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Studies of the visual capacity of neurological patients have provided evidence for a dissociation between the perceptual report of a visual stimulus and the ability to direct spatially accurate movements toward that stimulus. Some patients with damage to the parietal lobe, for example, are unable to reach accurately towards visual targets that they unequivocally report seeing. Conversely, some patients with extensive damage to primary visual cortex can make accurate pointing movements or saccades toward a stimulus presented in their 'blind' scotoma. But in investigations of visuomotor control in patients with visual disorders, little consideration has been given to complex acts such as manual prehension. Grasping a three-dimensional object requires knowledge not only of the object's spatial location, but also of its form, orientation and size. We have examined a patient with a profound disorder in the perception of such object qualities. Our quantitative analyses demonstrate strikingly accurate guidance of hand and finger movements directed at the very objects whose qualities she fails to perceive. These data suggest that the neural substrates for the visual perception of object qualities such as shape, orientation and size are distinct from those underlying the use of those qualities in the control of manual skills.

D.F., a patient with severe visual form agnosia, has been the subject of extensive research during the past decade. The fact that she could process visual input accurately for the purposes of guiding action despite being unable to perform visual discriminations on the same visual input inspired a novel interpretation of the functions of the two main cortical visual pathways or 'streams'. Within this theoretical context, the authors proposed that D.F. had suffered severe bilateral damage to her occipitotemporal visual system (the 'ventral stream'), while retaining the use of her occipitoparietal visual system (the 'dorsal stream'). The present paper reports a direct test of this idea, which was initially derived from purely behavioural data, before the advent of modern functional neuroimaging. We used functional MRI to examine activation in her ventral and dorsal streams during object recognition and object-directed grasping tasks. We found that D.F. showed no difference in activation when presented with line drawings of common objects compared with scrambled line drawings in the lateral occipital cortex (LO) of the ventral stream, an area that responded differentially to these stimuli in healthy individuals. Moreover, high-resolution anatomical MRI showed that her lesion corresponded bilaterally with the location of LO in healthy participants. The lack of activation with line drawings in D.F. mirrors her poor performance in identifying the objects depicted in the drawings. With coloured and greyscale pictures, stimuli that she can identify more often, D.F. did show some ventral-stream activation. These activations were, however, more widely distributed than those seen in control participants and did not include LO. In contrast to the absent or abnormal activation observed during these perceptual tasks, D.F. showed robust activation in the expected dorsal stream regions during object grasping, despite considerable atrophy in some regions of the parietal lobes. In particular, an area in the anterior intraparietal sulcus was activated more for grasping an object than for just reaching to that object, for both D.F. and controls. In conclusion, we have been able to confirm directly that D.F.'s visual form agnosia is associated with extensive damage to the ventral stream, and that her spared visuomotor skills are associated with visual processing in the dorsal stream.

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