Crossover is not a consequence of neglect: a test of the orientation/estimation hypothesis

Most patients with neglect demonstrate a crossover effect on line bisection. Crossover refers to a pattern of performance in which long lines (>10 cm) are bisected ipsilateral to brain injury and short lines (<2 cm) are bisected contralateral to brain injury. Crossover bisections on short lines are of interest because they are not predicted by contemporary theories concerning neglect. However, we propose that the effect depends on two independent factors that normally influence bisection performance but are merely exaggerated in neglect--a tendency to overestimate the length of short lines and underestimate long lines and a tendency to orient attention preferentially in one spatial direction. We predicted that both patients with unilateral left and right hemisphere injury would demonstrate crossover on line bisection and that they would overestimate short lines and underestimate long lines upon direct visual inspection. Further, the 2 groups were predicted to demonstrate crossover in opposite directions owing to different lesion-induced biases in attentional orientation. Testing 5 patients with right hemisphere injury and 7 patients with left hemisphere injury confirmed each prediction. Additionally, errors in length estimation were exaggerated among patients with right hemisphere injury, most of whom had neglect. It is concluded that while crossover is accentuated in cases of neglect, it is not a consequence of neglect per se. As such, crossover bisections are not at odds with contemporary neglect theory.