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Creative production (related to art-making) and aesthetic appreciation (related to art-viewing) are inherently linked in visual arts, but their relationship has never been explored explicitly in cognitive neuroscience, nor the nature of such connection. The available literature suggests two cognitive processes as possible foundations of these two experiences: motor simulation or inhibitory control. In a meta-analysis of fMRI studies, we addressed this issue: we investigated whether there are shared neurofunctional underpinnings behind aesthetic and creative experiences in the visual domain; further, we examined whether any shared brain activation may reflect either motor simulation or inhibitory processes. A conjunction analysis revealed a common involvement of the pre-SMA in both classes of studies, a brain region, if anything, more concerned with top-down inhibitory motor and volitional cognitive control rather than bottom-up motor simulation. In the art-viewing domain, this finding was primarily driven by figurative rather than abstract art. The methodological limitations in the available literature are discussed together with possible new ways to expand the existing findings.

Several studies have found in the sense of touch a good sensory modality by which to study body representation. Here, we address the “metric component of body representation”, a specific function developed to process the discrimination of tactile distances on the body. The literature suggests the involvement of the right angular gyrus (rAG) in processing the tactile metricity on the body. The question of this study is the following: is the rAG also responsible for the visual metric component of body representation? We used tDCS (anodal and sham) in 20 subjects who were administered an on-body distance discrimination task with both tactile and visual stimuli. They were also asked to perform the same task in a near-body condition. The results allow us to confirm the role of rAG in the estimation of tactile distances. Further, we also showed that rAG might be involved in the discrimination of distances on the body not only in tactile but also in visual modality. Finally, based on the significant effects of anodal stimulation even in a near-body visual discrimination task, we proposed a higher-order function of the AG in terms of a supramodal comparator of quantities.

Neuropsychology is the discipline that studies the processes belonging to the mental level in the Cartesian schemata through experimental means. Neuropsychology is an eminently interdisciplinary science, converging with neurology, neuroanatomy, neurophysiology, neurochemistry, psychology, linguistics, and artificial intelligence. Neglect represents a typical case in which the microelectrode technique can be usefully employed to clarify a neuropsychological syndrome. Neurophysiological data are consistent with the clinical aspects of the syndrome. The clinical disorder is neither purely sensory nor purely motor. The neurones of the areas involved are not purely sensory and cannot be defined as motor. The interaction among disciplines belonging to the neurosciences and cognitive disciplines has allowed for a new view of the problem without taking anything away from the richness of the phenomenon. Neurones are not only generators of impulses, but inserted in a network they function as stages of progressively more complex information processing.

Part I: Methodological Problems in Neuropsychology. Part II: Language Disorders. Part III: Memory Disorders. Part IV: Recognition Disorders. Part V: Movement Disorders. Part VI: Spatial Disorders. Part VII: Attentional Disorders. Part VII: Special Syndromes. Part IX: Dementia. Part X: Recovery of Functions.

Personal neglect (PN) is the hemi-inattention toward the contralesional bodily space that follows a cerebral lesion, usually to the right hemisphere. Objective To provide a historical, comprehensive review of the different theoretical accounts, of the available diagnostic measures, of the relationship with different body representation disorders, and of recovery-related issues. Moreover, to review the anatomo-functional correlates of PN, focusing on group studies that used modern voxel-based lesion-symptoms mapping. Method PubMed database was searched for all the available studies on PN conducted in the last 30 years. Relevant clinical data for each study were reported in a table, which was used as a reference for developing the discussion on the points of interest. Results Evaluation tools for PN suffer from limitations and should include both face- and body-related testing as well as require both basic exploration and object use in the same personal space. Dedicated rehabilitative procedures are lacking and advocated, given that recovery of PN and extrapersonal neglect can be dissociated and their degree is not correlated. PN is almost constantly associated with a cohort of body representation disorders that do not reveal themselves unless specifically investigated. PN is significantly correlated to alterations at the level of both the anterior parietal cortex and the underlying fronto-parietal fiber bundles. Conclusions The discussed data point to the need for a diagnostic and rehabilitative update. Following the topological and hodological lesional pattern, PN might emerge from the combination of a body representation disorder and a spatial inattention for half of the space. (PsycINFO Database Record

