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Multimodal spatial orientation de ® cits in left-sided visual neglect

Patients with right-sided temporo-parietal lesions often show contralesional neglect. However, neglect patients may also show spatial±perceptual de®cits beyond the bisection and space exploration de®cits frequently assessed in the horizontal plane, that is, de®cits in the judgment of the subjective visual vertical or horizontal. In a recent study (Kerkho, G. & Zoelch, C., Disorders of visuo±spatial orientation in the frontal plane in patients with visual neglect following right or left parietal lesions. Exp. Brain Res., 1998;122:108±120) we found signi®cant perturbations in the perception of these three visual±spatial axes in patients with contralesional neglect from right or left parietal lesions. To examine if this ®nding extends also to another modality we investigated how neglect patients perform tasks of visual± and tactile±spatial judgments of axis-orientation in the frontal plane. Visual±spatial and tactile±spatial judgments of the subjective vertical, horizontal and a right oblique orientation were obtained from patients with and without neglect as well as from normal subjects. Patients with left neglect showed a signi®cant, contraversive tilt of all three visual±spatial axes (+5.68 to +9.58, counterclockwise), and of the three tactile±spatial axes as well (+5.28 to +10.58, counterclockwise). In contrast, right and left hemisphere lesioned control patients without neglect and normal control subjects showed unimpaired visual and tactile±spatial judgments (constant errors: <1.08). Dierence thresholds in the visual±spatial tasks and unsigned errors in the tactile±spatial tasks were selectively elevated in the neglect group in contrast to all other subject groups. Spatial orientation de®cits were signi®cantly associated with the severity of clinical neglect (r= 0.55± 0.88), and with the patients' ambulation performance (r= 0.45±0.70). Furthermore, crossmodal axis orientation tests in two neglect patients showed a similar counterclockwise tilt of +58 to +158, suggesting a similar spatial de®cit in both modalities. Orientation judgments were signi®cantly aggravated by a 258-tilt of the head to the left, as tested in one neglect patient, while a comparable rightward head-tilt improved spatial judgments in both modalities. This suggests that spatial orientation judgments are signi®cantly modulated by gravitational input in neglect patients. Together these results are interpreted as evidence for multisensory spatial orientation de®cits in neglect patients which are modulated by head-position and are related to their accompanying postural impairment. # 1999 Elsevier Science Ltd. All rights reserved.