Spontaneous eye and head position in patients with spatial neglect

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Abstract
The most prominent deficit in patients with spatial neglect is a bias of their active behaviour, i. e. a deviation of exploratory movements towards the right. When searching for targets, copying, or reading, the patients direct their eye and hand movements towards the ipsilesional side, leading to neglect of the contralesional side. The present study investigated whether spatial neglect is predominantly linked with such active behaviour or if it is obvious also without any explicit requirements, namely in the patients' spontaneous eye and head position. To address this issue we investigated the patients' spontaneous resting position while "doing nothing", i. e. just sitting and waiting for an experiment to start. Using magnetic search coil technique, we recorded spontaneous eye–in–head and head–on–trunk orientation in that waiting period in 24 patients with and without spatial neglect. In contrast to controls, neglect patients showed a marked deviation of spontaneous eye and head orientation of about 30° (= gaze position) towards the right. The findings strengthen the view that one component of the behaviour in neglect patients is due to a very elementary disturbance of spatial information processing. The deviation of eye and head may be understood as a pathological adjustment of the subject's normal resting position to a more rightward position. While the position in healthy subjects is in line with trunk orientation, this "default position" is shifted to a new origin in patients with spatial neglect.