Background Although depressive symptoms are often reported to be comorbid with degenerative cerebellar diseases, the role of the cerebellum in depressive disorder needs to be elucidated. To address this aim, we investigated self-perception of the negative mood state in patients with cerebellar pathology and depressive symptoms. Methods Thirty-eight patients with cerebellar damage (10 with depressive symptoms – CB-DP and 28 with no depressive symptoms – CB-nDP), 11 subjects with depressive disorders without cerebellar damage (DP) and 29 healthy controls (CTs) were enrolled. A device for self-monitoring of the mood state (MoMo) and validated scales such as the Profile of Mood States questionnaire (POMS), the Self-Report Symptom Inventory-Revised (SCL-90-R) and the Hamilton Depression Rating Scale (HDRS) were used to evaluate depressive symptoms. Results Both CB-DP and DP patients showed higher scores than CTs on the POMS and SCL-90-R for depressive factors and on the HDRS. DP patients showed a lower frequency of ‘good’ mood and a higher frequency of ‘bad’ mood than CTs when using the MoMo device. However, although the two depressed populations showed comparable scores on these validated scales, CB-DP patients showed impaired self-awareness of the mood experience in ‘the here and now’, as evidenced by the absence of significant differences, compared with CTs, in the subjective mood evaluation performed with the MoMo device. Limitations The number of CB patients and inhomogeneity across MRI scans were study limitations. Conclusion Cerebellar dysfunction might slow the data integration necessary for mood state awareness, resulting in difficulty of depressed CB patients in explicitly recognizing their mood “in the here and now”.

Field independence (FI) has been defined as the extent to which the individual perceives part of a field as discrete from the surrounding field, rather than embedded in the field. It has been proposed to represent a relatively stable pattern in individuals' predisposition towards information processing. In the present study, we assessed the effect of FI on skills underpinning human navigation. Fifty Healthy individuals took part in this study. FI has been assessed by using the group embedded figures test (GEFT). Participants were also asked to perform several visuo-spatial orientation tasks, including the perspective taking/spatial orientation test (PTSOT), the mental rotation task (MRT) and the vividness task, as well as the Santa Barbara Sense of Direction Scale, a self-reported questionnaire, which has been found to predict environmental spatial orientation ability. We found that performances on the GEFT significantly predicted performances on the PTSOT and the MRT. This result supports the idea that FI predicts human navigation.

Previous studies have shown that individuals with heroin and cocaine addiction prefer to use these drugs in distinct settings: mostly at home in the case of heroin and mostly outside the home in the case of cocaine. Here we investigated whether the context would modulate the affective and neural responses to these drugs in a similar way. First, we used a novel emotional task to assess the affective state produced by heroin or cocaine in different settings, based on the recollections of male and female drug users. Then we used fMRI to monitor neural activity during drug imagery (re-creating the setting of drug use) in male drug users. Consistent with our working hypothesis, the majority of participants reported a shift in the affective valence of heroin from mostly pleasant at home to mostly unpleasant outside the home (p< 0.0001). The opposite shift was observed for cocaine; that is, most participants who found cocaine pleasant outside the home found it unpleasant when taken at home (p< 0.0014). Furthermore, we found a double dissociation, as a function of drug and setting imagery, in BOLD signal changes in the left PFC and caudate, and bilaterally in the cerebellum (allpvalues SIGNIFICANCE STATEMENTThe rewarding effects of addictive drugs are often thought to depend on shared substrates. Yet, environmental influences can unmask striking differences between psychostimulants and opiates. Here we used emotional tasks and fMRI to explore the influence of setting on the response to heroin versus cocaine in individuals with addiction. Simply moving from one setting to another significantly decreased heroin pleasure but increased cocaine pleasure, and vice versa. Similar double dissociation was observed in the activity of the fronto-striatal-cerebellar network. These findings suggest that the effects of opiates and psychostimulants depend on dissociable psychological and neural substrates and that therapeutic approaches to addiction should take into account the peculiarities of different drug classes and the settings of drug use.

10 Abstract. PURPOSE: A realistic body representation needs to be constantly updated. In case of physiological modifications, body representations integrate information coming from different sensory sources, including the sense of touch. Previous studies describedtransientmodificationsoftheserepresentationsfollowingillusorydistortions.Inthissinglecasestudy,wedocumented thechangesoccurredinlower-level,primarysomatosensory,andhigher-levelrepresentations,inacaseofupperarmselongation. METHOD: We explored effects of arm lengthening on primary tactile perception (sensitivity and acuity), an implicit perceptual measure of body size (tactile distance judgement), body image (Daurat-Hmelijak test), and peri-personal space representation (audio-tactile interaction task). RESULTS: We show that patient's arm representation was changed after surgery. Specifically, we observed significant changes on tactile distance judgments, body image test and audio-tactile interaction task; also even though no changes were found on primary tactile perception a significant modification emerged in tactile acuity. CONCLUSIONS: These findings are in line with evidence of cortical reorganization after arm elongation. They also support the view that the body representation of achondroplasics are modified after body-size reconstruction, and became similar to that of healthy controls. 11 12 13 14 15 16 17 18 19 20 21 22 23 24

We compared the judgment of distance between two simultaneous tactile stimuli applied to different body parts, with judgment of intensity of skin contact of the very same stimulation. Results on normal subjects showed that both tasks bilaterally activate parietal and frontal areas. However, the evaluation of distances on the body surface selectively activated the angular gyrus and the temporo-parieto-occipital junction in the right hemisphere. The different involvement of the brain areas in the two tactile tasks is interpreted as the need for using a Mental Body Representation (MBR) in the distance task, while the judgment of the intensity of skin deflection can be performed without the mediation of the MBR. The present study suggests that the cognitive processes underlying the two tasks are supported by partially different brain networks. In particular, our results show that metric spatial evaluation is lateralized to the right hemisphere.

