ATTENTION AND THE PARIETAL CORTEX: INVESTIGATIONS OF SPATIAL NEGLECT, OPTIC ATAXIA, AND THE INFLUENCE OF PRISM ADAPTATION ON ATTENTION
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Some authors have argued that the primary function of the posterior parietal cortex is to control visual attention and awareness, whereas others have argued that the posterior parietal cortex is specialized for controlling actions. The purpose of the present thesis was to examine the influence of prism adaptation – a visuomotor adaptation technique – on visual attention deficits in patients with lesions of parietal cortex. Lesions to dorsal regions of the posterior parietal cortex lead to optic ataxia – a disorder in which visually guided reaching is disrupted. In contrast lesions to ventral (i.e. inferior) regions of the posterior parietal cortex of the right hemisphere lead to spatial neglect – a disorder in which patients are unaware of people or objects in contralesional (left) space. Chapter 1 presents an overview of the organization of the posterior parietal cortex, as well as an introduction to the disorders of spatial neglect and optic ataxia and the use of prism adaptation as a treatment for spatial neglect. Chapter 2 examined the influence of prism adaptation on attentional deficits in patients with right brain damage. Results demonstrated that prism adaptation reduced both the disengage deficit and the rightward attentional bias, two of the classic attentional deficits in neglect. Chapter 3 investigated the role of the dorsal posterior parietal cortex in controlling both reflexive and voluntary attention in two patients with optic ataxia. Lesions to the dorsal posterior parietal cortex led to both a disengage deficit and a rightward attentional bias, similar to patients with neglect, even though neither of the patients had any clinical symptoms of neglect. Contrary to previous work these results indicated that dorsal portions of the posterior parietal cortex – a region not commonly damaged in neglect – are important for controlling the orienting and reorienting of both reflexive and voluntary attention. Furthermore, these results indicated that optic ataxia is not purely a visuomotor disorder that is independent of any perceptual or attentional deficits as was previously assumed. Based on the results of Chapters 2 and 3 it was hypothesized that the beneficial effects of prism adaptation on attention may operate via the superior parietal lobe, a region which is typically undamaged in neglect, and is known to be important for controlling attention and action. Chapter 4 provided support for this hypothesis by demonstrating that a patient with lesions to the superior parietal lobe, who had the same attentional deficits as the right brain damaged patients tested in Chapter 2, failed to demonstrate any beneficial effects of prism adaptation on his attentional performance. Specifically, prism adaptation had no influence on his disengage deficit or his rightward attentional bias. Therefore, these data provide direct evidence that the beneficial effects of prisms on attention rely, at least in part, on the superior parietal lobe. Finally, Chapter 5 concludes with a summary of the research findings from the present thesis, and puts forward a new theory to conceptualize the mechanisms underlying the beneficial effects of prisms in patients with neglect.