Assessment and Functional Impact of Allocentric Neglect: A Reminder from a Case Study

Abstract

SR suffered a right hemispheric stroke more than three years ago, and now lives with left-sided hemiparesis and chronic spatial neglect due to damaged white matter pathways connecting the frontal, temporal and parietal regions. We report here that SR suffers from both viewer-centered (i.e., egocentric) and object-centered (i.e., allocentric) spatial neglect. Notably, unlike most neuropsychological and functional assessments that focus on egocentric deficits, a specialized neuropsychological figurative discrimination test (the Apples test) revealed SR’s allocentric neglect. Further, using assessments sensitive to detect functional deficits related to allocentric neglect, we observed SR’s difficulty in reading and using clocks, reflecting his object-centered errors in these everyday activities. SR’s case suggests that allocentric-specific assessments, both neuropsychological and functional, are valuable in standard neglect examinations, particularly to predict daily function after stroke. We recommend that neglect-related functional disability be distinguished further with respect to allocentric spatial deficits, and functional assessments for allocentric neglect should be validated in future large sample studies. Identifying allocentric neglect early, and learning about its influence on daily function, may enhance care quality and facilitate effective rehabilitation planning for stroke recovery.

The role of the right superior temporal gyrus in stimulus-centered spatial processing

“…Allocentric neglect-like behavior was therefore induced selectively after right STG stimulation as evidenced from increased stimulus-centered rightward bias. These findings are consistent with lesion studies (Grimsen, Hildebrandt, & Fahle, 2008; Hillis et al, 2005; Medina et al, 2009; Shah, Spaldo, Barrett, & Chen, 2013; Verdon, Schwartz, Lovblad, Hauert, & Vuilleumier, 2010) that found a selective role of right STG in allocentric neglect deficits, and also fMRI studies in healthy individuals that linked activation in the right STG (Neggers et al, 2006) to allocentric judgment task demands (Galati et al, 2000).…”

“…Lesion studies suggest that reference-frame based spatial deficits arise from damage to distinct but related areas in the brain (Chen, Caulfield, Hartman, O'Rourke, & Toglia, 2016; Khurshid et al, 2012; Marsh & Hillis, 2008; Medina et al, 2009; Pouget & Driver, 2000). The right supramarginal gyrus (SMG; BA 40) and angular gyrus (BA 39) in the posterior parietal cortex (PPC) are often implicated in egocentric deficits (Hillis et al, 2005; Medina et al, 2009), whereas damage to the temporal areas such as the superior temporal gyrus (STG; BA 22), and the middle and inferior temporal gyri and their surrounding white matter (Grimsen, Hildebrandt, & Fahle, 2008; Hillis et al, 2005; Medina et al, 2009; Shah, Spaldo, Barrett, & Chen, 2013; Verdon, Schwartz, Lovblad, Hauert, & Vuilleumier, 2010) are frequently associated with allocentric deficits.…”

The different association of allocentric and egocentric neglect with dorsal and ventral pathways

“…After 7 months of rehabilitation, the results of Apple Cancellation test did not indicate the presence of egocentric neglect (score = 0, cutoff >2); however, they did reveal the presence of severe allocentric neglect (score = 10, cutoff >1). [ 18 , 25 ]…”

Status of Occupational Therapists on Unilateral Neglect Test Tools Usage and Symptom Classification

“…2,3 몸에서부터 무시증상이 발생하 는 거리에 따라, 신체 무시(personal neglect), 신체주위 무시(peri-personal neglect), 신체 바깥 무시(extra-personal neglect)로 나뉘고, 결손의 유형에 따라서 감각무시(sensory neglect)와 운동무시(motor neglect) 등으로 나뉘고 있다. 4,5 아울러 이러한 증상으로 인해, 환자들은 일상 생활에 상당한 영향을 받게 된다. 6,7 편측무시를 연구하기 위하여 많은 검사 도구들이 사용되었다.…”