The mirror-neuron system (MNS) connects sensory information that describes an action with a motor plan for performing that action. Recently, studies using the repetition-suppression paradigm have shown that strong activation occurs in the left premotor and superior temporal areas in response to action-related, but not non-action-related, stimuli. However, few studies have investigated the mirror system by using event-related potentials (ERPs) and employing more than one sensory modality in the same sample. In the present study, we compared ERPs that occurred in response to visual and auditory action/non-action-related stimuli to search for evidence of overlapping activations for the two modalities. The results confirmed previous studies that investigated auditory MNS and extended these studies by showing that similar activity existed for the visual modality. Furthermore, we confirmed that the responses to action- and non-action-related stimuli were distinct by demonstrating that, in the case of action-related stimuli, activity was restricted mainly to the left hemisphere, whereas for non-action-related stimuli, activity tended to be more bilateral. The time course of ERP brain sources showed a clear sequence of events that subtended the processing of action-related stimuli. This activity seemed to occur in the left temporal lobe and, in agreement with findings from previous studies of the mirror-neuron network, the information involved appeared to be conveyed subsequently to the premotor area. The left temporo-parietal activity observed following a delay might reflect processing associated with stimulus-related motor preparation.

It is still a matter of debate whether constructive apraxia (CA) should be considered a form of apraxia or, rather, the motor expression of a more pervasive impairment in visuo-spatial processing. Constructive disorders were linked to visuo-spatial disorders and to deficits in appreciating spatial relations among component sub-parts or problems in reproducing three-dimensionality. We screened a large population of brain-damaged patients for CA. Only patients with constructive disorders and no signs of neglect and/or aphasia were selected. Five apractic subjects were tested with both visuo-spatial and verbal tasks requiring constructive abilities. The former ones were tests such as design copying, while the latter were experimental tasks built to transpose into the linguistic domain the constructive process as phrasing by arranging paper scraps into a sentence. A first result showed a constructive impairment in both the visuo-spatial and the linguistic domain; this finding challenges the idea that CA is confined to the visuo-spatial domain. A second result showed a systematic association between CA and unawareness for constructive disorders. Third, lack of awareness was always associated with a lesion in the right dorsolateral prefrontal cortex, a region deemed as involved in managing a conflict between intentions and sensory feed-back. Anosognosia for constructive disorders and the potential role of the right prefrontal cortex in generating the impairment, are discussed in the light of current models of action control. The core of CA could be the inability to detect any inconsistency between intended and executed action rather than a deficit in reproducing spatial relationship.

Human awareness of left space may be disrupted by cerebral lesions to the right hemisphere (hemispatial neglect). Current knowledge on the anatomical bases of this complex syndrome is based on the results of group studies that investigated primarily the best known aspect of the syndrome, which is visual neglect for near extrapersonal (or peripersonal) space. However, another component-neglect for personal space-is more often associated with, than double-dissociated from, extrapersonal neglect, especially, in chronic patients. The present investigation aimed at exploring the anatomical substrate of both extrapersonal and personal neglect by using different advanced methodological approaches to lesion-function correlation. Fifty-two right ischaemic patients were submitted to neuropsychological assessment and in-depth MRI evaluation. The borders of each patient's lesion were delimited onto its own high-resolution anatomical image and then submitted to an automated spatial normalization algorithm. Besides conventional lesion density plots and subtraction analysis, region-based statistical analyses were performed on percentage values of the lesioned tissue also using a new parcellation of the white matter (WM). Data were finally submitted to voxelwise statistical analysis using a recently proposed method (voxel-based lesion-symptom mapping). Results converged in showing that awareness of extrapersonal space is based on the integrity of a circuit of right frontal (ventral premotor cortex and middle frontal gyrus) and superior temporal regions, whereas awareness of personal space is rooted in right inferior parietal regions (supramarginal gyrus, post-central gyrus and especially the WM medial to them). Common but less crucial regions for both neglect sub-types were located in the temporo-peri-Sylvian cortex. We suggest that extrapersonal space awareness critically involves a ventral circuit recently described for the exogenous allocation and reorienting of attention in space. Disruption of personal space awareness, instead, seems to be due to a functional disconnection between regions important for coding proprioceptive and somatosensory inputs, and regions coding more abstract egocentric representations of the body in space. In conclusion, present data strongly support a segregation of personal and extrapersonal spatial awareness in humans, both from a functional and an anatomical point of view.

