatiomotor performance.

It has been shown that unilateral left neglect can be significantly improved for a short time after a short period of adaptation to a prismatic shift of the visual field to the right. In neuropsychological studies, however, there is no evidence demonstrating long‐lasting effects following treatment by prism adaptation (PA). The first aim of the present study was to find out whether the short‐term amelioration found after prismatic adaptation could be converted into long‐term therapeutic improvement. Secondly, we investigated whether the improvement of neglect in standard tests could be generalized to ecological visuospatial tests. Thirdly, the effects of prism adaptation on different spatial domains (far, near and personal space) were evaluated. Fourthly, the influence of PA on high‐order visuospatial functions, such as spatial representation, and on a low‐order factor, i.e. sensory–motor bias, was investigated. Finally, we investigated the possible correlation between neglect amelioration, the adaptation effect and the visuomotor after‐effect, as assessed by a pointing task during and after PA. Seven patients with right hemisphere lesion and left visuospatial neglect were treated with prismatic lenses in twice‐daily sessions over a period of 2 weeks. In each training session, patients were required to perform a pointing task wearing base‐left wedge prisms inducing a shift of the visual field to the right by 10°. The presence of visual neglect and the duration of the amelioration achieved were assessed before the treatment and 2 days, 1 week and 5 weeks after treatment by using a standardized battery that included a series of behavioural and ecological visuospatial tests. Six control, untreated patients, matched to the experimental group for gravity and duration of illness, were submitted to the same tests at the same intervals as the experimental patients. The results showed an improvement in the experimental patients’ performance after PA, which was maintained during the 5‐week period after treatment. The amelioration of neglect was found in standard as well as in behavioural tests and in all spatial domains. In contrast, control patients did not show any improvement in neglect. The amelioration of neglect occurred only in patients who showed the adaptation effect and the after‐effect in the pointing task. Neglect amelioration did not occur in one patient who did not show the adaptation effect and had an unstable after‐effect. In conclusion, these findings show that prism adaptation is a productive way of achieving long‐lasting improvements in neglect treatment.

Recent fMRI evidence has detected increased medial prefrontal activation during contemplation of personal moral dilemmas compared to impersonal ones, which suggests that this cortical region plays a role in personal moral judgment. However, functional imaging results cannot definitively establish that a brain area is necessary for a particular cognitive process. This requires evidence from lesion techniques, such as studies of human patients with focal brain damage. Here, we tested 7 patients with lesions in the ventromedial prefrontal cortex and 12 healthy individuals in personal moral dilemmas, impersonal moral dilemmas and non-moral dilemmas. Compared to normal controls, patients were more willing to judge personal moral violations as acceptable behaviors in personal moral dilemmas, and they did so more quickly. In contrast, their performance in impersonal and non-moral dilemmas was comparable to that of controls. These results indicate that the ventromedial prefrontal cortex is necessary to oppose personal moral violations, possibly by mediating anticipatory, self-focused, emotional reactions that may exert strong influence on moral choice and behavior.

Humans and monkeys share similar sensory integrated processing of tactile and peri-hand visual inputs for coding peripersonal space surrounding the hand. In monkeys, tool use is known to induce a transient elongation of hand-centred peripersonal space along the tool axis. Here we report evidence that, also in humans, the use of a tool can increase the spatial extent of the representation of peri-hand visual space to incorporate the tool. We investigated this phenomenon in patients with tactile extinction, by using a cross-modal paradigm well suited to reveal visual-tactile integration near patients' hand. In the present study cross-modal extinction was assessed far from patients' ipsilesional hand, at the distal edge of a hand-held rake. We found that cross-modal extinction was more severe after patients used the rake to retrieve distant objects with respect to a condition in which the rake was not used. This evidence of an expansion of peri-hand space lasted only a few minutes after tool use. By contrast, peri-hand space expansion was not observed when motor actions towards distant objects did not involve the tool. These findings show that visual peri-hand space has important dynamic properties in humans; it can be expanded and contracted depending upon tool use.