Simultanagnosia

Abstract: An earlier report described a patient (RM) with bilateral parietal damage who showed severe binding problems between shape and color and shape and size (Friedman-Hill, Robertson, & Treisman, 1995). When shown two different-colored letters, RM reported a large number of illusory conjunctions (ICs) combining the shape of one letter with the color of the other, even when he was looking directly at one of them and had as long as 10 sec to respond. The lesions also produced severe deficits in locating and reaching for objects, and difficulty in seeing more than one object at a time, resulting in a neuropsychological diagnosis of Balint's syndrome or dorsal simultanagnosia. The pattern of deficits supported predictions of Treisman's Feature Integration Theory (FIT) that the loss of spatial information would lead to binding errors. They further suggested that the spatial information used in binding depends on intact parietal function. In the present paper we extend these findings and examine other deficits in RM that would be predicted by FIT. We show that: (1) Object individuation is impaired, making it impossible for him correctly to count more than one or two objects, even when he is aware that more are present. (2) Visual search for a target defined by a conjunction of features (requiring binding) is impaired, while the detection of a target defined by a unique feature is not. Search for the absence of a feature (0 among Qs) is also severely impaired, while search for the presence (Q among 0s) is not. Feature absence can only be detected when all the present features are bound to the nontarget items. (3) RM's deficits cannot be attributed to a general binding problem: binding errors were far more likely with simultaneous presentation where spatial information was required than with sequential presentation where time could be used as the medium for binding. (4) Selection for attention was severely impaired, whether it was based on the position of a marker or on some other feature (color). (5) Spatial information seems to exist that RM cannot access, suggesting that feature binding relies on a relatively late stage where implicit spatial information is made explicitly accessible. The data converge to support our conclusions that explicit spatial knowledge is necessary for the perception of accurately bound features, for accurate attentional selection, and for accurate and rapid search for a conjunction of features in a multiitem display. It is obviously necessary for directing attention to spatial locations, but the consequences of impairments in this ability seem also to affect object selection, object individuation, and feature integration. Thus, the functional effects of parietal damage are not limited to the spatial and attentional problems that have long been described in patients with Balint's syndrome. Damage to parietal areas also affects object perception through damage to spatial representations that are fundamental for spatial awareness.

Abstract: Objectives: From a series of glimpses, we perceive a seamless and richly detailed visual world. Cerebral damage, however, can destroy this illusion. In the case of Balint9s syndrome, the visual world is perceived erratically, as a series of single objects. The goal of this review is to explore a range of psychological and anatomical explanations for this striking visual disorder and to propose new directions for interpreting the findings in Balint9s syndrome and related cerebral disorders of visual processing. Methods: Balint9s syndrome is reviewed in the light of current concepts and methodologies of vision research. Results: The syndrome affects visual perception (causing simultanagnosia/visual disorientation) and visual control of eye and hand movement (causing ocular apraxia and optic ataxia). Although it has been generally construed as a biparietal syndrome causing an inability to see more than one object at a time, other lesions and mechanisms are also possible. Key syndrome components are dissociable and comprise a range of disturbances that overlap the hemineglect syndrome. Inouye9s observations in similar cases, beginning in 1900, antedated Balint9s initial report. Because Balint9s syndrome is not common and is difficult to assess with standard clinical tools, the literature is dominated by case reports and confounded by case selection bias, non-uniform application of operational definitions, inadequate study of basic vision, poor lesion localisation, and failure to distinguish between deficits in the acute and chronic phases of recovery. Conclusions: Studies of Balint9s syndrome have provided unique evidence on neural substrates for attention, perception, and visuomotor control. Future studies should address possible underlying psychoanatomical mechanisms at “bottom up” and “top down” levels, and should specifically consider visual working memory and attention (including object based attention) as well as systems for identification of object structure and depth from binocular stereopsis, kinetic depth, motion parallax, eye movement signals, and other cues.

Abstract: Simultanagnosia is a disorder of visual perception characterized by the inability to interpret complex visual arrays despite preserved recognition of single objects. We report a series of investigations on a simultanagnosic patient which attempt to establish the nature of this visual processing disturbance. The patient performed normally on a feature detection task but was impaired on a test of attention-requiring visual search in which she was asked to distinguish between stimuli containing different numbers of targets. She was not impaired on a visual-spatial orienting task. She identified single briefly presented words and objects as rapidly and reliably as controls suggesting that access to stored structural descriptions was not impaired. With brief, simultaneous presentation of 2 words or drawings, she identified both stimuli significantly more frequently when the stimuli were semantically related than when they were unrelated. On the basis of these and other data, we suggest that the patient's simultanagnosia is attributable to an impairment in the process by which activated structural descriptions are linked to information coding the location of the object.