Right brain damage patients may not complain of a left sided paralysis up to the point of denying it or even claiming of having just moved an otherwise paralyzed limb. This condition is known as anosognosia for hemiplegia (AHP). Recent behavioural experiments suggest that some residual intentionality might be preserved in patients with anosognosia and that the false belief of having moved originates from a failure to notice discrepancies between movement expectancies and the actual state of the motor system. This failure may be caused by a lack of afferent sensory information concerning the movement or alternatively by a direct dysfunction of the brain regions involved in actions' motor monitoring (i.e., the comparator system). Here we examined the effect of anodal transcranial direct current stimulation (tDCS) of the right premotor cortex in a patient with a bilateral lesion, involving predominantly the right hemisphere, and a dense unawareness for his left hemiplegia. During sham or anodal tDCS the patient was requested to judge his ability to perform simple motor actions (i) without actually executing the movement itself ("offline" condition) and after having performed a series of verbally cued finger opposition movements ("online" condition) with (i) eyes-closed or (ii) eyes-open. We found that anodal tDCS induces a significant remission of the false experience of movement only when the patient is requested to actually perform the movement with eyes open. Conversely, the patient's awareness does not improve in both the "offline" condition (in which the patient does not attempt to perform the movement) and in the "online" condition, when vision is precluded ("online" condition, eyes-closed). We conclude that the stimulation of the premotor cortex by tDCS activates brain regions involved in motor monitoring, temporary restoring the ability of the motor comparator system to correctly appreciate afferent information and build up a veridical motor awareness.

Thirty patients with cerebellar ataxia and 40 healthy volunteers underwent 7 days of mood monitoring using a new device requiring a low motor load. Its convergent validity and compliance were tested. The measurements resulted consistent with validated scale scores. Patients׳ motor impairment did not affect the compliance.

Because sensory systems use different spatial coordinate frames, cross-modal sensory integration and sensory‐motor coordinate transformations must occur to build integrated spatial representations. Multimodal neurons using non-retinal body-centred reference frames are found in the posterior parietal and frontal cortices of monkeys. We used functional magnetic resonance imaging to reveal regions of the human brain using body-centred coordinates to code the spatial position of both visual and somatic sensory stimuli. Participants determined whether a visible vertical bar (visual modality) or a location touched by the right index finger (somatic sensory modality) lay to the left or to the right of their body mid-sagittal plane. This task was compared to a spatial control task having the same stimuli and motor responses and comparable difficulty, but not requiring body-centred coding of stimulus position. In both sensory modalities, the body-centred coding task activated a bilateral fronto-parietal network, though more extensively in the right hemisphere, to include posterior parietal regions around the intraparietal sulcus and frontal regions around the precentral and superior frontal sulci, the inferior frontal gyrus and the superior frontal gyrus on the medial wall. The occipito-temporal junction and other extrastriate regions exhibited bilateral activation enhancement related to body-centred coding when driven by visual stimuli. We conclude that posterior parietal and frontal regions of humans, as in monkeys, appear to provide multimodal integrated spatial representations in body-centred coordinates, and these data furnish the first indication of such processing networks in the human brain.

Studies of real-time processing in aphasia suggest that linguistic symptoms may be due to deficits in activation dynamics rather than loss of linguistic knowledge. To investigate the domain specificity of such processing deficits, we compared performance by Italian-speaking fluent aphasics, nonfluent aphasics, and normal controls in a linguistic priming task (grammatical gender) with their performance in a color-priming task that requires no verbal mediation. Normal or larger than normal color-priming effects were demonstrated in both aphasic groups. Gender priming did not reach significance in either group, even though the patients displayed above-chance sensitivity to gender class and gender agreement in their accuracy scores. The demonstration of spared gender knowledge despite impaired gender priming underscores the utility of on-line techniques in the study of aphasia. The demonstration of spared color priming suggests that priming deficits in aphasia are either (1) specific to speech and language or (2) specific only to those sensorimotor and attentional processes that language shares with other nonlinguistic systems.

Right brain-damaged patients with left visuospatial neglect were required to bisect a line placed in front of them in two different body positions (upright and supine) and two different light conditions (light and dark). The neglect patients, unlike right brain-damaged patients without neglect, strongly reduced their rightward directional error in the supine compared with the upright position. No systematic changes were produced by the light-dark manipulation. The present result cannot be explained with an attentional interpretation of hemispatial neglect. We suggest that the present data provide further evidence that hemineglect is the consequence of a mismatch between different afferent information integrated into an egocentric space representation. According to this model, the presence of a lateralized brain lesion produces asymmetries in some intermediate spatial representations (eye-head, head-trunk, body-environment) but not in the retinotopic one. Any experimental manipulation that reduces the asymmetry of the intermediate representation such as the reduction of gravitational inputs may improve the dynamic integration of the egocentric coordinates.

A study of the effect of specific training for visual neglect on the recovery of motor and functional impairment in stroke patients is reported. Two groups of right hemisphere stroke patients with hemispatial neglect and one group without neglect were assessed by means of three functional and neurological scales (Rivermead Mobility Index, Barthel Index, Canadian Neurological Scale). Three evaluations were made at 0, 2 and 4 months from the beginning of physical rehabilitation. During the first 2 months of physical rehabilitation one of the two groups of neglect patients was randomly assigned to specific training for neglect, and the second group to a general cognitive intervention; during the final 2 months of rehabilitation the types of training were switched in the two groups. The non-neglect patients improved steadily during physical rehabilitation. In contrast, the functional recovery of the two neglect groups was time-locked to the period of the specific training for neglect. At the time of admission, the two neglect groups performed at the same level; after 2 months of rehabilitation, the group with neglect training showed higher functional recovery than the group with only general cognitive intervention. When the latter group received neglect training, there was no longer any difference between the two neglect groups. This pattern was present for both of the functional scales used but not for the neurological scale. Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect.

The effects of optokinetic stimulation on the disorders of position sense in the horizontal and vertical planes were assessed in 24 patients with unilateral cerebral lesions (eight right brain-damaged patients with visuo-spatial hemineglect, eight right brain-damaged patients without neglect, eight left brain-damaged patients without neglect). In neglect patients, the position sense disorder was more severe, and affected by optokinetic stimulation in a direction-specific fashion. In both the horizontal and the vertical plane, and in both arms, stimulation with a direction of the movement contralateral to the side of the lesion improved the disorder, whereas stimulation with an ipsilateral direction worsened the deficit. The suggestion is made that in patients with neglect the disorder of position sense is produced, at least in part, by an ipsilateral distortion of an egocentric co-ordinate system, comprising both the horizontal and the vertical dimension, which may be affected by direction-specific optokinetic stimuli.

Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20), in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.

In four patients with left visuo-spatial hemineglect and right brain- damage, the therapeutic effects of Transcutaneous Electrical Nervous Stimulation (TENS) of the left neck muscles, associated with a non-specific treatment, and of a specific rehabilitation paradigm were investigated. The two treatments were given for an 8-week period each. TENS had positive effects on hemineglect in two out of four patients, whereas the specific treatment produced a major improvement of the disorder in all four cases. The suggestion is made that an effective treatment of neglect requires a paradigm comprising a range of visuo-spatial exploratory tasks of increasing complexity and a systematic feedback as to the success of the patients' performance. This is the case of the specific treatment. By contrast a procedure confined to a sensory stimulation, which produces a short-term improvement in the range of minutes, does not have comparable long-term effects. © 1996 Elsevier Science Ireland Ltd. All rights reserved.

Horizontal saccades during wakefulness and horizontal rapid eye movements (REMs) during REM sleep were recorded in 6 unilateral brain damaged patients suffering from attentional neglect and 6 unilateral brain damaged control patients. During REM sleep, patients with neglect showed a nearly total suppression of REMs directed away from the side of the lesion; controls had a significantly milder frequency reduction of the same movements. In all patients the frequency reduction of REMs contralateral to the lesion equally affected isolated REMs (i.e., REMs preceded by intervals of oculomotor quiescence longer than 2 sec) and REM bursts (i.e., REMs preceded by intervals shorter than 2 sec). During voluntary inspection in waking, saccades directed ipsilaterally and contralaterally to the lesion were present in both groups of patients, although patients with neglect confined their inspection to the hemispace ipsilateral to the lesion. Results are discussed in terms of their implications for the understanding of the neurophysiological basis of REM sleep oculomotor activity and dream production, as well as for the neurophysiopathological basis of the neglect syndrome. It is proposed that REMs are functionally equivalent to waking reflex orienting saccades generated by a neural network including the relevant modulatory action of the parietal lobes and the superior colliculi.

Though unilateral neglect (UN) of space after acute right hemispheric stroke is usually a transient disorder, in a minority of patients it can persist for several months and interfere with rehabilitation. Lesion site and size, ventricular size, and occipital width asymmetries were assessed on the CT scans of a population of 24 patients with chronic UN. The most common lesion site in these patients was temporoparietal, with extension to the frontal lobe or to the thalamus relatively uncommon. Severity of neglect correlated significantly with the size of the lesion but not with that of the ventricular system. No correlation between severity and lesion size was found in a subgroup of patients after rehabilitation training. The pattern of occipital asymmetry was normal. CT scan data do not appear to be particularly helpful in predicting severity and duration of unilateral neglect or response to rehabilitation training.

SummaryStudies in nonhuman and human primates have demonstrated that sound-producing actions are mapped on the same mirror circuits that are activated during the visual recognition and execution of actions [1–12]. However, no causative link between the auditory recognition and execution of actions has been provided thus far. Here, we sought to determine whether patients with apraxia, who are by definition impaired in performing specific gestures, are also impaired in recognizing sounds specifically linked to human actions. Twenty-eight left-hemisphere-damaged patients with or without limb and/or buccofacial apraxia and seven right-hemisphere-damaged patients with no apraxia were asked to match sounds evoking human-related actions or nonhuman action sounds with specific visual pictures. Hand and mouth action-related sound recognition were specifically impaired in limb and buccofacial apraxia patients, respectively. Lesional mapping revealed that the left frontoparietal cortex is crucial for recognizing the sound of limb movements. By contrast, the left inferior frontal gyrus and adjacent insular cortex are causatively associated with recognition of buccofacial-related action sounds. These behavioral and neural double dissociations indicate that a left-lateralized multimodal mirror network is actively involved in the body-part-specific motor mapping of limb and mouth action-related sounds, as well as in the execution of the very same actions.

In his reply to our study (Mammucari et al., 1988), Buck criticizes (1) our review of previous literature and (2) methodological aspects of our study, including his conviction that the FAGS technique is insufficiently sensitive. Our fundamental disagreement with Buck is based upon our different research goals: he aims toward evaluating the possible derangement in communicative ability that follows a right hemisphere lesion; whereas we are specifically interested in evaluating the content of emotional responding in a relatively spontaneous situation. Several areas of concern are discussed in relation to this discrepancy, i.e. the use of subjective versus objective evaluations in examining facial expressions, the selection of stimuli for emotional stimulation, the issue of data-driven versus hypotheses-driven research on emotional responding in brain damaged patients.

Shape, size and relative position in space perception were tested in 17 right brain damaged (RBD) patients with neglect symptoms, 10 RBD patients without neglect and 11 controls. Simultaneous pair comparison task in free vision was used. Two arrangements of the visual display were used: side by side and top-bottom. Neglect patients' performance was comparable to RBD and controls in the shape and size test, but was below the other groups in the relative space position test. The selective failure of neglect patients in the position task did not depend on the spatial arrangement of the visual display, which may indicate a general perceptual deficit, rather than a deficit restricted to the neglect hemifield.

In this chapter a brief review of studies analyzing the relation between disorders in mental representation of space and environmental navigation is reported. Most of the studies concern the role on navigation of unilateral neglect, that is the inability to represent and to attend to the contralesional side of the space, that often follows lesion in posterior regions of the right hemisphere. Different studies demonstrate that unilateral neglect does not affect the ability to use some basic navigational processes such as path integration, but it affects the ability to develop and use cognitive maps of the environment for navigation. A case is also described of a patient who never developed navigational skills due to a congenital brain malformation. The only remarkable deficits the patients presented concerned mental imagery, supporting the hypothesis that mental imagery plays a crusial role in navigation.

We present data from right brain-damaged patients, with and without spatial heminattention, which show the influence of hemispatial deficits on spoken language processing. We explored the findings of a previous study, which used an emphatic stress detection task and suggested spatial transcoding of a spoken active sentence in a 'language line'. This transcoding was impaired in its initial portion (the subject-word) when the neglect syndrome was present. By expanding the original methodology, the present study provides a deeper understanding of the level of spoken language processing involved in the heminattentional bias. To ascertain the role played by syntactic structure, active and passive sentences were compared. Sentences comprised of musical notes and of a sequence of unrelated nouns were also compared to determine whether the bias was manifest with any sequence of events (not only linguistic ones) deployed over time, and with a sequence of linguistic events not embedded in a structured syntactic frame. Results showed that heminattention exerted an influence only when a syntactically structured linguistic input (=sentence with agent of action, action and recipient of action) was processed, and that it did not interfere when a sequence of non-linguistic sounds or unrelated words was presented. Furthermore, when passing from active to passive sentences, the heminattentional bias was inverted, suggesting that heminattention primarily involves the logical subject of the sentence, which has an inverted position in passive sentences. These results strongly suggest that heminattention acts on the spatial transcoding of the deep structure of spoken language.

Human cortical plasticity has been studied after peripheral sensory alterations due to amputations or grafts, while sudden 'quasi-physiological' changes in the dimension of body parts have not been investigated yet. We examined the cortical reorganization in achondroplastic dwarfs submitted to progressive elongation (PE) of lower limbs through the Ilizarov technique. This paradigm is ideal for studying cortical plasticity because it avoids the perturbation connected with deafferentation and re-afferentation. Somatosensory evoked-potentials (SEP) and fMRI studies were performed before and after PE during foot and knee stimulation, above and below the surgical fracture. A body schema test was also performed. Following PE, cortical modifications were observed in the primary somatosensory cortex for foot stimulation and in higher order somatosensory cortices for foot and knee. The former modifications tended to decrease 6 months after the elongation ending, whereas the latter tended to persist. Results are interpreted in terms of cortical adaptation mediated by temporary disorganization.

The finding of a multisensory representation of actions in a premotor area of the monkey brain suggests that similar multimodal action-matching mechanisms may also be present in humans. Based on the existence of an audiovisual mirror system, we investigated whether sounds referring to actions that can be performed by the perceiver underlie different processing in the human brain. We recorded multichannel ERPs in a visuoauditory version of the repetition suppression paradigm to study the time course and the locus of the semantic processing of action-related sounds. Results show that the left posterior superior temporal and premotor areas are selectively modulated by action-related sounds; in contrast, the temporal pole is bilaterally modulated by non-action-related sounds. The present data, which support the hypothesis of distinctive action sound processing, may contribute to recent theories about the evolution of human language from a mirror system precursor.

Topographical orientation relies on several cognitive strategies adopted by humans to move within the environment. In the present study, we investigate whether mental representation disorders affect specific cognitive mechanisms subserving human orientation. In order to differentiate distinct cognitive mechanisms involved in topographical orientation, we created a human version of the well-known “Morris Water Maze” and tested left and right brain damaged patients in a place-learning task. The test required the subjects to explore an experimental room in which no visual cues were present, find a target location, and then reach it in different conditions. The ability to memorise target locations in short- and long-term memory was also assessed. We found that all participants were able to reach the target location by using idiothetic cues (vestibular inputs, motor efferent copy, etc.). On the other hand, when starting position changed and re-orientation was necessary to reach the target location, in order to compute a new trajectory, only patients affected by representational neglect got lost. These results provide the first neuropsychological evidence of involvement of mental representation in a specific cognitive process allowing humans to reach a target place from any location in the environment.

The utility of single-case vs. group studies has been debated in neuropsychology for many years. The purpose of the present study is to illustrate an alternative approach to group studies of aphasia, in which the same symptom dimensions that are commonly used to assign patients to classical taxonomies (fluency, naming, repetition, and comprehension) are used as independent and continuous predictors in a multivariate design, without assigning patients to syndromes. One hundred twenty-six Italian-speaking patients with aphasia were first classified into seven classic aphasia categories, based on fluency, naming, auditory comprehension, and repetition scales. There were two goals: (1) compare group analyses based on aphasia types with multivariate analyses that sidestep classification and treat aphasic symptoms as continuous variables; (2) present correlation-based outlier analyses that can be used to identify individuals who occupy unusual positions in the multivariate "symptom space." In the service of the first goal, group performance on an external validation measure (the Token Test) was assessed in three steps: analyses of variance based on aphasia type, regressions using the same cut-offs for fluency, naming, comprehension and repetition as independent but dichotomous predictors, and regressions using the same subscales as continuous predictors (with no cut-offs). More variance in Token Test performance was accounted for when symptoms were treated as continuous predictors than with the other two methods, though use of independent but dichotomous predictors accounted for more variance than aphasia taxonomies. Thus, if we by-pass classical taxonomies and treat patients as points in a multidimensional symptom space, better predictions are obtained. Outlier analyses show that group results depend on heterogeneity among patients, which can be used as a search tool to identify potentially interesting dissociations. Hence this multivariate group approach is complementary to and compatible with single-case methods.

The aim of this study was to investigate whether it is possible to strengthen the rehabilitation of spatial hemineglect by combining standard training for spatial scanning with optokinetic stimulation. A simple randomized design was used: one group of neglect patients was treated with a combination of the two techniques, and a second group received only the standard treatment. Both treatments were given for six consecutive weeks and produced significant improvements. However, addition of the optokinetic stimulation did not improve the patients' performance. Also, none of the independent variables (i.e., presence/absence of hemianopia) predicted the positive effect occasionally observed in individual patients.

Objective: The study aimed to characterize neuropsychiatric symptomatology and its evolution in a large group of poststroke patients during their first year. Method: The Neuropsychiatric Inventory (NPI) was administered to a sample of 124 poststroke patients, divided into three independent groups on the basis of time from stroke (2, 6 and 12 months). The controls were 61 healthy subjects. Results: A wide range of neuropsychiatric symptoms was found significant in the poststroke population: mostly depression (61%), irritability (33%), eating disturbances (33%), agitation (28%), apathy (27%) and anxiety (23%). Modifications in terms of greater depression, anxiety, irritability and eating disturbances evolved in the year following stroke. Other symptoms were significantly present depending on time from stroke. Clear relations with other clinical and demographic variables were also found. Conclusion: Neuropsychiatric symptoms constitute an important part of comorbidity in stroke patients; thus, suitable assessment tools may improve clinical understanding of these patients.

Functional magnetic resonance imaging was used to compare the neural correlates of three different types of spatial coding, which are implicated in crucial cognitive functions of our everyday life, such as visuomotor coordination and orientation in topographical space. By manipulating the requested spatial reference during a task of relative distance estimation, we directly compared viewer-centered, object-centered, and landmark-centered spatial coding of the same realistic 3-D information. Common activation was found in bilateral parietal, occipital, and right frontal premotor regions. The retrosplenial and ventromedial occipital–temporal cortex (and parts of the parietal and occipital cortex) were significantly more activated during the landmark-centered condition. The ventrolateral occipital–temporal cortex was particularly involved in object-centered coding. Results strongly demonstrate that viewer-centered (egocentric) coding is restricted to the dorsal stream and connected frontal regions, whereas a coding centered on external references requires both dorsal and ventral regions, depending on the reference being a movable object or a landmark.

The aim of the present study was to assess whether the consistent bias in reproducing distances and lengths on visual tasks that characterizes hemispatial neglect is also present when whole body displacements have to be calculated and reproduced. Two different experiments were proposed to participants with right brain lesions and neglect syndrome (RN+), right (RN-) and left brain lesions (LN-) without neglect and to participants without brain damage (C). In Experiment 1, participants actively reproduced passive linear displacements in the same or in a different direction. This task could be performed using only vestibular and somatosensory input, since no relevant visual input was available. In Experiment 2, relevant visual information had to be integrated with vestibular and somatosensory information in order to make the active reproduction. In Experiment 1, all brain-damaged groups reproduced the horizontal displacements similarly to the control group and without any spatial asymmetry. In Experiment 2, when vestibular, somatosensory and visually remembered information was required to produce an integrated mental representation, RN+ processed contralesional displacements differently from ipsilesional ones. Rectilinear displacements of the whole body in space were not affected by focal left and right brain lesions, suggesting that the computation of nonvisual information can be accomplished by brain structures different from those involved in spatial visual processes. However, when body displacements in space required a mental representation based on visual and nonvisual sensory information, a significant asymmetry appeared only in patients with hemispatial neglect. Some attempts are made to identify the neural substrates involved in this integration.

We document for the first time the effect of a spatial deficit on an spoken language task. Right brain-damaged patients with and without neglect were administered a task of emphatic stress. Patients listened to 60 subject-verb-object sentence pairs. The emphatic stress could be placed on the subject, on the verb or on the object word. Patients had to judge whether the two sentences were same or different for the position of the emphatic stress. The judgements were more impaired in patients with neglect and when the stress was placed at the beginning of the sentence (on the subject word), that is to say, at the leftmost location of a hypothetical spatial representation of the heard sentence. We hypothesize that auditory language undergoes a spatial transcoding, and that this transcoding is affected by the presence of a spatial bias like that observed in patients with neglect.

It is widely documented that the left hemisphere is dominant in all complex linguistic tasks, including the processing of inflectional morphology. Both in Italian and in other languages, patients with brain damage with a selective deficit in derivational morphology have never been reported. Here we present the unusual case of two patients with very similar right-hemisphere lesions, who in the absence of aphasic disorders showed a selective inability in producing derivational morphology. Although both patients were unimpaired in producing verb infinitives, they both showed a selective deficit in producing nouns derived from verbs. This difficulty was not present in deriving nouns from other grammatical categories, such as adjectives. Interestingly, both patients mostly substituted the derived noun with the past participle of the verb. This pattern of results documents for the first time a right-hemisphere contribution in the domain of derivational morphology.

Double dissociations play an important role in neuropsychology, but they are often identified through subjective estimates of "high" versus "low" performance, without considering the probability that such an outcome might have occurred by chance. To determine whether two measures "come apart" in an interesting way in brain-damaged patients, it is important to know the degree to which variance in one measure can be predicted by variance in the other. This study introduces a statistical procedure to determine the probability of a double dissociation when the correlation between measures is taken into account. Different quantitative definitions of dissociations were compared in two large samples of neurological patients, and applied to four pairs of measures (two for language, two for hemispatial neglect) with different degrees of intercorrelation (ranging from +.21 to +.84). If the correlation between measures is not taken into account, large numbers of dissociated cases may be missed, especially for measures that are highly correlated. There are also qualitative differences between methods in the identity of those individuals who meet each definition.

Disorders in perceiving and exploring the visual space contralateral to a brain lesion have been frequently described. Many patients with hemi-neglect for extrapersonal space also show neglect in a representational domain when the task requires imagining a well-known piazza from a given vantage point or comparing two visual images. Cognitive and psychophysiological studies show a functional parallelism between the perceptual and imaginative domain, indicating that spatial perception and imagery share the same neural substrata. Here we describe a patient with a persistent disorder in visual imagery for familiar piazzas in the absence of any neglect for stimuli located in a far or near space or on his own body. Contrary to previous cases involving imagery disorders, computerized tomography scans showed a lesion confined to the right frontal lobe, suggesting the role of the frontal lobe in some specific types of mental imagery.